Introduction.
The sudden death (MS) in infants is one of the most tragic conditions in the family life, representing one of the most frequent causes d infant death in developed countries. Despite all the effort many aspects unknown which occurs this tragedy
How is it defined?
The sudden death (SD) infant is defined as the death of a child under one year, with history, physical examination and post-mortem evaluation revealed no known cause. Frequency
Since 1999, the MS is the third leading cause of infant death in North America, most cases being children aged between 3 and 5 months of age (90% occur before 6 months). In Chile, information about exact figures for the incidence of MS.
Why does it occur?
To date, no mechanisms have been identified to explain their cause. Have been postulated multiple theories.
In addition, most cases of MS are probably in a sequence started by a defect in the control of respiratory or cardiac center during vulnerable periods of neurological maturation. Findings
after the tragedy
MS diagnosis necessarily involves a study of autopsy. The findings are classically blue color of the skin and mucous membranes, abundant mucus in the oral and nasal cavity. Autopsies reveal the presence of food debris in the airway, which supported the theory of aspiration horn cause of MS, but it is unclear if this phenomenon would occur post-deceased
RISK FACTORS
There are numerous risk factors for MS, extrapolated from population studies., Within this group, highlights the prenatal and postnatal maternal smoking, which increases the nsk up to 3 times. There is much evidence that MS is more common in lower socioeconomic population. Foreign population studies show that 57% of mothers of children with sudden death had not completed studies and 32% were teenage mothers.
risk factors associated with sudden death while sleeping position
Males Smoking
Prematurity Low birth weight and delay
Intrauterine growth
Socioeconomic
prone sleeping position:
Prone position prone infant sleep has been linked to increased risk of MS;
The introduction of mass media campaigns promoting the supine position during sleep showed a significant reduction in the numbers of MS.
The decrease in the incidence of MS has been more than 50% since 1992 in countries where the campaign was built. New recommendations
While in 1992, the American Academy of Pediatrics (AAP) recommended as safe "any position not prone" to sleep currently is no consistent evidence that states that the lateral position is equally risky to sleep in the prone position.
The risk of lateral decubitus position attributed to the possibility of turning prone during sleep. Based on the above is that the AAP in its latest recommendations only recommends supine sleep position for infants. "Supine means sleeping face up
proper mattress sleep habits, such as the use of soft surfaces, pillows and soft blankets have been associated with an increased risk of suffocation and MS
Sharing bed with parents is a topic of debate. Although studies have shown sleep patterns in infants that promote breastfeeding, reported cases of suffocation and death in infants who shared a bed with their parents have questioned this behavior.
The risk is also higher, having a history of smoking or drug abuse in parents of children.
The AAP recommends that infants under 6 months, the safest place to sleep is a crib in the same room of parents and not in the same bed with them.
pacifier use.
pacifier use as a protective factor has been supported by multiple studies, with an OR of 0.47 on average. The mechanism by which the use of pacifiers decrease the MS is not clear, it postulates a reduction to wake up. Pacifier use in this age group has not shown cause problems with breastfeeding or dental care, however, there is no consensus on its use.
Sobreabrigar the child
sobreabrigar There is some evidence that infants would be associated with greater MS, especially in children who sleep in the prone position.
more frequent in children of low birth weight
About 30% of children who died from MS weighed <2500g al nacer y tenían el antecedente de ser prematuros de menos de 37 semanas. El riesgo se hace mayor a menor peso de nacimiento < 1500g.
Relationship
vaccines present no evidence linking MS to vaccines and immunizations. There are case reports that linked the vaccine Diphtheria-Tetanus-Pertussis with MS, however, no data to support this assertion. Relationship
breastfeeding
The association between breastfeeding and MS is unclear and not been a consensus among experts. Physiological studies show that breastfed infants have a lower threshold of wakefulness that formula-fed peers. This would support a protective effect of breastfeeding on the MS. However, epidemiological studies do not reflect this benefit, there is a reduced risk of MS or sufficient evidence in the literature to establish breastfeeding as a protective factor for MS.
INFANTICIDE AND CHILD ABUSE
First reports made in the 1970's that supported the theory of cardiorespiratory control in a family with several children with MS were found to be infanticide, after the confession 30 years after the mother of these children. It is recommended to maintain a high suspicion of infanticide in recurrent cases or doubtful. An undercover murder could be the cause of MS in 6 to 10%.
MANAGEMENT AND DISPLAY OF MONITOR
The indication of a cardiorespiratory monitor in patients with risk factors or sudden death frustrates "event or apparent threat to life (ALTE) was for many years, the mainstay of prevention a possible MS future. However, there is no evidence in the literature to support the use of a cardiorespiratory monitor for the prevention of MS.
The current AAP recommendation is for the following cases:
- Patients with ALTE or life-threatening event "
- Patients with tracheotomy or alterations of the airway that can lead to unstable air.
- infants with metabolic or neurology affecting respiratory control.
- Patients with chronic lung disease requiring oxygen therapy or home ventilation.
The recommendation of a monitor must be accompanied by teaching CPR to parents. Should be advised of the real impact of the monitor and that does not prevent MS, but allows recognition of possible risk events by parents or caregivers of patients at risk
Brothers with MS MS in the recurrence of another brother is low. Described in the literature reports a frequency of about I%, the twins have a higher risk of recurrence to 4%. The indication of a cardiorespiratory monitor in a patient's siblings died of MS is controversial. There is insufficient evidence to support this practice
Recommendations
final recommendations to prevent MS suggested by the AAP are summarized below:
- promote supine sleep position for infants prone
- Avoid positions and lateral
- Prevent infants sleeping on soft surfaces
- Avoid soft items like stuffed animals, blankets, etc. in the cradle of the infant Suspend
- pre-and postnatal smoking.
- suggest that infants sleep close (in a cot) but not with parents in the same bed.
- sobreabrigar not sleep.
- cardiorespiratory not use the monitor as a preventive method of MS and indicate when really justified.
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