Sids presentation nrp 540 j. penunuri l. hansen

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SIDS presentation FNP students

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  • John> Welcome to this segment of House Call. In the United States Sudden Infant Death Syndrome accounts for 56 deaths/100,000 live births. Sudden infant death syndrome (SIDS) is the sudden and unexpected death of an infant or young child between 2 wk and 1 yr of age in which an examination of the death scene, thorough postmortem examination, and clinical history fail to show cause SIDS is the most common cause of death of infants between 2 wk and 1 yr of age, accounting for 35 to 55% of all deaths in this age group To help us understand SIDS, it’s risk factors, and what families can do to decrease their risk is our special guest, NP Lillian Hansen.
  • Lilly> Caregivers unaware in 24hrs prior to death that death is imminent Phenomenon of simultaneous SIDS, where twins die from SIDS within 24hrs of each other http://www.ncbi.nlm.nih.gov/pubmed/11444658
  • John> Statistics show SIDS rates declined from 120 deaths/100,000 in 1992 to 56 deaths/100,000 in 2001 (56%); however, no change from 2001-2006.
  • Lilly> SIDS is the most common cause of death in infants Unexplainable form of SUID New classifications of kinds of deaths has allowed more infants to be labeled as dying from a cause other than SIDS, so unsure if death rate has really declined
  • Discussion: 40 bed-sleeping families compared 40 infants who slept in their own cots researchers report that desaturation events were more common in bed-sharing infants and that this was associated partly with the warmer microenvironment during bed-sharing. researchers identified 80 episodes of rebreathing . Those occurred among 22 bed-sharing infants, but in only 1 who slept in a cot . Nearly all of those events were preceded by head covering . characteristics of the sampled families (relatively few smokers, high standard of maternal education, and high breast-feeding rate) might help explain why the infants seemed to be able to physiologically adapt to their warmer, sometimes stuffier microenvironments in the parental bed Baddock and colleagues study, published online July 16 in Pediatrics Deaths related to co-sleeping are more likely to show intra-alveolar hemorrhage; more commonly reported at autopsy in deaths associated with co-sleeping in infants younger than 6 months vs infants who were not co-sleeping; suggesting that a proportion of these deaths associated with co-sleeping may be related to asphyxia.
  • John> Over the years we have been told to have the baby sleep on its belly, then on its side… What is the current research and recommendations for sleeping? Lilly> Side sleeping increases risk of rolling onto stomach compared to rolling on stomach from back Sleeping prone or side increases the risk of rebreathing expired gases, causing hypercapnea and hypoxia Also raises body temperature
  • Lilly> Decrease by 53% from 1992 to 2001 Since 2001, rate remains unchanged, corresponds to steady rate of prone positioning (70% in 1992, 11-13% since 2002). During this time that the rate has remained unchanged, the rates of other causes of SUID have significantly increased. So many deaths previously classified as SIDS are now classified as other causes of SUID. The leveling of the rate of SIDS is occurring during the leveling of the rate of prone positioning. May need to reduce rate of prone positioning to see reduction in rate of SIDS again. John> Why still sleeping prone? Lilly> Parents/caregivers afraid of choking and aspiration, and thinking baby does not sleep as well when supine b/c awaken frequently (infants are characteristically light sleepers and should wake frequently) John> When can baby safely sleep prone? Lilly> Once infant can easily roll over from back to front and front to back, ok to allow infant to sleep in position that he assumes when layed down to sleep supine. AAP recommends wait until at least 1 year old to allow to sleep prone John> OK, prone only when awake and supervised (tummy time). Wait until 1 year of age for prone sleeping
  • John>What are the associated risk factors for SIDS? Lilly> 90% of SIDS cases occur before 6 months of age, peaks from 1-4 months old African Americans and Native Americans: rate of SIDS is 2.5x that of white Americans, corresponds to higher rate of prone positioning and soft bedding Sleeping prone Smoking impairs the development of arousal centers in brain and inhibits normal functioning of cardiovascular reflexes
  • John> Certain risk factors are non-modifiable but many are. These are the risk factors that can be modified or eliminated.
