Sudden infant death

from Wikipedia, the free encyclopedia
Classification according to ICD-10
R95 Sudden infant death
ICD-10 online (WHO version 2019)

The sudden infant death syndrome , sudden infant death or crib death (Latin mors subita infantium ) is the unexpected and not explainable decease of an infant or young child that occurs mostly in the (presumed) Bedtime infant. In the industrialized nations it is considered to be the most common cause of death of small children beyond the newborn period.

Sudden infant death syndrome most commonly occurs in the first year of life; However, 2 to 6% of deaths occur in the second year of life.

The term is also known under the English abbreviation SIDS (from sudden infant death syndrome ). Closely related to this is the term near-SIDS or near-missed-SIDS , which corresponds to the more commonly used ALTE ( apparent life-threatening event ) in German , which stands for primary sleep apnea in infancy .

definition

Sudden infant death syndrome is defined as the sudden death of an infant for which no cause - such as illness or accident - can be determined despite an autopsy and examination of the location. So it is always a diagnosis of exclusion. This means that the pediatrician or pathologist , sometimes also the forensic doctor (unexplained death ), all other conceivable natural and unnatural causes of death such as infections , metabolic disorders , bleeding (also after shaking trauma ), malformations and accidents (poisoning, electricity, fall, hypothermia , Drowning, asphyxiation, ...) and the clinical history and the specific circumstances of death must not provide any indicative information before one can speak of sudden infant death syndrome. At the same time, however, this also means that one does not know a cause for sudden infant death syndrome, only that there are different hypotheses about it. However, this definition comes from the time this phenomenon was discovered, before most of the relevant research took place. In the meantime, frequent matches in circumstances of death are known and there have been discussions for decades about a revision of the traditional definition, partly because of problems with the definition of inexplicability. Apparently, accidental asphyxiation has long been included.

Epidemiology

Sudden infant death syndrome is a major challenge for research in pediatric pathology and preventive medicine in paediatrics . In 2014, 119 children in Germany died of infant death syndrome compared with 714,927 children born alive ( risk : 0.17 ‰). In Germany, cot death is only the third most common type of death in childhood beyond the neonatal period.

Male babies are 60% more affected than female babies. Two thirds of the deaths occur in the winter months.

About 80% of deaths occur before the infant is six months old. Sudden infant death syndrome most often occurs in the second to fourth month of life of the infant.

In most cases, cot death occurs during the (suspected) bedtime of the infant.

A study from the United States that examined 568 cases from 1991 to 2008 shows that 99% of the children affected had at least one risk factor. 75% had one intrinsic and one extrinsic factor, and 57% even had two extrinsic and one intrinsic factors. Only in 5% of the deceased children could no increased extrinic risk factor be found. In the absence of a control group in the study, however, these figures are only of limited significance. It is unknown what percentage of unaffected children also has at least one risk factor. Depending on the selected risk factors (e.g. male gender), it can be assumed that at least one risk factor applies even to a high percentage of unaffected children.

Risk factors and risk groups

On the basis of autopsies, surveys and statistics, doctors and other scientists try to determine risk factors and risk groups for sudden infant death syndrome.

Risk factors

The main risk factors are:

  • Age of mother
  • a life-threatening crisis that has already occurred
  • a sibling who died of sudden infant death syndrome
  • a premature birth before 33 weeks or a very low birth weight
  • Drug use of the mother (especially polytoxic drug use )

Other risk factors for the infant:

  • Secondhand smoke both during pregnancy and after childbirth
  • overheat
  • Sleep in the prone position. Back sleep campaigns like the successful “Safe to Sleep” campaign have led to a dramatic decrease in deaths.
  • Covering the head or insufficient air circulation
  • The bed surround (nest)
  • Sleep in your own children's room


Controversial:

  • Sleeping in parents' bed (see also: Co-Sleeping )
  • Staphylococcus aureus and Escherichia coli bacteria
  • Refraining from breastfeeding

risk groups

Previous studies have shown that children with a low birth weight (premature births), multiple births and infants with several older siblings are particularly at risk of sudden infant death syndrome. In addition, children from socially disadvantaged families, children of especially young mothers (under 20 years of age) and children of single parents are considered to be at above-average risk. Whether siblings of children who have already died from sudden infant death syndrome are at an increased risk of infant death is controversial.

Infants who sweat profusely during sleep or infants who are noticeable through long pauses in breathing ( apnea ) are also particularly at risk . Unusual paleness of the child during sleep or the blue tinting of the arms and legs during sleep can also be indications of a particular risk. Children who have already survived an acutely life-threatening event are also considered at risk.

If a pregnant woman smokes more than ten cigarettes a day, the risk of SIDS increases sevenfold. The risk of SIDS with parental tobacco consumption is two to four times higher than in smoke-free households.

