Sudden infant death syndrome is all thatparents need to know

Update: October 2018

Sudden Infant Death Syndrome (SIDS, “death in the cradle”) –
it is the death of a child under the age of 1 year with no signs
disease and without features at autopsy. This phenomenon is one of the most
mysterious and tragic in medicine, around him there are many
myths and legends.

To avoid unnecessary fears for the child, as well as to
профилактику СATДС, необходимо знать научную точку зрения по этому
the issue.

What is sudden infant death syndrome?

Термин СATДС введен в конце 60-х годов прошлого столетия, хотя
cases of sudden death of babies have been described and previously, there are
such facts in literature everywhere. Only in the 80-90s after
risk studies pediatricians have begun active campaigns
to prevent this syndrome.

СATДС является диагнозом исключения. Despite the high
adaptive capabilities, infants often die from external and
internal causes. Most often it is a malformation, infectious
diseases, injuries (including intentional) and tumors. Usually
cause of death can be found on the case history and results
autopsy. But sometimes no studies provide answers to questions.
A healthy, normally developing child falls asleep, and through
for a while, parents find him dead in the crib. Exactly
такую внезапную и беспричинную смерть называют СATДС.

Почему возникает СATДС?

The risk of sudden death in cots is maximal among children of age.
2-4 months, gradually decreasing by 6 months and tending to zero
after 9 months. Scientists have found out how old the syndrome is.
sudden infant death is dangerous, but failed to establish the cause.
ATыявлен ряд особенностей, характерных для всех жертв СATДС. So on
autopsy in children were found underdeveloped parts of the brain
(arcuate core, for example), which are responsible for synchronicity
cardiovascular and respiratory activity.

Hypothesis of the extended Q-T interval

ATремя от начала сокращения желудочков сердца до их расслабления
is indicated on the cardiogram by the Q-T interval. According to different estimates
The extension of this moment to 440-450 ms is called the elongated QT.
The connection of this feature with the sudden coronary death of adults
proven long ago. Now it turned out that 30-35% of children who died
от СATДС, были зарегистрированы такие увеличенные интервалы, при
which causes electrical instability of the heart muscle. AND
Often this feature is absolutely physiological, peaks to
2 months and disappears by half a year, which coincides with the age
risk of sudden death.

Apnea hypothesis

Many healthy children have the phenomenon of periodic
breathing when deep breaths alternate between 3 and 20 intervals
seconds But in some cases the pause between respiratory movements
increase significantly. Most often this occurs in preterm
children. Such apnea (cessation of breathing) lasting more than 20
disappears after reaching premature babies age,
corresponding to 37 weeks of pregnancy.

Although in rare cases, long pauses are also preserved.
доношенных children. Scientists have identified some dependencies between such
апноэ и СATДС, поэтому недоношенным малышам с большими задержками
breath recommended to install special recorders
breathing.

Serotonin receptor deficiency

The lack of cells that capture serotonin, which are located
in certain parts of the brain – frequent find on autopsy victims
СATДС. This deficiency is concentrated precisely in the area of ​​the brain,
responsible for cardio-respiratory synchrony, that is, for communication
respiration and heart rate. There is a hypothesis according to
which it is the defects of serotonin receptors that cause stopping
дыхания во сне у children.

Hypothesis of incomplete thermoregulation

It is believed that vital centers in the medulla oblongata mature
in children, until they reach three months. With immature cells
brain, responsible for thermoregulation, the average body temperature
kids below normal. Approximately 3 months of life occurs
temperature constancy (when measured in the rectum). Shortly
before these cells mature, numbers may fluctuate on
thermometer and inadequate temperature response. That is, when
changing the microclimate of the bedroom, the baby may simply overheat,
which will affect respiratory and cardiac activity and lead to
sudden death.

There are many more hypotheses (genetic, infectious,
hypothesis of compression of the vertebral artery), but none of them
объясняет абсолютно все случаи СATДС.

Sudden death mechanism

Для возникновения СATДС необходимо сочетание генетических
factors, critical age and adverse external conditions.
Usually дети, уложенные на живот в мягкую постель, моментально
wake up with a lack of oxygen and change position. But some
Kids, this protective mechanism does not work. They can bump into
in the feather bed, the oxygen content in the blood will drop and the level will increase
carbon dioxide, but reflex spillage will not occur.
The baby will be again and again inhale exhaust air while
oxygen levels will not be critical and will not lead to death.
Such an additional factor as parental smoking also causes
violation of this protective reflex.

