SIDS - Death in the Cradle

Generality

SIDS is the so-called Sudden Infant Death Syndrome or cot death.

This is an unexpected death that affects children below the age of life and apparently free of anomalies or particular pathologies.

Quite a rare phenomenon, SIDS arises for reasons that doctors do not yet know. The only observations of the latter concern some physical factors and some environmental factors, which seem to favor the occurrence of the aforementioned tragic event.

Currently, there are no effective anti-SIDS remedies; however, some experts believe that some of the following countermeasures are very useful in reducing the risk of cot death:

on the cradle or on the bed, lay the newborn on its back;
do not cover the baby excessively and do not overheat the sleeping room;
do not smoke during pregnancy or in the presence of the newborn;
do not sleep with the child and free the bed in which he sleeps.

What is SIDS?

SIDS is the acronym that, in the medical field, indicates the unexpected deaths of children below the year of life and apparently healthy.

SIDS is the English acronym of Sudden Infant Death Syndrome, that is in Italian: Sudden Infant Death Syndrome .

A rather widespread synonym of SIDS, already known perhaps to some readers, is " death in a cradle ".

Epidemiology

SIDS is a fairly rare event. For example, in a country like the United Kingdom, the annual number of cot deaths is around 300.

In 90% of cases, the victims are children less than 6 months old. As shown by various statistical researches, the peak of deaths during this first semester is between 2 and 4 months.

Starting from the 6th month, the risk is gradually reduced, until complete resolution.

In general - although it is not particularly widespread - SIDS is one of the main causes of death in newborn children.

In 2010, SIDS deaths worldwide were around 22, 000, 8, 000 fewer than 20 years earlier (1990).

Causes of SIDS

At the present time, doctors ignore the precise cause of SIDS, but they agree that, at the base of this dramatic event, there is always a set of triggering circumstances: some of the children 's own (physical factors) and others of an environmental nature, capable of causing severe stress to the newborn.

PHYSICAL FACTORS

Several studies have found a correlation between SIDS and:

Some congenital brain abnormalities . Autopsy investigations on the brains of certain children who died of SIDS have brought to light the presence of non-functional nerve cells linked to the communicative mechanism of serotonin.
In other words, in the brains of some newborns, doctors have identified inadequately functioning brain areas.
These are brain areas that regulate breathing, awakening from sleep (particularly blood pressure at the time of awakening) and heartbeat.
Premature birth . Premature babies are subjects that, having been born a few weeks before the scheduled date, have not completed intrauterine development. Failure to complete intrauterine development usually results in immaturity from organs such as the brain and lungs. If immature, these two vital organs could function inadequately and, as in the previous case, alter the normal breathing mechanism and heartbeat.
Premature birth is often accompanied by low birth weight, which, not surprisingly, includes the typical physical characteristics of children who died of SIDS.
For readers who are not aware of it, a birth is premature when it takes place at least three weeks before the fortieth and last week of pregnancy, while the birth weight is low when it is less than 2.5 kilograms.

ENVIRONMENTAL FACTORS

Premise: in medicine, the term plural " environmental factors " indicates the set of circumstances, habits and behaviors that concern an individual and change their lives to a certain extent. Two examples of environmental factors are cigarette smoking and the type of diet.

According to numerous medical researches, the environmental factors affecting SIDS would be:

The prone or hip position of the newborn during sleep . Children who sleep with their stomachs resting on the bed or on either side breathe inadequately, because the two aforementioned positions obstruct the respiratory airways.
All this explains why doctors, especially pediatricians, recommend new parents to sleep their baby rigorously and always with their stomach facing upwards.
Lay down or let the baby sleep on a soft, soft surface . As in the previous case, this circumstance can affect the child's breathing, to the point of causing death.
For similar reasons, they are equally dangerous situations: lay the child on a water bed, leave the plush toys around the cradle and place the quilts over the head.
Sleep in the company of the newborn . We are clearly referring to parents who are in the habit of sleeping with their child. The danger of this circumstance stems from the fact that the adult person, in his sleep, could move and assume, inadvertently, a position which prevents the newborn from breathing normally.
Smoking or inhaling smoke during pregnancy . Numerous clinical cases have confirmed that active smoking and passive smoking are extremely dangerous for pregnant women. In fact, in addition to favoring SIDS, they predict spontaneous abortion, the death of the child at birth, premature birth, low birth weight, the presence of congenital defects in the infant and placental problems in the mother.
Exposure of the newborn to passive smoking . Passive smoking is extremely harmful to the health of the child. Several investigations have shown that, among the possible consequences, there is also SIDS.
Excessive clothing worn by the child to protect him from the cold . Too many clothes, too many blankets and too hot environments can lead to hyperthermia in newborns. Hyperthermia means strong increase in body temperature; in common language, it also takes the name of "heat stroke".
Several researchers have tried to explain how hyperthermia affects SIDS: according to their hypothesis, excessive increase in body temperature could alter the respiratory capacity of the newborn, to the point of causing the death of the latter.
The use of illegal drugs and alcohol by the mother during pregnancy .

WHAT DOES THE RISK OF SIDS INCREASE?

Although it may affect any newborn, SIDS is particularly common among male children, black children, the Amerinda breed (the American Indians) and the Eskimo breed

Furthermore, according to other observations, it appears that the children of mothers under the age of 20 are more at risk.