Sudden infant death syndromes can occur in rare syndromes, such as congenital hypereplexia .

Preventive measures to avoid risk

One of the most important and effective preventive measures is to avoid or reduce the known risk factors. Preventive measures include:

  • smoke free environment
  • Bedroom temperature 16-18 ° C
  • Lie on your back for sleeping, also not on your side, because of turning
  • Sleep in the master bedroom
  • firm, air-permeable mattress
  • no bed border (nest)
  • Matching sleeping bag , no headgear and no additional blankets, furs, pillows, cushions etc.

It is also recommended that children in their first year of life do not sleep in their own room, but in one room with their parents. However, there are contradicting statements about how parents and children sleep together in one bed (so-called family bed or co-sleeping ). A more recent study from Scotland was able to show again that especially infants younger than eleven weeks old have an increased risk of sudden infant death syndrome if they share the bed with their parents. In contrast, z. B. to find both views in the USA.

According to other studies, sucking on a pacifier is said to have a preventive effect.

In countries like Great Britain and the Netherlands , the preventive measures mentioned above have even been publicized on television, with the success that the number of deaths has been markedly reduced. In the Netherlands, for example, the number of sudden infant deaths fell by a factor of 10 from 1987 (0.91 ‰ live births) to 2004 (0.09 ‰ live births); the Netherlands thus has the lowest child death rate in the western world. In the Netherlands, there is a comprehensive, structured health promotion in postpartum care by midwives and maternal carers who practice compliance with the rules of safe sleep in the first eight days of life with the parents. In Germany, the supine position has been recommended as a sleeping position for babies since 1991. Between 1991 and 2002 the number of child deaths in Germany decreased from 1285 cases in 1991 to 367 cases in 2002 (from 1.55 ‰ to 0.51 ‰ live births), which is often attributed to the recommendation to lie on the back and other preventive measures .

In the past, it was argued against the supine position while sleeping that children would develop a deformed skull from this position . Studies on small children show that a possible deformation does not result in permanent changes.

So-called sleep positioners (baby pillows) do not promise any success and can even increase the risk of infant death. Sleep positioners are designed to prevent infants from turning on their stomachs while sleeping and thus taking a risk position for infant death. However, the US regulatory authority has become aware of twelve deaths in which infants suffocated in the sleep positioner (as of 2010). So far there is no scientific evidence that the use of breathing monitors reduces the incidence of sudden infant deaths.

Attempts to explain

The actual cause of sudden infant death syndrome remains unknown. A variety of mechanisms are discussed. There are over two hundred theories. A multifactorial event appears conceivable with a combination of external factors (such as an infection) and internal factors.

Impaired blood flow to the brain stem

In a study published in 2010 with ultrasound examinations of 18,194 healthy children, it was suggested that the reduced blood supply to the brain stem could be a cause of sudden infant death syndrome. In a small proportion of healthy babies (approx. 0.33%), the inadequate supply can be provoked by turning the head to the side in the prone position. For this purpose, ultrasound measurements were carried out on 18,194 babies in various lying positions and the blood flow in the basilar artery was examined by Doppler sonography. Through special education of the parents concerned, the risk of sudden infant death syndrome in the study group could be significantly reduced, as the values ​​of the study group - 0.055 ‰ (1: 18,194) - compared to those of the control group - 1.14 ‰ (4: 3,519); (p <0.0030) - show. A possible connection had already been pointed out earlier.

Serotonin homeostasis disorders

In studies on the brains of young children who died suddenly, morphological and biochemical abnormalities were found in serotonin- producing nerve cells in the raphe nuclei . Experiments with transgenic mice in which a certain serotonin receptor (5-HT 1A ) was reversibly overexpressed showed that overexpression of this receptor resulted in more frequent sporadic bradycardias and hypothermia . These dysregulations of the autonomic nervous system often lead to the death of these animals, so that disruption of serotonin homeostasis is discussed as a possible cause of sudden infant death syndrome .

Botulism theory

Here the opinion is held that one cause of sudden infant death syndrome is the pathogen Clostridium botulinum , which z. B. can occur in contaminated honey. C. botulinum forms a paralyzing poison, botulinum toxin , which causes botulism . According to this theory, the dose that is present in honey is completely harmless for adults. Infants only have gastric acid levels at the end of the second year of life like adults and the intestinal flora is also not yet mature and offers the bacterium an environment for reproduction and toxin formation. The toxin gets into the bloodstream and causes respiratory paralysis. In fact, in a series of autopsy cases, C. botulinum was found in 4.3% of the 211 children who died from cot death. A German research group succeeded in detecting botulinum toxin in 9 of 75 autopsy cases (including 57 children who died from sudden infant death syndrome).

