Sudden Infant Death Syndrome: A Review

Abstract

Sudden infant death syndrome (SIDS) is the sudden unexpected death of an apparently healthy infant younger than age 12 months whose cause of death remains unknown despite a thorough death scene investigation, a review of the clinical history, and an autopsy. Despite the huge achievement of the Back to Sleep program, SIDS remains one of the leading causes of infant death in the United States. In recent years, the SIDS rate has remained stationary despite major public health efforts aimed at high-risk groups to improve sleep environment and strategies. This review focuses on SIDS epidemiology, pathogenesis and risk factors, the American Academy of Pediatrics recommendations on safe infant sleeping environment, and the US Centers for Disease Control and Prevention's multistate registry to improve knowledge on SIDS, evaluate trends, and analyze circumstances and events surrounding SIDS cases. [Pediatr Ann. 2018;47(3):e118-e123.].

Risk Factors for Sudden Infant Death Syndrome and Sleeping Practices in Korea

“…An infant's vulnerability to SIDS results from factors including, but not limited to, health problems and ethnic or genetic characteristics. Health-related SIDS risk factors include PTB, being 6 months of age or younger (peak at 2~4 months), low birth weight, a low Apgar score at birth, exposure to smoking and alcohol, cardiac arrhythmia, and recent viral infections [15]. Each of these factors has a different mechanism, but they are intertwined and are exacerbated by infants' immature immunity and poor physiological regulation.…”

“…When an infant born at 32 weeks turns 6 months old, his or her actual corrected age is 4.0 months, which overlaps with the critical period of 2~4 months of age in SIDS risk models. Furthermore, mothers' direct and indirect exposure to smoking and alcohol before, during, and after pregnancy needs to be assessed because these are well-known risk factors of PTB, infant health problems, and SIDS separately and in combination [8,15]. Recent Korean birth statistics have indicated rapid increases in PTB, by 7.6%p in 2018, a twofold increase compared to a decade ago [17].…”

“…A defining factor of SIDS is that it occurs during sleep. Well-known risk factors related to sleeping practices include prone and lateral positions, co-bedding, and the improper use of bed sheets or supplementary sheets, cloth, swaddling, and mattresses [15]. It is important to seriously consider whether these factors are real contributors to SIDS, and if so, through which mechanisms.…”

“…The prone position is known to be associated with SIDS, particularly when soft bedding is used, as it increases the likelihood of suffocation in infants who cannot easily lift their head or change their position to avoid air pockets where carbon dioxide is concentrated in the hollows of soft bedding or other comforters around them [8,15]. As well, the prone position may restrict the movement of the arms and legs, making https://doi.org/10.4094/chnr.2020.26.1.82…”

“…The improper use of bedding materials, such as sheets or pillows, may block an infant's breathing, increasing the risk of suffocation or asphyxia as an independent risk factor or in addition to the infant's inability to change his or her head or body position during sleep [8,14,15]. Furthermore, because pillow usage for infants is much more popular in Asian cultures than in Western societies [19], it may be difficult to distinguish unintentional suffocation from SIDS unless the SIDS criteria are satisfied.…”