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Asthma, Apnea, SIDS

SIDS The sudden unexpected death of an infant in which death remains unexplained after the performance of an adequate post
SIDS 3 ways to Identify An autopsy Investigation of scene and circumstances of death Exploration of medical history of the infant & family
SIDS Etiology Many theories; largely unknown, Respiratory Control abnormalities, Prolonged apnea during sleep, Increased frequency of brief respiratory pauses, Excessive periodic breathing, Impaired response to increased CO2 or decreased O2
SIDS: 3 Major Risk Factors Environmental, Ethnicity, Daycare
SIDS: 7 Environmental Risk Factors Environmental: Season, Lower SES, Time of Day, Bundling, Second hand tobacco smoke, Sleep position, Co bedding
SIDS: 5 Maternal Risk Factors Maternal: Age, Smoking, Lack of prenatal care, Drug use, Shorter inter
SIDS: 7 Infant Risk Factors Infant: Age, Prematurity, Twin or triplet, LBW, Previous ALTE, Gender, Siblings
SIDS: 3 Post Mortem Exam Autopsy, Death Scene Investigation, Medical hx of infant and family
SIDS: 5 Systems for Differential Diagnosis CV, Respiratory, GI, CNS, Systemic
SIDS: 3 Major Prevention: DECREASE KNOWN RISK FACTORS!!, Protective factors, AAP “Positioning Statement”
SIDS: 4 Ways On How To DECREASE KNOWN RISK FACTORS!!: Prevent teen pregnancy, Prenatal care, Avoid substance abuse, Stop smoking
4 SIDS Protective factors Immunizations, Pacifier, Breast feeding, Sleep Practices
SIDS: Prevention: AAP “Positioning Statement” Infants should be placed in a non-prone position during sleep, Soft surfaces and gas trapping objects should be avoided in sleep environment, Recommendations are for healthy infants, Provide tummy time
SIDS: Supporting Families (Shortly after death) Provide information on SIDS and support groups, Listen, Anticipatory guidance concerning grief process, Discuss sibling response (Understanding of death, Changes in behavior)
Infantile Apnea NIH clarifies definitions in Consensus Statement (1986)
Apnea cessation of respiratory airflow for 20 seconds.
Apnea May be central, diaphragmatic, obstructive or mixed. Several types.
Central Apnea Absence of airflow and respiratory effort
Obstructive Apnea Absence of airflow but presence of respiratory effort.
Periodic Breathing Three or more respiratory pauses of 3 or more seconds in duration within a period or normal respiration of 20 seconds or less.
Pathologic Apnea A clinical syndrome in infancy of unexplained cessation of air flow for 20 seconds or longer
Pathologic Apnea A shorter respiratory pause associated with bradycardia, cyanosis or pallor.
AOP: Apnea of Prematurity Periodic breathing with pathologic apnea in a premature infant.
AOP: Apnea of Prematurity Usually idiopathic and resolves by 36 weeks post conceptual age.
AOP: Apnea of Prematurity Use of caffiene and methylxanthines (Monitor levels and s/s of toxicity, Nasal CPAP)
AOP: Apnea of Prematurity Some may continue and require monitoring.
AOI: Apnea of Infancy Pathologic apnea that usually presents with an apparent life threatening event (ALTE).
AOI: Apnea of Infancy Generally occurs > 37 weeks
AOI: Apnea of Infancy Idiopathic: cause is not identified.
Apparent Life Threatening Event An episode that is frightening to the observer which is characterized by some combination of apnea, color change, marked change in muscle tone, and choking or gagging.
Apparent Life Threatening Event Near Miss SIDS or Aborted Crib Death
Illnesses Associated with APNEA URI, Pneumonia, Bronchiolitis, Sepsis, Metabolic Disorders, Cardiac anomolies, Seizures, IVH, Meningitis, GER
ALTE: Acute Management Hospital Admission, Protective monitoring, Thorough hx. of the event, Expedited diagnostic testing, Treatment of associated conditions, Parent Education
Home Monitoring Considerations Symptomatic Infants, Family Hx of SIDS, Premature Infants, Other Illnesses, Assymptomatic Infants
ALTE: Parent Education: Knowledge of Equipment Belt placement, Troubleshooting, Response to alarm, Expected utilization, Settings
PEDIATRIC TRACH CARE Close monitoring…, Trach ties should be snug and allow “pinkie” to be inserted, PRN suctioning
PEDIATRIC TRACH CARE, PRN Suctioning Insert to premeasured depth (May be hyperventilated, Infant: no longer than 5 seconds, Child: no longer than 10 seconds), Stoma site care: soap and H2O; No peroxide
Discontinuing the Monitor  Apnea free for 2-4 months  3 full sets of immunizations  Resolution of medical indication  Remember parental response