SIDS and RSV

1. SIDS and RSV

2. Sudden Infant Death Syndrome Ricci, p. 1439, 1928

3. Incidence and Etiology • Unexpected death of a previously healthy infant that remains unexplained after autopsy, investigation of scene, and thorough history—not predicted by apnea • Third leading cause of death between one month and one year and leading cause of cardiopulmonary arrest. • Most are non-white males between 2 and 3 mos of age of lower socioeconomics • May have genetic disposition

4. Pathophysiology • Autopsy shows pulmonary edema and intrathoracic hemorrhages—confirms dx • Thought to be a brainstem abnormality in the cardiorespiratory center • Abnormality is manifested by unresponsiveness to rising levels of carbon dioxide

5. Risk Factors • Maternal smoking • Maternal age • Poor prenatal care • Co-sleeping • Suffocation hazards (soft bedding or surfaces, “overlaying”) • Overheating • Prone position

6. Immediate Care • Compassion is paramount—no accusations or suggestion of wrongdoing. • Just collect factual info and talk about need for autopsy • Allow parents to spend time with infant • Provide support for grieving • Understand the additional stress of guilt

7. Care After Death • Visit or arrange for a professional to visit the family at home • Provide information on SIDS and answer questions • Be supportive and compassionate—allow parents to ventilate feelings • Refer to support group if indicated • Give online info for support (Box 40.4)

8. Teaching • Risk of prone and side-lying during sleep, smoking, co-sleeping, bedding, overheating • Importance of good and early prenatal care • Breastfeeding and pacifiers • How to decrease risk of plagiocephaly—headgear, special pillows, changing positions • Teach parents and other caregivers including day care workers. • CPR

9. Respiratory Syncytial Virus Ricci, pp. 1412-1414

10. RSV • Also known as bronchiolitis • Highly contagious, acute inflammation of bronchioles and small bronchi; seasonal • Viral caused by adenvirus, influenza, and meta-pneumovirus • Usually occurs around 6 mos old and is most severe in younger children

11. Etiology and Pathophysiology • Transmitted into nasopharynx thru direct contact with articles or surfaces contaminated with the virus • Spreads to lower airways • Destroys respiratory epithelium • Causes plugging by mucus and exudate with resulting obstruction • Allows inspiration but not expiration, thereby causing hyperinflation and atelectasis, poor gas x-change, and hypoventilation.

12. Risk Factors • Young male • Prematurity • Multiple birth • Born between April and September (peak season) • Comorbid conditions of respiratory, cardiac, or immune systems • Tobacco smoke • Crowded conditions • Low socioeconomic status • Lack of breastfeeding

13. Manifestations • Profuse clear runny nose • Pharyngitis • Low grade fever • Cough, wheeze • Poor feeding, listless, uninterested • Air hunger, respiratory distress with grunting, nasal flaring, retractions

14. Diagnostics • Abnormal pulse ox, blood gases • CXR—hyperinflation with atelectasis, possible infiltration • Nasal-pharyngeal washings or nasal culture positive for RSV • + ELISA, + IFA

15. Management • Close observation; HOB up; frequent VS. Slowing of respiratory rate could mean infant is getting tired, not getting better. • Contact precautions • Oxygen support • Suctioning • Hydration • Antipyretics—no antibiotics • May be managed at home, but severe cases with respiratory distress need hospitalization. • Deterioration requires ventilatory support

16. Parent Education • If managing at home, teach parent to watch for signs of increasing respiratory distress • Cough may persist for weeks after acute stage is over • Handwashing at home and day care • Palivizumab IM qmo thruout season for those highly susceptible with comorbid conditions or prematurity • Influenza vaccine also recommended