I used to work as a primary care physician in a small hospital at my place. I can vividly recall one early morning at around 6 o’clock, I was called by the nurse on duty to see an infant brought in by the mother. I rushed to the emergency room and saw a lifeless two-month old baby, bluish in color and seemed to be dead for several hours already. The mother told me that the baby was apparently healthy. She remembered putting the baby to sleep after breastfeeding that night with no unusual symptoms at all. The father claimed that when he woke up at 2 o’clock in the morning to drink a glass of water, he still saw the baby alive. The couple had been living in a small room and sharing the same bed with their 2 month old baby and another son. There were no untoward incidents that evening except that there was a blackout in the area and their electric fan was turned off, reducing the air circulation. Upon post-mortem examination, the baby had normal built with no indication of malnutrition. There were neither signs of trauma nor any lesions implicating possible diseases afflicting the infant. After eliminating the possibilities, I could only think of one primary culprit: Sudden Infant Death Syndrome (SIDS). 

Sudden Infant Death Syndrome (SIDS) is marked by symptoms of sudden and unexplained death of an apparently healthy infant aging from one month to one year that cannot be explained after a thorough investigation is conducted including complete autopsy, examination of death scene, and review of the clinical history. In United Kingdom, Australia, and New Zealand, this is known as cot death, while crib death is oftentimes used in North America. Typically, the infant is found dead after having been put to bed and showed no signs of having suffered in any form.

Sudden Infant Death Syndrome (SIDS) is the third leading cause overall of infant mortality in the United States. The overall rate of SIDS in the US has declined by more than 50% since 1990. But preventing SIDS remains one of the top public health priorities.

Very little is known about the possible causes of SIDS. Some studies look into the possibility of gene alteration (SIDS gene) predisposing an infant to SIDS. Other researchers who studied the brains of infants who died of SIDS discovered abnormalities in the part of the brain called medulla oblongata which helps control functions like breathing, blood pressure and arousal. Others also implicated the role of bacterial infections.

 SIDS cannot completely be prevented. However parents are advised to do several precautions in order to decrease the likelihood of SIDS. Current recommendations include placing the infant on its back to sleep on a firm, tight-fitting mattress in a crib; removing pillows, comforters, bumper pads, stuffed toys and other soft items from the crib; using a sleeper or sleepsack (“baby sleep bag”) as an alternative to blankets; and making sure that the infant’s head in uncovered. Sleeping on the back has been recommended by the American Academy of Pediatrics. This method supports the idea that small infants with little or no control of their head, while face down, may inhale their exhaled breath which is high in carbon dioxide. Other precautions include avoiding the infant from secondhand smoke, avoiding bed sharing with the infant, and considering the use of pacifiers.

A recent study revealed that using a fan in the room seemed to lower the risk of SIDS.  Fan use during sleep was associated with a 72% reduction in SIDS risk. The mechanism suggested is that increasing the movement of air near the sleeping infant could significantly decrease accumulation of carbon dioxide, thereby lowering the risk of rebreathing.

SIDS can strike infants without warning, especially if parents are not watchful enough to avoid risks associated with it. That’s why parents should make all the necessary measures to avoid this common tragedy from happening to their infants. This silent killer is still out there.

References:

1) Sudden Infant Death Syndrome. http://en.wikipedia.org/wiki/Sudden_infant_death_syndrome
2) Sudden Infant Death Syndrome (SIDS). Department of Health and Human 
      Resources. Center for disease Control and Prevention. 
      http://www.cdc.gov/SIDS/index.htm
3) Patrick L Carolan, MD; Sudden Infant Death Syndrome. 
      http://www.emedicine.com/ped/TOPIC2171.HTM#Multimediamedia4
4) Laurie Barclay, MD; Head Covering During Sleep May Increase Risk for Sudden
      Infant Death Syndrome. http://www.medscape.com/viewarticle/575666
5) Laurie Barclay, MD; Using a Fan During Sleep May Help Prevent Sudden Infant 
      Death Syndrome. http://www.medscape.com/viewarticle/581570
6) Opdal SH; Rognum TO; The sudden infant death syndrome gene: does it exist?. Institute of Forensic Medicine, University of Oslo, Rikshospitalet University Hospital, Oslo, Norway. Pediatrics.  2004; 114(4):e506-12 (ISSN: 1098-4275)