SUDDEN UNEXPECTED DEATH OF AN INFANT (SUDI)

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Fig : Ref (1)

Losing the one whom we love to the extreme levels is one of the major distresses what we often face. One's situation becomes more complicated and emotional when a small child dies in front of his mother's eyes that too suddenly and unexpectedly. Then just think what the position of his mom and dad is. So, one must know regarding this.
Sudden unexpected death of an infant is the death of any infant, which is unexpected and the reason for the death is initially unexplained (2). Generally a medical examiner determines the cause of death after a thorough investigation and autopsy. Deaths, which can be attributed to identifiable causes and deaths for which the cause remains unexplained both comes under "sudden unexpected death in infancy" (SUDI). (3)
Deaths, which remain unexplained, are known as sudden infant death syndrome (SIDS) which generally occurs under the age of 1 year.SIDS is one kind of Sudden Unexpected Infant Death (SUDI). In the United States, major cause of death in infants is SIDS occurs between the ages of 1 month to 1 year particularly between the ages of 2 to 4 months.Causes of SIDS remain unexplained but SIDS is not contagious and not caused due to suffocation, vomiting, choking or due to minor illness like cold, infection. In a study of the various causes of sudden unexpected death in infancy (SUDI), it is found that the most common reason for SUDI are infection in 7.1% followed by cardiovascular anomaly 2.7%, child abuse 2.6%, and metabolic or genetic disorders 2.1% out of 623 cases. Cardiovascular defects and serious infections are easier to diagnose than the many inherited metabolic disorders at necropsy. In a few specialists' centers, the inherited metabolic disorders (IMDS) and other genetic disorders are under diagnosed as a cause of SUDI. Most IMDS are resulted by single gene defect, which resulting in the deficiency of a specific enzyme. For example the first inherited metabolic disorder to be recognized is fatty acid oxidation-medium chain acyl CoA dehydrogenase (MCAD) deficiency is the cause of death in an infant in 1984. Diagnosis in vivo generally depends upon a series of complex biochemical tests on blood and other tissues. (4)
The advent of Tandem Mass Spectrometry (MS/MS) made the diagnosis of inherited metabolic disorders much easier. By using this tandem mass spectrometry we can easily identify many different metabolites in dried blood spot specimens. This new technology is fast, sensitive, reliable, and specific for the diagnosis of fat oxidation defects particularly (4). If a significant proportion of SUDI cases are truly caused by IMD, it is necessary to conduct a neonatal screening by using tandem mass spectrometry to prevent at least some of these deaths. (4)

Needed Investigations Are :( 5)
* Interpretation of findings at the scene of death
* A multiagency approach
* Medical or forensic investigation of sudden deaths in infancy

OTHER CONDITIONS THAT CONTRIBUTE TO SUDI :( 2)
1. Placing the infant on side of the mother while she is sleeping
2. When infant exposed to any tobacco smoke during and after pregnancy.
3. When the baby bundling with heavy blankets too tightly
4. Over dressing to the baby
5. Low birth weight
6. Material risk factors like :
? age of mother is less than 20 at pregnancy
? a short interval between pregnancy
? placental abnormality
? low weight gain during pregnancy etc,

SUDI RISK REDUCTION FACTORS: (2)
To reduce the risk the most important step is to provide a safe sleeping environment to the baby because every year number of infants dies while sleeping. Hence it is necessary to ensure that, sleeping baby's breathing remains clear and unobstructed. Neonatal screening is necessarily conducted to prevent SUDI, which is resulted by inherited metabolic disorders.

GUIDELINES TO PARENTS TO REDUCE RISK REGARDING SUDI: (2)
By knowing and following some simple guidelines parents can reduce the risk. Those are:
? By placing the babies on their back to sleep. Side sleeping is not safe and hence it is not advised.
? The bed room temperature must be kept comfortable to the baby.
? Do not bundle the baby too tightly in heavy blankets. If blanket is used it should not cover the head and face of the baby.
? It is necessary to maintain a smoke free environment around the baby.
? Never let a baby fall asleep with persons who is smoking, has taken medication, alcohol or substances which cause drowsiness.
? Alter the head position that is placing the baby head position to one side for one week and change the position next week to the other side for reduce the risk of developing flat area on the back of the head.
? The American academy of pediatrics suggests that babies be offered a pacifier at nap time and bed time and the pacifier must be regularly cleaned.


References:

1. (Accessed on June 20, 2010) http://dr-is-in.com/2009/07/23/complicated-grief/

2. (Accessed on June 22, 2010) http://healthvermont.gov/family/SUDI/index.aspx

3. (Accessed on June 21, 2010) http://www.iom.edu/Reports/2003/Immunization-Safety-Review-Vaccinations-...

4. (Accessed on June 21, 2010) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770550/

5. (Accessed on June 24, 2010) http://www.bmj.com/cgi/content/extract/328/7435/331

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Comments

Prof. J. Vijaya Ratna's picture

Dear Sowjanya This focus is rightly placed. The loss of a baby can be infinitely painful. We must take all precautions to prevent such losses. In Indian culture there are mountain high extent of rules and traditions and sentiments and all are aimed at protecting infant and lactating mother. There are many differences between how the westerners see this and how we see this. In India you will not find a young mother sleeping away from her baby. Babies sleep with mothers and accidents do not happen. Stories abound in our culture about how only a mother can protect a child where even GODS cannot do so. We don't go by the rule book method. But we protect our babies. All things are not found in research papers. But your focus is on the right issue and i appreciate it. Vijaya Ratna
Sirisha Pingali's picture

dear sowjanya.. Amazing blog from your side. Your blog shows the significance of neonatal care..I didnt get the first point in "Other conditions leading to SUDI"

Sirisha Pingali

http://www.pharmainfo.net/sirisha

Viswanadha Institute of Pharmaceutical Sciences.

www.vnips.edu.in

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