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Brief resolved unexplained events (BRUE) / SIDS - Coggle Diagram
Brief resolved unexplained
events (BRUE) / SIDS
SUDI
risk of death x4 greater in infancy than @ any other age in childhood
= sudden unexpected death in infancy
in some a previously undiagnosed congenital abnormality will be found @ autopsy, or a metabolic disorder dxed (e.g. MCAD deficiency)
if no cause identified = SIDS (sudden infant death syndrome)
usually natural causes, rarely suffocation or non-accidental injury
management
retain child's clothes, bedding, nappy for police
NP aspirate for bacteriology + virology
blood - tox, metabolic screen, chromos, culture
urine - biochem, tox
CSF - culture + virology
postmortem
MDM
consider neglect/abuse
consider implications for future pregnancies - genetic counselling
bereavement counselling
BRUE
infant under 1 stops breathing, has a change in muscle tone, turns pale or blue in color, or is unresponsive
Event occurs suddenly, lasts < 30-60 s, + is frightening to the person caring for the infant
present only when there is no explanation for the event after a thorough history + exam
aka apparent life-threatening event (ALTE)
combo of apnoea, colour change, alteration in muscle tone, choking or gagging
most common in infants under 10wks
may occur on multiple ocassions
may indicate potentially serious disorder, although often no cause IDed
do detailed hx + thorough exam
infant should be admitted to hosp
multi-channel overnight monitoring usually indicated
usually brief with rapid recovery, baby clinically well
do overnight monitoring - O2 sats, respiration, ECG
parents should be taught resus
Causes
infections (RSV, pertussis)
seizures
reflux
upper airways obstruction (natural or imposed)
arrythmia
breath holding
anaemia
heavy wrapping/heat stress
central hypoventilation syndrome (sleep-related breathing disorder, congenital or acquired)
intrapulmonary shunting (pul oedema, pneumonia)
consider these investigations
blood glucose
blood gas
o2 sats
CR monitoring
EEG
oeso pH monitoring
barium swallow
FBC
U+E
LFTs
lactate
urine - metabolic studies, M C+S, tox
ECG
CXR
LP
SIDS
no adequate cause found after thorough post mortem
variation in incidence in different countries, suggesting environmental factors are important
most commonly @ 2-4 mo old
risk for subsequent children slightly increased
incidence fallen dramatically since "Back to Sleep" campaign
infants should be put to sleep on back, feet to foot position
overheating by heavy wrapping/high room temp should be avoided
seek medical advice promptly if infant becomes unwell
parents should have baby in bedroom for first 6mo of life
don't bring baby into bed with them if they are tired/ have had alcohol/drugs/sedative meds
don't sleep with infant on sofa, settee or armchair
risk factors
infant
1-6 mo old, peak = 12wks
LBW + preterm (but 60% are normal BW term infants)
boys (60:40)
multiple births
parents
low income
poor/overcrowded housing
maternal age <20 (although 80% >20)
single unsupported mother
high maternal parity
maternal smoking during pregnancy
parental smoking after baby's birth (do not smoke in same room)
environment
sleeps prone
overheated
commonest cause of death in children ages 1mo-1yr