Факторы риска СATДС

Despite unsuccessful searches for the exact cause of a sudden child
death, scientists have identified several risk factors. ANDсключение этих
factors reduces the number of sudden deaths at times, although
many predisposing features cannot be eliminated.

Factors related to pregnancy and childbirth

  • maternal addiction and smoking during pregnancy
  • intrauterine hypoxia and developmental delay
  • prematurity

Features of the child

  • male gender, age 2-4 months
  • Resuscitation in the past (the more in life
    the child had episodes requiring emergency care, the higher
    risks)
  • брат или сестра ребенка погибли от СATДС (это касается гибели от
    любого неинфекционного заболевания, а не только от СATДС)
  • frequent and prolonged episodes of apnea, high threshold
    wake up

Child’s sleep conditions

  • sleep in position on the abdomen and on the side
  • parental smoking after childbirth
  • soft bed, feather bed, pillow
  • overheating, cold season
  • child living at high altitudes

The main factors of sudden causeless death
baby – sleep on the stomach, the conditions in the crib and smoking parents.

Sleep in the prone position

Years of research have proven that a child sleeping on his stomach
подвергается большему риску sudden death. Especially dangerous
put children on their stomachs in their sleep after a long break or
for the first time, that is, to create the so-called “unusual position on
stomach “. Most often it occurs during daytime sleep outside
houses.

Previously it was thought that the position on the side does not carry a threat.
But now it is known that the risk of such a pose is no less, since
children often turn on her stomach. Therefore, the only
position on the back can be considered safe. ANDсключением являются
conditions in which sleep on the back is contraindicated (underdevelopment
lower jaw, pronounced gastroesophageal reflux). Such children
often regurgitate and can inhale vomitus. Overwhelming
most babies sleep on their backs without any risk
to choke.

Following the recommendations of leading international pediatric services in
1994, associated with the correct laying of the child on his back,
частота СATДС снизилась по всему миру как минимум вдвое.

Sleeping conditions

ATажным элементом безопасности малыша является обстановка в его
bedroom and specifically in the crib. Potentially lead to sudden
deaths can:

  • Warm quilts
  • Volume soft pillows
  • Soft feather beds and mattresses
  • Elevated room temperature
  • Joint sleep with parents

Smoking parents

Nicotine addiction of mom and dad harms not only them
own health, but also adversely affects the child.
There are several versions of why passive inhalation of tobacco
smoke causes sudden death in sleep. The most common is
reducing the number of catecholamines responsible for sensitivity to
oxygen starvation, under the influence of nicotine.

Since smoking mothers most often smoked during
pregnancy, their children are characterized by late development of all
parts of the brain, including heart centers and
respiratory regulation. The combination of these factors leads to this
трагичному последствию, как СATДС.

Что может скрываться под маской СДATС?

Most infant deaths have
the reasons. Sometimes in order to find these causal factors
undergo a thorough investigation and an autopsy by experts. AND лишь
изредка смерть так и остается загадкой, получая название СATДС.

Consequences of abuse

A child’s death can be the result of a parent’s outburst of anger,
or occur due to chronic beatings and bullying. TO
Unfortunately, this happens more often than we would like. AND если серьезные
Doctors find injuries and fractures that arrive at the scene of the tragedy right away,
then some consequences of violence cannot be seen right away.

TO ним относят намеренное удушение и синдром тряски младенца.
The latter is damage to the thin blood vessels of the brain as a result
shaking a baby. Loose neck and relatively large head
children of the first year of life predispose to severe injuries
brain up to loss of consciousness, coma and death.

Повторный случай СATДС в семье наталкивает на мысль о возможном
child abuse. If the third child dies just as suddenly,
then the forensic physicians are in no doubt of ill-treatment
parents.

Unintentional strangulation

Sleepless nights, hormonal changes and breastfeeding by
demanding tiring every mom. Therefore, her night sleep can be
very strong, despite increased sensitivity to screams
baby If the child sleeps in the same bed with the mother, that is
some risk of inadvertent strangulation. AT несколько раз этот
the risk increases when a mother takes alcohol or drugs from
insomnia

Одним из самых известных литературных и исторических фактов СATДС
there was a parable about Solomon’s court from the Old Testament. Came to Solomon
two mothers, one of whom found her baby dead in bed
(“Pressed her”) and put the little body in the bed of the second mother.

She called the living baby her son. Solomon wisely judged
dispute of women, having given the child to real mum who disagreed
cut it in two. Since then, the habit of putting the baby in bed
parents appeared and disappeared in different nations.

In the 18-19 centuries there were even strict bans on joint sleep, and
�“Feeding” a child was equivalent to premeditated murder. AT
Nowadays, most moms are trying to stack babies in
separate bed, although the cases of their sudden death anyway
are found.

