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SIDSDefinitionSIDS: Unexpected death of infant / young child with failure to demonstrate adequate cause at post-mortemALTE: Periodic breathing: normal breathing in neonates resp pauses 3-10secs followed by rapid breathing for 20secs; no change in colour / toneBreath holding: 6/12 – 6yrs; behaviouralApnoea: be concerned if >20secs or assoc with decr HR, cyanosis, change in muscle toneEpidemiologySIDS: Leading cause of death in 1/12 – 1yr; incidence 1:1000; decr incidence in past 10yrs; peak incidence at 18wks; 50% <5/12; 60% maleALTE: peak incidence 8/52Risk factors SIDSPhysio: LBW, prem, twins, FH SIDS, prolonged QTc Enviro: winter, URTI, warm room, tightly wrapped blankets, young mother, substance abuse, smoking, prone sleepingIn ALTE: incr risk SIDS if colour change, tone change, apnoea >3secs, choking / gaggingCauses ALTECause found in 60% (GORD, seizures, resp infection (2.7% have serious bacterial infection), prem)Causes apnoeasNS: central, seizuresInfections: meningitis, encephalitis, pertussis, pneumonia, RSVMetabolic: hypoG, hypoCa, inborn errors of met, GORDCardiac: SVT, congenital heart diseaseOther: periodic breathing, NAI, breath holding attack, ICH, botulism, drugsSymptomsSIDS: cold, blue, lifeless, no resp effort; 1Y event is resp arrestALTE: apnoeic episode (>20 secs) assoc with bradycardia / pallor / cyanosisInvestigationsSeptic screenALTE: apnoea monitoringMngSIDS: comfort, explain, reassure, answer, inform; SW etc…; physical memento; coroner’s case; arrange FUALTE: xanthine derivatives may stimulate resp centre in neonatesNotes from: Dunn ................
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