Aspiration of Gastric Contents in Sudden Infant Death Syndrome without Cardiopulmonary Resuscitation

doi:10.1016/j.jpeds.2006.12.012

The Journal of Pediatrics

Volume 150, Issue 3, March 2007, Pages 241-246

https://doi.org/10.1016/j.jpeds.2006.12.012 Get rights and content

Objectives

(1) To compare demographic profiles among sudden infant death syndrome (SIDS) infants with or without gastric aspiration, for whom cardiopulmonary resuscitation (CPR) had not been attempted; (2) to review the severity and potential significance of aspiration in those SIDS cases; and (3) to assess the risk of supine sleep position with regard to gastric aspiration.

Study design

Retrospective review of records and microscopic slides for all postneonatal SIDS cases (29 to 365 days of age) accessioned by the San Diego County Medical Examiner from 1991 to 2004.

Results

Ten (14%) of 69 cases of SIDS infants who had not undergone CPR before autopsy revealed microscopic evidence of gastric aspiration into the distal lung; this group was not otherwise clinically or pathologically different from cases of SIDS infants without aspiration. Similar proportions of infants were found supine or prone, regardless of gastric aspiration.

Conclusions

Gastric aspiration is not uncommon in infants dying of SIDS, and supine sleep position does not increase its risk. Gastric aspiration may be a terminal event that some infants, representing a subset of SIDS cases, cannot overcome.

Section snippets

Methods

The Rady Children’s Hospital-Health Center Institutional Review Board approved this study. A search of the records of all postneonatal infants (29-365 days of age) dying suddenly and unexpectedly who were autopsied at the Medical Examiner’s Office in San Diego County, California, between January 1, 1991 and December 31, 2004 and accessioned into the San Diego SIDS Research Project database at Children’s Hospital-San Diego revealed 69 cases of infants who had a diagnosis of SIDS and had not

Results

Group I (SIDS cases with aspiration) includes 10 (14%) of the 69 cases. No demographic findings were significantly different between the two groups (Table I). The majority of infants in both groups were male, born term, delivered vaginally, and fed formula as their last meal. None of the infants who were breast-fed for their last meal had evidence of gastric aspiration. Clinically documented gastroesophageal reflux (GER) was more common in cases with aspiration (20% vs 2%); a history of apnea

Discussion

Prone sleep position has been long recognized as one of the most important risk factors for SIDS.6, 7, 8, 9, 10 Adoption of the supine sleep position as recommended in the Back to Sleep campaign and other similar public education programs has resulted in a dramatic reduction in the incidence of SIDS.9, 11, 12 However, some segments of the population have not followed the supine sleep recommendation, causing disparities in the decreasing rates of SIDS.13, 14, 15, 16 Fear of gastric aspiration