  • John> What are some measures that can be considered “protective” if any against SIDS? Lilly> Room sharing also reduces risk of suffocation, strangulation, and entrapment that can occur with bed sharing. AAP does not endorse devices that make co-sleeping safe, such as small basinets that lay in bed surface Use of pacifiers not officially recommended due to “nipple confusion” and reduction in breastfeeding, as well as increased risk of otitis media, GI infections, and oral colonization with candida among pacifier users Cool sleeping environment Tummy time (supervised) (not to be confused with prone sleeping) reduces positional plagiocephaly (flat or mishapen head due to laying with head in one position too long) Breastfeeding infants are more easily aroused from sleep and lower incidence of GI infections and URI that increase risk of SIDS John> Interesting that you should mention cool sleeping environment: co-sleeping increases heat; heated rooms, excessive blankets, prone sleeping all increase body heat and are associated with SIDS. Immunizations: we will go more into this in a few minutes, but it is believed to be possibly protective, but at least not a risk factor for getting SIDS
  • John> Bed sharing is of particular importance and should be emphasized: Since 1992, when the AAP recommended that all babies be placed on their backs to sleep, deaths from SIDS have declined dramatically; however, sleep-related deaths from other causes, including suffocation, entrapment, and asphyxia, have increased Cultural practice Very common in U.K. (accounts for 50% of SUIDS/SIDS) Co-sleeping is Increasing in the U.S. according to a study published in the April issue of the Journal of Paediatrics and Child Health http://www.medscape.org/viewarticle/762302
  • John> So based on what you have said, it is my understanding that a crib should be used without the use of bumper pads, use a firm mattress, avoid excessive blankets, and avoid overheating. Is that correct? Lilly> yes.
  • Lillie - peak of SIDS corresponds to peak of vaccination for infants. Led to suspicion that vaccines is causing SIDS. CDC has led research studies that show no relationship and possible protective benefit.
  • Controversial advertisement against SIDS
  • Safe to Sleep includes recommendations to avoid other causes of SUID, such as suffocation
  • john
  • lillie
  • john
  • John: Parents are now the patient of focus Information best offered to family members who will be support system First Candle: Bilingual crisis counselors American SIDS Institute: Family Support providing crises phone counseling, grief literature and referrals.
  • We will go over some of those myths and facts in just a moment
  • I figured I could give a myth and you could give the fact.
  • JOHN> HPI: 3 month old male infant found dead after being placed in prone position. Pronounced dead on arrival to Pediatric Services of Sokolac Health Centre. 11:30 AM the infant was bottle-fed cow’s milk and placed in his crib by his mother, face down and covered with blankets. Found un-responsive 1-2 hours later. Normal vaginal birth, normal weight, pre-natal care. Normal growth and development at check-up 2 and 3 months. What can you tell me about the crib? Lilly> Sleeping environment consisted of a crib with “several blankets” and a “soft mattress.” The room was noted as “humid.” John> what did the investigation of the child reveal? Lilly> No external trauma or violence. Mild cyanosis. Internal exam reveal mild edema, cyanosis which were non-specific as to the cause of death. All findings leading to a conclusion of natural death. S/s typically seen in SIDS.
  • Discussion: 40 bed-sleeping families compared 40 infants who slept in their own cots researchers report that desaturation events were more common in bed-sharing infants and that this was associated partly with the warmer microenvironment during bed-sharing. researchers identified 80 episodes of rebreathing . Those occurred among 22 bed-sharing infants, but in only 1 who slept in a cot . Nearly all of those events were preceded by head covering . characteristics of the sampled families (relatively few smokers, high standard of maternal education, and high breast-feeding rate) might help explain why the infants seemed to be able to physiologically adapt to their warmer, sometimes stuffier microenvironments in the parental bed Baddock and colleagues study, published online July 16 in Pediatrics Deaths related to co-sleeping are more likely to show intra-alveolar hemorrhage; more commonly reported at autopsy in deaths associated with co-sleeping in infants younger than 6 months vs infants who were not co-sleeping; suggesting that a proportion of these deaths associated with co-sleeping may be related to asphyxia.