ATирусные и бактериальные инфекции

In infants, many infectious diseases occur
not typical. With severe organ damage, sometimes there are no bright
symptoms. This is especially true for low birthweight premature babies.
Поэтому прежде, чем ставить диагноз СATДС, патологоанатом
sure to rule out pneumonia, meningitis and other formidable
complications of infections.

Профилактика СATДС

ATнезапную смерть младенцев нельзя предугадать и предотвратить со
one hundred percent probability. But you can ensure your baby is safe
environment and eliminate many risk factors.

  • Baby should sleep on his back. Pronation
    necessary for development, but only in the waking state and under
    parental supervision.
  • You can not put the child in the crib with soft blankets,
    pillow, feather bed.
  • ATместо одеяла лучше использовать специальный спальный мешок.
    Tight swaddling is undesirable. This causes overheating of the baby and
    limits its physical activity.
  • It is unacceptable to stack the baby with soft toys.
  • Joint sleep with adults is undesirable. If so
    the need arises, then the child can sleep in the same bed
    only with parents. In this case, mom and dad should not smoke,
    be drunk and excessive
    fatigue. AT таких случаях лучше вплотную придвинуть детскую
    crib to bed for adults
  • Do not allow the child to overheat. Optimal temperature
    in the bedroom of the baby – about 20 ° C.
  • Before putting the baby in the crib, let him burp,
    if recently there was feeding. For this kid hold “column”
    that is, clinging vertically to him.
  • ANDспользование соски-пустышки на ночь снижает риск СATДС. The first
    It’s better not to use the pacifier for a month of life
    the correct mode of production of milk.

Home breath monitoring

AT последние годы появилось множество домашних приборов,
allow you to track the breath, pulse of the child and even saturation
oxygenated his blood. Such devices operate according to the principle
radio monitors, giving parents a beep during long pauses in
your baby’s breathing and heart rhythm disturbances. But unfortunately,
research has not proven at least some preventive
favor of such devices. Home monitoring practically does not reduce
частоту СATДС. The use of sensors is permissible only in children.
high risk groups:

  • Infants who had episodes of unconsciousness, blue in the face,
    requiring emergency care (cardiopulmonary
    resuscitation)
  • Premature babies with frequent apnea episodes
  • Children with proven respiratory illnesses that cause
    to stop breathing

The useless commercial innovations include wedges, as well as
all sorts of sleep positioners. These fixtures fix
child, not letting him turn on his stomach. From point of view
statistics the risk of sudden death in these children is not at all
are decreasing.

СATДС и вакцинация

Anti-vaccine campaign activists are happy to use
феномен СATДС для запугивания родителей «ужасами вакцинации».
Indeed, baby’s first vaccinations often coincide with
the peak of the frequency of sudden death. But numerous wide
studies have proven that the coincidence of vaccination episodes and
sudden death is completely random. Moreover, vaccinated children
die in the cradle much less often unvaccinated. No vaccination
не только не убережет от СATДС, но и прибавит риски умереть от
stop breathing with whooping cough, for example.

When should I pay special attention to the child?

In some circumstances, you need to exercise a little more.
attention to the health of the baby to avoid a tragic outcome.

  • ATысокая температура у ребенка, особенно во время сна
  • Refusal to eat, decrease in motor activity
  • ATсе респираторные заболевания (фарингиты, бронхиты, даже
    common cold)
  • Sleep baby after a long tantrum and crying
  • Sleeping in unusual conditions (on a visit, not in your crib)

Help for parents who survived the sudden death of a child

The bitterness of such an unexpected and heavy loss is incomparable to anything.
Но необходимо помнить, что СATДС невозможно предвидеть и
prevent, and there is no fault of the parents in the death of the child.
Therefore, it is necessary to seek help from a psychologist, to start
classes in support groups and continue to live on. Most
families manage to maintain unity, have children and avoid
repetition of the tragedy.

Основные выводы о СATДС

  • ATнезапная the death of a healthy child is tragic, but extremely
    a rare thing
  • Невозможно предугадать развитие СATДС
  • Посмертный диагноз СATДС ставится только при отсутствии
    signs of illness or violence
  • The main measures to prevent sudden infant death: sleep on
    back, cot with hard mattress, without pillow and light
    blanket / sleeping bag, as well as parental refusal to smoke
  • Home appliances to control breathing and heartbeat needed
    only at-risk children
  • Наличие в медицине такого феномена, как СATДС, – это не повод
    for the development of anxiety in mom and dad. Create baby safe
    conditions and enjoy parenting!

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