MYTHS TO DEAL WITH

In studying the causes of SIDS, doctors and researchers have also dispelled some myths and strange theories, relating to the possible triggering effects or possible features of the event.

First of all, cot death is an impossible event to predict ; secondly, it is not the result of neonatal-age vaccinations, it is not a contagious condition, it is not something inherited and it is nobody's fault (in other words, it just happens).

Third and last, it has no association with obstructive sleep apnea and so-called ALTE. ALTE is the English acronym of Apparent Life-Threatening Events, whose Italian meaning is Apparently Dangerous Events for Life.

Characterized by sudden changes in breathing, skin color and muscle tone, ALTE are often the result of some specific conditions, including: respiratory infections, gastroesophageal reflux disease or epilepsy.

SIDS, instead, as someone will remember from the definition, is an event that concerns healthy subjects, without any suspicious signs.

When and how does it occur?

Most SIDS events occur during nighttime sleep or daily naps .

According to some interesting statistics, the time slot most at risk - as that in which deaths generally occur - is between midnight (00:00) and 9:00 in the morning.

FEATURES OF THE EVENT

The moment it takes place, the SIDS is silent, in the sense that the newborn does not cry and shows no problematic or unusual behavior.

Moreover, it seems to be very fast, a matter of seconds or minutes.

Complications for parents

For obvious reasons, the SIDS events represent a tragic event for the parents of the deceased newborn. Indeed, some mothers or fathers may be so deeply affected that they develop a sort of depression .

To overcome such situations, doctors advise the families involved and particularly shocked by the tragedy of:

Attend support groups, involving people in similar difficulties.
Ask expert psychotherapists for help.
Confide with friends, relatives and / or your partner and express all your feelings to them.
Don't blame yourself for the death.
Be patient, because time is the best therapy.

Diagnosis

Although the unpredictability of death and good health of the dead infant are two relevant and particularly significant indications, confirmation of the SIDS event requires at least 4 specific examinations, which are:

Post-mortem laboratory analyzes, to exclude the presence of physiological problems, viral infections, bacterial infections, etc.
Autopsy, to study the state of health and development of the brain, lungs and heart.
Analysis of the circumstances of death, to exclude infanticide.
Analysis of the clinical and family history of the newborn, to exclude a predisposition to respiratory problems or similar.

POST-MORTEM LABORATORY ANALYSIS

Post-mortem laboratory analyzes consist mainly of measuring the concentration of electrolytes in the blood and in viral and bacterial cultures.

In the case of SIDS, these analyzes show no abnormality.

AUTOPSY

A good part of the autopsy on infants who died of SIDS shows the presence of small cerebral, cardiac and / or pulmonary anomalies.

However, it is important to point out two aspects:

At present there is no evidence to support a consequential relationship between the aforementioned anomalies and SIDS death.
There are many cases of SIDS whose autopsies do not reveal any anomalies.

ANALYSIS OF THE CIRCUMSTANCES OF THE DEATH

The analysis of the circumstances of the death is an investigation, conducted by competent personnel, which aims to clarify whether there is any criminal liability on the part of someone.

In general, it includes a careful inspection of the place where the newborn died and a series of interrogations involving parents, any other family members and close friends.

ANALYSIS OF THE CLINICAL AND FAMILY HISTORY OF THE NEWBORN

Analyzing an individual's medical history means reviewing his or her current and past health status. If the patient is an individual of young or very young age, it is essential that those who carry out the aforementioned analysis question the closest parents and relatives.

Analyzing family history, on the other hand, means observing if, in the past, the family members of the patient / victim have suffered similar disorders or have died in similar circumstances.

Prevention

Doctors believe that there is no 100% effective method of preventing SIDS.

However, I am of the opinion that we can reduce the risk of appearance by taking care of some aspects - such as the position of the baby during sleep (or the naps), the temperature in the room in which the baby sleeps and the consistency of the bed (or cot) - and avoiding some completely dangerous behaviors - such as smoking during pregnancy (advice for the mother) or in the presence of the child and sleeping in the same bed as the newborn.

LOCATION DURING SLEEP

In the bed (or in the cradle), the ideal anti-SIDS position is the supine position, ie with the subject lying on his back.

During the first 5-6 months of life, newborns tend not to move during sleep (WARNING: it is rare, but not impossible!); when they begin to do so, the risk of SIDS - for unknown reasons - is no longer as worrying as before.

Therefore, if the child were to assume different positions after the first half of life, it is not necessary to put him back in the supine position by force, nor does he constantly monitor his movements.

During the first months of life, the prone and hip position should be avoided .

ENVIRONMENTAL TEMPERATURE

Too much heat the environment in which the child normally sleeps is wrong. In the same way, it is wrong to cover it with too many blankets (ATTENTION: no heating quilts) or place the cradle near a heat source (radiator, window on which "beats" the sun, etc.).

According to experts, the temperature of the room in which the baby sleeps is quite safe when it is between 16 and 20 ° C.

A parent can tell if their newborn is too hot with the following signs: sweating, damp hair, heat rash, increased number of breaths and fever.

MATTRESS CONSISTENCY

The most congenial anti-SIDS mattresses are those with a rigid consistency. Surely, parents must avoid beds and cribs that are too soft, in which the baby can "sink".