Sudden infant death syndrome

A patient of mine, an undergraduate, came for consultation. A pregnancy test was done and the result came out positive. I had congratulated her, but to my surprise, she was moody.

The following conversation then ensued between us:

Doctor: Congrats, you have started another journey of nine months.

Patient: Thank you.

Doctor: how many kids do you have and how are they doing?

Patient: I have two kids (then she started crying)

Doctor: (After giving her about five minutes to express her feelings) It is well, this must be a cry of joy!

Patient: Doctor, I lost one of my kids two months ago.

Doctor: What happened to him? How old is he?

Patient: He was 11 months old. He slept well overnight, and in the morning, I bathed him and later attempted to feed him. Then I noticed that the child was stiff and was not moving anymore.

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Doctor: Sorry about that. Didn’t you rush him to a hospital?

Patient: I did. I got to the nearby hospital within 10 minutes, and the doctor said the baby was not breathing and that I should take him to the general hospital. At the general hospital, the doctors certified him dead.

Doctor: Did they do post-mortem? If yes, what was the finding?

Patient: No. They wrote cardiovascular failure in the death certificate.

Doctor: This is called sudden infant death syndrome, something went wrong.

Sudden infant death syndrome is the sudden, unexpected and unexplained death of an apparently healthy baby. No cause for the death can be found.

Sudden infant death syndrome, SID, also known as cot death, is a diagnosis that’s made when an apparently healthy baby dies without warning, and for no clear reason.

When a baby dies suddenly, doctors and investigators try to find out why. This includes a post-mortem examination, seeing where the baby died, and a review of the baby’s medical notes.

The cause of the death may be diagnosed as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma (accidental or non-accidental). All these are termed sudden unexpected death in infancy, SUDI.

SIDS is not very common, but it is still the most common cause of death in newborns.

Causes

No one knows why some babies die this way. It may just be a combination of factors that affect a baby at a vulnerable stage in his development. Some babies may have a problem with the part of the brain that controls breathing and waking.

Such babies don’t respond if their breathing is slightly restricted, such as if there are bedclothes covering their nose or mouth.

Factors which put a baby at a higher risk of SIDS include premature birth (before 37 weeks) and low birth weight of less than 2.5kg.

Most unexpected deaths occur while the child is asleep in his cot at night. However, SIDS can also occur when a baby is asleep during the day or, occasionally, while they are awake.

At about five months or six months, babies start to roll. At this age, the risk of cot death reduces and it’s safe to let the baby find his/her own comfortable sleeping position.

How to prevent SID

By removing known risk factors and providing a safe sleeping environment, most of these deaths are preventable.

• Don’t smoke when you are pregnant or after your baby is born, and do not let anyone else smoke in the same room as your baby. Smoking during pregnancy increases baby’s risk. The airway of infants is small; so, smoking near infants increases Sudden Infant Death Syndrome. People should not smoke in the presence of infants, as it puts them at risk of SIDS.
• Place your child on his back to sleep. The safest place for babies to sleep is in a cot in a room with you for the first six months. Infants younger than one year of age should be put to sleep on their backs in order to decrease the risk of SIDS. Statistics show that placing infants on their backs when sleeping opens their small airways better and they can breathe better while sleeping. It’s not as safe for babies to sleep on their sides as on their backs. Healthy babies placed on their backs are not more likely to choke. When the baby is old enough to roll over, don’t prevent them from doing so.
• Do not share a bed with your baby, particularly if you have been drinking alcohol or taking drugs. Never sleep with your baby on a sofa or on an armchair.
• Do help them burp to digest milk/formula, so that they won’t run the risk of spitting up and inhaling formula/milk when they are sleeping.
• Do not let your baby get too hot. Feel your baby’s tummy or neck to see if he/she is getting too hot or too cold and adjust the bedding accordingly. Remove your baby’s cap and any extra layers of clothing as soon as you come indoors after being outside, even if it means waking her up.
• Seek medical advice if your baby is unwell. For the first six months, try to have your baby in the same room as you when she takes her naps.

Take your baby for regular check-ups, do exclusive breastfeeding and keep immunizations up to date. It helps.