Toxic gases

At the end of the 19th century, Bartolomeo Gosio was tasked with investigating sudden infant death syndrome and discovered that the arsenic fungus releases a life-threatening gas when wallpaper containing arsenic paints decompose, which Frederick Challenger identified as trimethylarsine in 1932 .

In 1990 Barry A. Richardson published that he was able to detect the arsenic fungus in all mattresses of 45 babies who died from SIDS circumstances. Sleeping areas are affected, where heat and moisture promote fungal growth. He suspected that the fungus in mattresses that contain flame retardants or plasticizers could release toxic gases and cause SIDS.

A group of experts appointed by the UK Department of Health in 1994 could not detect the pathogen and, in their report (Limerick Report) of May 1998, assumed Richardson's errors. Warnock was also unable to detect the fungus in 1995. Richardson issued a comprehensive statement on the Limerick Report in June 1998, in which he stated, among other things, that - contrary to what the Limerick Report claims - the experiments were not carried out according to his specifications. This statement was not forwarded to the research team and was not otherwise considered. Since the Limerick Report was published, the theory of toxic gases has therefore also been disproved at the international level. A Scottish study in 2002, which suggests a connection between used mattresses and sudden infant death, could not change this either.

Vaccinations

From Impfgegnern a possible connection of sudden infant death has been discussed with vaccinations. Sudden infant death syndrome was linked to whooping cough vaccination as early as the 1980s . This suspicion has been refuted by extensive epidemiological studies, and it has also been shown that the risk of SIDS is even reduced in primary-immunized infants compared to unvaccinated infants. Finally, in Sweden, it has been observed that sudden infant death rates have increased after whooping cough vaccinations decreased.

Another possible connection was postulated after the introduction of six-fold vaccines in autumn 2000 in Europe. Five children died suddenly and unexplained within 24 hours of the vaccination; By this time, around 3 million children in Europe had been vaccinated with six-fold vaccines. The incidents were investigated by both the Paul Ehrlich Institute and the scientific committee of the European Medicines Agency. According to this, there is no connection between child vaccines and sudden infant death syndrome. According to other studies, vaccinations (including six-fold vaccinations) reduce (halve) the risk of sudden child death.

In the US, an environmental study found that SIDS incidence decreased between 1975 and 2009, while vaccination rates for diphtheria, tetanus and pertussis increased over the same period. Similarly, the incidence of SIDS is falling in Germany (1990: 15 SIDS cases per 10,000 live births; 2013: 2.2 cases per 10,000 live births) despite the introduction of new standard vaccinations in the same period.

Phosphate deficiency

There is current speculation as to whether a lack of phosphate in the child's blood is the cause of sudden infant death syndrome. It can also explain some other symptoms.

Parents' concern

The parents are completely surprised by the sudden death of the child. For the parents there is a need to mourn and say goodbye, for the forensic doctors there is a need for clarification. Despite the numerous theories, the diagnosis of “sudden infant death” does not give the grieving family an answer to the question of the actual cause.

According to a Danish study that examined the fate of more than 21,000 parents whose children died of cot death, the life expectancy of these parents is reduced. According to this, the probability that affected mothers will commit suicide or suffer serious accidents within the first four years after the child's death is four times as high as that of other mothers whose children are still alive. The mother's risk of developing cancer is also increased by 44%. In the case of affected fathers, the risk of suicide or a fatal accident doubles compared to unaffected fathers. One of the authors of the study, Jørn Olsen, explains this with the fact that the loss of the child is one of the worst possible experiences and that the stress that it causes can be . a. can lead to high blood pressure and heart disease.

literature

  • S1 guidelines for sudden infant death of the German Society for Sleep Research and Sleep Medicine (DGSM). In: AWMF online (as of 2017)
  • Gerhard Jorch : Prevention of sudden infant death . In: Monthly Pediatrics . tape 158 , no. 6 , 2010, p. 564-569 , doi : 10.1007 / s00112-009-2159-7 .
  • Evelyn Krieger, Stefanie Uibel, Daniel Müller, David Quarcoo, Doris Klingelhöfer, Simona Zitnik, David A. Groneberg: On the syndrome of sudden infant death syndrome (SIDS) - current state of science . In: Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie . tape 62 , no. 4 , 2012, p. 206-214 , doi : 10.1007 / BF03346149 .
  • Ronald Kurz, Thomas Kenner , Christian Poets, Reinhold Kerbl, Mechtild Vennemann, Gerhard Jorch (eds.): The sudden infant death: Basics - risk factors - prevention - parenting advice . 2nd Edition. Springer-Verlag, 2014, ISBN 978-3-7091-1444-5 ( limited preview in Google book search).

Web links

Wiktionary: SIDS  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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