  • Sids presentation nrp 540 j. penunuri l. hansen

    1. 1. HOUSE CALL
    2. 2.  Defined by the CDC as: “sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history”
    3. 3. 120 deaths/100,000 in 199256 deaths/100,000 in 2001No change from 2001-2006
    4. 4. “Convergence of these factors ultimately results in a combination of progressive asphyxia, bradycardia, hypotension, metabolic acidosis, and ineffectual gasping, leading to death”
    5. 5.  1992: AAP recommends infants be placed in non-prone position (side or supine) for sleep 1990s: National Institute of Child Health and Human Development conducts surveys on SIDS 1994: NICHHD, AAP, SIDS Alliance, and US Public Health Service campaign “Back to Sleep” 2000: AAP advised sleeping on back confers the lowest risk of SIDS
    6. 6.  Age less than 6 months African American and Native American race Sleeping prone and side position Use of soft bedding (pillows, blankets, bumpers) Sleeping in carseat or bouncer Maternal smoking during pregnancy Exposure to second-hand smoke Respiratory infections Bed sharing  worse with multiple bed sharers, use of alcohol or overtired adult, bed sharing on couch Child care  Higher incidence of prone positioning during sleep
    7. 7.  Age less than 6 months African American and Native American race Sleeping prone and side position Use of soft bedding (pillows, blankets, bumpers) Sleeping in carseat or bouncer Maternal smoking during pregnancy Exposure to second-hand smoke Respiratory infections Bed sharing  worse with multiple bed sharers, use of alcohol or overtired adult, bed sharing on couch Child care  Higher incidence of prone positioning during sleep
    8. 8.  Room sharing without bed sharing Use of pacifier at bedtime and naptime Cool sleeping environment Tummy time Breastfeeding infant Immunization (possibly)
    9. 9.  Co-sleeping is associated with unexplained SUDI/SIDS in infants aged < 6 months, suggesting that co-sleeping is related to the pathogenesis of death in younger infants. The finding that intra-alveolar hemorrhage is more common in co-sleeping suggests that a minority of co- sleeping-associated deaths may be related to an asphyxial process. Accounts for 50% of SUIDS/SIDS in U.K. Co-sleeping is increasing in U.S.
    10. 10.  There is no evidence that bumper pads reduce the risk for injury to young infants, and these devices are not recommended because of the potential for entrapment or strangulation Firm mattress Avoid excessive blankets Avoid overheating
    11. 11.  Co-sleeping  Shown to facilitate breastfeeding, popular in USA  No evidence for protective benefit against SIDS Immunization  Case reports from 1970s suggested relationship between vaccination and SIDS  No relationship exists and suggests vaccination could be protective against SIDS
    12. 12.  “Safe to Sleep” campaign (formerly “Back to Sleep” campaign)  SIDS resource kits targeted for specific populations (African Americans, Native Americans, Hispanics) Safe Sleep for your Baby YouTube video
    13. 13. Nonprofit organization dedicated to safe pregnancies and survival of babies through first years of life
    14. 14.  Families who have had an infant die from SIDS should be treated with compassion and empathy. They should be supported through the process of the death investigation and guided through problems:  Such as ending lactation and funeral planning.  Grief counseling and referral to a SIDS support group should be offered.  Parents should be counseled that the risk of future children dying from SIDS is not increased First Candle has bilingual crisis counselors available 24 hours a day, 7 days a week. Call toll free at (800) 221-7437 American SIDS Institute Phone: 239-431-5425 Fax: 239-431-5536Autopsy should be done quickly. As soon as the preliminary results are known(usually within 12 h), they should be communicated to the parents.
    15. 15.  Educate patients in family practice  Ask about sleeping on back at EVERY pediatric visit for infants  Review modifiable risk factors for SIDS and educate about myths vs facts about SIDS CE program for SIDS risk reduction for nurses  http://www.nichd.nih.gov/SIDS/sidsnursesce.cfm
    16. 16. Myth: Babies can catch SIDS Fact: SIDS can not be caught. It is not contagious and there are not symptoms before death.Myth: Cribs cause death or SIDS Fact: Cribs do not cause SIDSMyth: Babies who sleep on their back Fact: Babies cough up or swallow fluid thatchoke on spit or vomit enters their airway. Doctors found no increase risk in choking or other problems in babies sleeping on their backs.Myth: Only white babies die of SIDS Fact: African American babies are twice as likely to die of SIDS as white babiesMyth: SIDS deaths can be prevented Fact: Although there is no way to ensure a baby will not die of SIDS, the chances can be reduced by placing babies on their backs.Myth: Shots/medications cause SIDS Fact: Shots or medications do not cause SIDS. All babies should be seen for well-baby checkups and receive shots on-time.Myth: SIDS can occur at any age Fact: SIDS is the unexplained death of a baby younger than 1. Most deaths occur between 2 and 4 months of age. The number of deaths drop significantly after 6 months of age.
    17. 17. 3 month old male infant found dead after being placed in prone position.
    18. 18.  Centers for Disease Control and Prevention (2012). Sudden infant death syndrome and vaccines. Retrieved from http://www.cdc.gov/vaccinesafety/Concerns/sids_faq.html. First Candle (2012). First Candle. Retrieved from http://www.firstcandle.org. National Institute of Child Health and Human Development (2012). Safe to Sleep public education campaign. Retrieved from http://www.nichd.nih.gov/sids. Task Force on Sudden Infant Death Syndrome (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030- 1039. Task Force on Sudden Infant Death Syndrome (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245-1255.

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