SIDS-More Data, but Still No Cure
ABSTRACT & COMMENTARY
Source: Kohlendorfer U, et al. Sudden infant death syndrome: Risk factor profiles for distinct subgroups. Am J Epidemiol 1998;147:960-968.
Sudden infant death syndrome (sids) is the most common cause of death in children 1 month to 1 year of age and, likely, is a multifactorial syndrome involving both prenatal and postnatal factors. Kohlendorfer and colleagues used a case-control format to study risk profiles of SIDS victims as a function of age of death. Ninety-nine Austrian infants who died from SIDS between 1984 and 1994 were compared to 136 non-SIDS controls. Bimodal distribution of age of death was demonstrated, with early and late SIDS being defined as younger than 120 days of age and older than 120 days of age, respectively.
Both SIDS groups were found to have significantly less antenatal care, lower parental socioeconomic and educational status, and greater likelihood of prone sleeping position than case controls. Significant risk factors determined solely in the early SIDS group included gestational age younger than 37 weeks, birth weight less than 2500 g, positive family history of SIDS, and maternal smoking. Winter preponderance was more common only in the late SIDS cohort. As such, Kohlendorfer et al have identified two age-related subgroups of SIDS with different risk profiles. They emphasize the multifactorial nature of the syndrome and the differing effects of these factors based upon infant age.
COMMENT BY FREDERIC KAUFFMAN, MD
SIDS remains, for all practitioners of emergency medicine and pediatrics, one of the most devastating and perplexing syndromes in clinical medicine. By its nature and definition, the death of the child is unexpected, and autopsy fails to reveal an adequate cause of death. It strikes suddenly and unexpectedly, though a multitude of risk factors have been identified (See Table). Much is known about SIDS, and, yet, it remains a syndrome about which all-too-little can be done. However, an intimate knowledge of potentially correctable risk factors is helpful for the emergency physician so that parental education can be undertaken when children younger than 1 year of age or expecting parents are seen in the ED for any reason. Such education costs nothing other than a little time and can have significant impact. In addition, emergency physicians need to be knowledgeable in the recommended evaluation and management of children who present with an apparent life-threatening event (ALTE) and in the counseling of parents and family members who have suffered a SIDS death. Research continues and, like many things in medicine with few absolute answers, SIDS may ultimately prove to be more than one specific syndrome. Kohlendorfer et al have added one more piece to the overwhelming puzzle of SIDS, and they add credence to the theory that many genetic and environmental factors may play important roles in this devastating disorder.
Table
Risk Factors for SIDS1
Male gender
Autumn and winter seasons
More than one SIDS sibling
Prematurity and low birth weight
Prone sleeping position
Maternal smoking during pregnancy
Young maternal age
Reference
1. Lazoff M, Kauffman F. Sudden infant death syndrome-Part III: Emergency department approach. Acad Emerg Med 1995;2:1077-1080.
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