An autopsy is performed on an 11-week-old girl after the mother found the infant unresponsive in her bassinet after a nap. The parents had placed her on her side with a pacifier and without any loose bedding or items in the bassinet prior to the nap. The infant had a normal examination with appropriate weight gain at a well-child visit 3 weeks ago; she received vaccinations at that time including DTaP. After vaccination, she cried uncontrollably for an hour. The infant also recently had congestion, rhinorrhea, and fever for 3 days but had no symptoms for the past week. She was born at term via an uncomplicated spontaneous vaginal delivery. Birth weight was appropriate for gestational age. The infant lived at home with her parents and older brother, all of whom shared a room in a 1-bedroom apartment. The autopsy is inconclusive. Which of the following is a risk factor associated with this infant's cause of death?

Question

An autopsy is performed on an 11-week-old girl after the mother found the infant unresponsive in her bassinet after a nap.  The parents had placed her on her side with a pacifier and without any loose bedding or items in the bassinet prior to the nap.  The infant had a normal examination with appropriate weight gain at a well-child visit 3 weeks ago; she received vaccinations at that time including DTaP.  After vaccination, she cried uncontrollably for an hour.  The infant also recently had congestion, rhinorrhea, and fever for 3 days but had no symptoms for the past week.  She was born at term via an uncomplicated spontaneous vaginal delivery.  Birth weight was appropriate for gestational age.  The infant lived at home with her parents and older brother, all of whom shared a room in a 1-bedroom apartment.  The autopsy is inconclusive.  Which of the following is a risk factor associated with this infant's cause of death?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d691_5bd3_bc81_bd6139f622f5_MD0003_00 This infant's sudden, unexplained death with an inconclusive postmortem examination is consistent with sudden infant death syndrome (SIDS). Pathogenesis is thought to involve an underlying susceptibility (eg, delayed brain maturation) in some infants that results in impaired CNS arousal responses to hypoxia and hypercarbia (eg, airway obstruction). The peak age of affected infants is age 2-4 months, but SIDS can occur until age 12 months. Risk factors for SIDS include the following: Nonmodifiable: prematurity, low birth weight, young maternal age (<20 years) Modifiable: smoke exposure, unsafe sleep environment Factors related to sleep environment that increase the risk of SIDS include prone-sleep or side-sleep positioning. Prone-sleep positioning is associated with increased sleep duration and decreased arousal in infants. Side-sleep positioning is a less significant risk factor but should be avoided due to an increased ability to roll into the prone position. Infants should instead always be placed in a supine position for sleep. Notably, once an infant consistently and purposefully rolls over from prone to supine and vice versa (typically age 4-6 months), arms should be unswaddled and the infant should be allowed to roll into his/her preferred position for sleep, even if prone. supine position for sleep Other sleep environment-related risk factors include soft or inclined sleep surfaces, crib bumpers, and loose crib items (eg, blanket, stuffed animal). In addition, bed-sharing with parents and/or siblings should be avoided, particularly in the setting of substance (eg, alcohol, illicit drugs) use that may impair alertness; room-sharing with separate sleep surfaces, in contrast, is protective of SIDS (Choice D). (Choice B) Common adverse effects of infant vaccination include local reactions and systemic symptoms (eg, fever, irritability); less common reactions include syncope, inconsolable crying (as seen in this infant), and febrile seizure. Risk of SIDS is not associated with vaccination or increased in patients who have adverse reactions. (Choice C) Intercurrent illness prior to death has been associated with SIDS. In contrast, this infant was well at the time of death with a resolved illness the week prior, making this association an unlikely contributing factor. (Choice E) Pacifier use during sleep is associated with a decreased risk of SIDS. The mechanism is unclear but may relate to easier arousability from sleep while using a pacifier. Educational objective: Modifiable risk factors for sudden infant death syndrome include unsafe sleep environments, such as prone- or side-sleep positioning, soft/inclined sleep surfaces, crib bumpers, loose bedding, and bed-sharing. References: SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. (http://www.ncbi.nlm.nih.gov/pubmed/27940805)

An Autopsy Is Performed on an 11-Week-Old Girl After the Mother