Question | Answer |
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 |