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Citation Excerpt :
Cruz et al. [25] support tracheotomy as the method of airway intervention which will completely resolve significant obstruction while causing the least disruption to oro-motor mechanics, thereby enhancing the child's potential to overcome feeding difficulties. Our finding that GER is significantly related to penetration is well supported by the literature [9,26–29]. Many children who are at risk for aspiration undergo surgical intervention, such as a fundoplication, to reduce their chances of aspiration pneumonia.
(1) Determine the relationships among a family's specific answers to health history questions and their child's risk for aspiration as determined by a swallow study. (2) Identify key factors which may predict a child's risk for aspiration.
Answers to questions and results of Functional Endoscopic Evaluation of Swallow (FEES) and/or Video Swallow Study (VSS) for a sample of 198 children were collected. Subjects were categorized into groups: “aspiration”, “penetration” or “no aspiration or penetration”. Logistic regression modeling was used to determine the contribution of certain characteristics to the odds of aspiration. A model for predicting aspiration or penetration based on those characteristics was assessed. The sensitivity and specificity of the model in predicting aspiration and penetration was determined.
One hundred ninety eight subjects had a FEES or VSS. Of these, 18% (n = 36) aspirated and 21% (n = 42) were found to have penetration. Many of the factors identified in the health history were found to be significantly associated with aspiration or penetration. The variables “demonstrated aspiration” (this included parent or caregiver seeing food in the tracheotomy tube or aspiration noted on a previous FEES or VSS) (p = 0.02), “hypotonia” (p = 0.02) and “tracheotomy” (p = 0.001) were most predictive of aspiration. History of tracheotomy was found to have an inverse relationship with aspiration. “gastroesophageal reflux” (GER) (p = 0.0007) was most significantly associated with penetration, followed by “prematurity” (p = 0.03) and “developmental delays” (p = 0.04). Based on the prediction model, the probabilities for a child with a history of combinations of the above variables to have aspiration or penetration were calculated.
Significant relationships exist between aspiration or penetration and the family's answers about their child's medical history. Practitioners should consider a swallow assessment whenever a child has a history which includes variables with a strong association with aspiration or penetration.
Changes in infant sleeping position after an educational intervention in a university general hospital during a ten year follow up
2008, Anales de Pediatria
La posición en decúbito prono al dormir se ha identificado como el principal factor de riesgo para el síndrome de muerte súbita del lactante (SMSL).
Conocer los cambios en la prevalencia de la posición al dormir en lactantes de hasta 6 meses en un período de 10 años, durante los cuales se realizó una intervención educativa para modificar los factores de riesgo del SMSL en un hospital general universitario.
Estudio prospectivo y analítico. Se definió como posición recomendada (PR) el decúbito supino y/o lateral y como posición no recomendada (PNR) el decúbito prono y/o indiferente.
Las pruebas de chi al cuadrado de tendencia y chi al cuadrado se consideraron significativas con un valor de p menor de 0,05.
Se obtuvieron 100 encuestas en los años 1996, 1998-2001, 2004 y 2006. El porcentaje de madres que colocaron a sus hijos en la PR a dormir fue del 49 % en el año 1996 frente al 90 % en el año 2006 (p = 0,0001). Se dividió en dos intervalos de tiempo el cumplimiento de la PR: 1996-1998 (59 %) y 1999-2006 (88 %), p = 0,0002.
La prevalencia de lactantes acostados en decúbito prono fue disminuyendo sustancialmente en la población estudiada. Sin embargo, a partir de 1999 no hubo una mejoría significativa en el cumplimiento de la PR y sólo en los años 1999 y 2004 la prevalencia de la posición en decúbito prono durante el sueño incluyó a menos del 10 % de los lactantes, que es el objetivo propuesto en los países desarrollados.
The prone sleeping position has been identified as the main risk factor for the sudden infant death syndrome (SIDS).
The aim was to asses the prevalence of the different sleeping positions of infants, between 1 and 6 months, who attended the immunizations office of the “Hospital Italiano de Buenos Aires” during a ten year period. During this time an important educational intervention, called “Project Link” was developed.
An analytical, prospective study was developed. The recommended position (RP) was the supine position,as well as the side position, to place infants to sleep. Mothers were advised to avoid the prone position or a non-recommended position (NRP).
A hundred completed questionnaires were obtained each year in 1996, 1998-2001, 2004 and 2006. The percentage of mothers who placed their infants in sleep supine was 49 % in 1996 vs. 90 % in 2006 (p = 0.0001). The accomplishment of the RP was divided in two periods: 1996-1998 (59 %) and 1999-2006 (88 %), p = 0.0002.
The prevalence of the infant prone sleeping position reduced gradually in the studied population. Nevertheless, it is imperative to emphasize the benefits of the RP, because only during 1999 and 2004 was the percentage of prone position less than 10 %, as in developed countries.
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: Grant support from the CJ Foundation for SIDS and First Candle/SIDS Alliance. Donations from the San Diego Guild for Infant Survival, the Orange County Guild for Infant Survival, and the San Diego SIDS/SUDC Research Project.

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Original articleAspiration of Gastric Contents in Sudden Infant Death Syndrome without Cardiopulmonary Resuscitation

Objectives

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr

Forensic Sci Int

Frequency and type of aspiration in cases of sudden infant death (SID) in correlation with the body position at the time of discovery

J Sudden Infant Death Syndrome Infant Mortality

Gastric aspiration and sleeping position in infancy and early childhood

J Paediatr Child Health

The impact of attempted resuscitation in SIDS: postmortem findings

Aspiration of food and vomit

Q J Med

Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach

Pediatrics

Results from the first year of the New Zealand cot death study

N Z Med J

Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study

BMJ

Changing epidemiology

Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the “Back to Sleep” program

Pediatrics

The decline of SIDS: a success story for epidemiology

Epidemiology

Infant sleep position practices 2 years into the “back to sleep” campaign

Clin Pediatr (Phila)

Prevalence and predictors of the prone sleep position among inner-city infants

JAMA

Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development

Pediatr Pathol

Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study

JAMA

Factors associated with caregivers’ choice of infant sleep position, 1994-1998: the National Infant Sleep Position Study

JAMA

Sleeping position, infant apnea, and cyanosis: a population-based study

Pediatrics

Original article
Aspiration of Gastric Contents in Sudden Infant Death Syndrome without Cardiopulmonary Resuscitation