Differential diagnosis

Some conditions that are often undiagnosed and could confused with or comorbid with SIDS include:

medium-chain acyl-coenzyme A dehydrogenase deficiency (MCAD deficiency);[63]

infant botulism;[64]

long QT syndrome (accounting for less than 2% of cases);[65]

Helicobacter pylori bacterial infections;[66]

shaken baby syndrome and other forms of child abuse;[67][68]

overlying.[69]

For example, an infant with MCAD deficiency could have died by "classical SIDS" if found swaddled and prone with head covered in an overheated room where parents were smoking. Genes indicating susceptibility to MCAD and Long QT syndrome do not protect an infant from dying of classical SIDS. Therefore, presence of a susceptibility gene, such as for MCAD, means the infant may have died either from SIDS or from MCAD deficiency. It is currently impossible for the pathologist to distinguish between them.

A 2010 study looked at 554 autopsies of infants in North Carolina that listed SIDS as the cause of death, and suggested that many of these deaths may have been due to accidental suffocation. The study found that 69% of autopsies listed other possible risk factors that could have led to death, such us unsafe bedding or sleeping with adults.[70]

Prevention

Air circulation with fan use

According to a study of nearly 500 babies published in the October 2008 Archives of Pediatrics & Adolescent Medicine, using a fan to circulate air correlates with a lower risk of sudden infant death syndrome. This is plausible because a prone sleeping baby with nose to the sleeping surface could rebreathe some of its exhaled breath which is enriched in CO2 and depleted in oxygen. A fan could increase the mixing of the exhalation into the room air and lessen the risk of SIDS related to infant hypoxia. Researchers took into account other risk factors and found that fan use was associated with a 72% lower risk of SIDS. Only 3% of the babies who died had a fan on in the room during their last sleep, the mothers reported. That compared to 12% of the babies who lived. Using a fan reduced risk most for babies in poor sleeping environments.[6] Author De-Kun li said that "the baby's sleeping environment really matters" and that "this seems to suggest that by improving room ventilation we can further reduce risk."[71]

However, Dr. John Olssen at East Carolina University has pointed out that this study had a number of methodological flaws, such as selection and recall bias, low enrollment numbers, and dissimilar study groups. Olssen argues that although fan use is probably not harmful, it should not be recommended as a means to reduce the risk of SIDS.[72]

Bedding

Product safety experts advise against using pillows, overly soft mattresses, sleep positioners, bumper pads, stuffed animals, or fluffy bedding in the crib and recommend instead dressing the child warmly and keeping the crib "naked."[73][74]

Blankets should not be placed over an infant's head.[75] It has been recommended that infants should be covered only up to their chest with their arms exposed. This reduces the chance of the infant shifting the blanket over his or her head.

Breastfeeding

A 2003 study published in Pediatrics, which investigated racial disparities in infant mortality in Chicago, found that previously or currently breastfeeding infants in the study had 1/5 the rate of SIDS compared with non-breastfed infants, but that "it became nonsignificant in the multivariate model that included the other environmental factors". These results are consistent with most published reports and suggest that other factors associated with breastfeeding, rather than breastfeeding itself, are protective."[76] More recent studies however claim to show a significantly reduced incidence of SIDS in breastfed infants. [77][78][79]

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Bumper pads

Bumper pads may be a contributing factor, claims Health Canada, the Canadian government's health department. They issued an advisory[80] recommending against the use of bumper pads, stating:

The presence of bumper pads in a crib may also be a contributing factor for Sudden Infant Death Syndrome (SIDS). These products may reduce the flow of oxygen rich air to the infant in the crib. Furthermore, proposed theories indicate that the re-breathing of carbon dioxide plays a role in the occurrence of SIDS.

Date: 2015-12-17; view: 622