One of the most tragic for a young family, where the recently born baby, may be the syndrome “death in the crib,” or SIDS (sudden infant death syndrome) baby. Such term in Pediatrics is called the deaths from unknown causes of relatively healthy children under one year of age. Death occurs due to interruption of the heart or respiratory centre, while obvious reasons for the autopsy to detect the experts it is not possible. In fact it is a causeless death of a child in a dream.
The study of this problem is not one year, and although the exact cause of this phenomenon is not clear, today put forward the basic of the leading causes and selected certain influence, which can act as provocateurs of this disease. In connection with this phenomenon, parents need to be vigilant at an early age the crumbs constantly monitoring his condition.
What is the sudden infant death syndrome
This syndrome refers to the disease is the death certificate given by a coroner after the autopsy, when neither the study results nor any data in the medical record the crumbs do not give obvious reasons for the deaths.
This condition does not, if the autopsy was discovered malformations, informed not show (and affecting the heart and breathing), or if the death occurred for reasons of accidents.
SIDS is not a new condition, the sudden death of infants was recorded from antiquity, but even today, the explanation for this sad phenomenon has not been found, and leading specialists around the world are actively studying this fact, attempting explanations of lethal changes. SIDS statistics are not typical for children of Asian origin, and among European children die twice as often than among Indian and African families.
Characteristics of SIDS babies
According to doctors, most often SIDS occurs during sleep of the baby, and before the death there were no alarming symptoms or diseases, such cases are noted with a frequency of up to 6 children per 1000 births.
According to post-mortem changes and retrospective analyses have identified certain patterns of tragic events. So, most often susceptible to SIDS children up to six months, the critical period is the age from the second to the fourth month of life. And is dominated by scenes of death during a cold period, with a peak attributable to the January-February, but according to date, this regularity can be traced not so clearly.
Up to 60% of children who are victims of SIDS are male, but to predict this is impossible, as well as prevented by any treatment. SIDS itself is not connected with the carrying out child immunizations and other medical procedures. One of the leading risk factors for such tragedies, doctors consider the state of prematurity and immaturity.
How is such a diagnosis?
That is the medical term SIDS introduced into the practice of Pediatrics in the 60-ies of the last century, but previously had been describing similar episodes. By the mid 90-ies of the first physicians of Europe and America, and then around the world began a proactive campaign to prevent similar tragedies. But today, such a diagnosis is made by exclusion on postmortem examination, when fully found no evidence of any painful causes.
Although children and adapted to life in a new environment, and have a high capacity to adapt to at an early age, but, nevertheless, they can sometimes die from the action of the critical external changes or internal processes (malformations of organs and systems, injuries – both intentional and unintentional, infection, tumor growth).
Often outwardly of the reasons for the death, but according to the analysis of medical records and the autopsy revealed a previously unreported problems and pathology. But if no changes of the body no, in this case the death happened in a dream, and the children were quite healthy, is SIDS.
A critical age for the development of sudden infant death syndrome
Retrospectively studying and analyzing hundreds of stories of SIDS, experts have come to certain conclusions about the age, the most dangerous for the death of “Cribs“.
So, noted these facts:
- The development of SIDS is not typical for the first month of life,
- Most often, the death occurs within 2 to 4 months after birth
- The most critical is considered the 13th week of life,
- Up to 90% of cot deaths, innocent deaths occur in the first half of life,
- After a year the episodes of SIDS is extremely rare, although completely it cannot be ruled out.
In the literature there are descriptions of sudden death in children of preschool and school age and in adolescence, especially against the background of sport and physical activity and complete rest and even during sleep.
Probable mechanisms for the development of the syndrome
Although it is the whole mechanism of this condition has not been studied, but scientists assumed certain steps in the formation of SIDS. So, for death in the cradle at the same time it was a combination of certain genetic characteristics (heredity), on the background of the critical age and the influence of external adverse factors.
Children who are placed to sleep on a soft bed, with lack of oxygen (acute hypoxia) instantly awaken to the change posture or give signals to parents, crying or groaning. If for any reason these mechanisms are not working, and reflexes protection is not included, then the baby can bury your face into the fabric, which leads to lower blood oxygen level and a sharp increase of CO2 level. This leads to a condition initially oppression and then suppress the consciousness, until the complete stop of breathing and cardiac activity.
The baby will breathe as long as the CO2 level reaches the critical limits, when there will be a blackout of consciousness. If at this point not to stir – it’s death. Accordingly, all factors that lead to hypoxia, as the ambient air, and those that affect the mechanism of respiration and reflex activity, dangerous in terms of SIDS.
The sudden infant death syndrome: causes and theories of development
Although it has been clarified the age of the children, in the period in which the most dangerous development of the SVDS, but the exact cause of this fact is still not revealed. However, in the course of the research, the doctors had noted some of the features of the dead from the syndrome children. So, according to the autopsy, it was revealed among all kids underdevelopment of regions of the brain in the region of the arcuate nucleus and reticular formation, as well as the stem region, where the centers – the respiratory and vasomotor. But today the syndrome is not exactly understood, there are mechanisms for the explanation and the theory of the origin, the most close to reality describing events leading to death. Discuss the most common theory.
Disorder of the functions of respiration
In the period of sleep that is characterized by periods of apnea (temporary stopping of breathing) associated with immaturity of cerebral structures regulating center of the brain stem. As a result of such delays the accumulation of CO2 in blood, with a sharp decline in O2 level that in normal conditions stimulates the center of the breath, leading to more frequent and deeper breathing crumbs. If this excitation pulse from the brain is not received, the child may die.
Because of the immaturity of the respiratory center apnea 10-15 seconds are not so rare, sometimes they say their parents, but if this appears more than once in an hour, and the periods exceed the 15 second interval, this is the occasion to appeal to doctors.
Disorders of the heart
The second most common theory is considered to be the cardiac hypothesis of SIDS associated with violations of rhythm of cuts that threatens to asystole. (cardiac arrest in the phase of relaxation). So, this is possible if the children’s heart arrhythmia with extrasystoles (extra-curricular, unnecessary abbreviations) or in the development of blockade (violation of the pulse on the branches of the nerve).
In addition, dangerous reduction of heart rate less than 70 beats per minute and irregular, floating rate. Confirmation of this theory can be detected in children who died of SIDS, specific genetic mutations, leading to changes in the structure of the special channels in cardiac muscle. It is through them and there are deadly arrhythmia.
Rhythm changes are typical for healthy children, but they have no critical stops and interruptions, the heart is stable.
Changes in brain structures
In the medulla oblongata (region of the trunk), located in the respiratory and cardiac centers, and as a result of research, scientists have identified the enzymatic defects that lead to a violation of special education mediators (substances that transmit impulses from cell to cell in the nervous system). These mediators are poorly allocated in the area of the brain stem, and they are particularly affected in the presence of passive Smoking (if the mother or father smokers). The birth of a child from a Smoking mother increases the risks of SIDS, which has been proved for a long time.
Also in some children who died from SIDS were identified as lesions of brain structures and changes in cells in the brain stem area, which was the result of fetal hypoxia. In addition, there were also noted changes in ultrasound data of the brain with abnormalities of the cerebral arteries that nourish the brain stem. This also speaks in favor of the theory of hypoxic lesions of the centres of respiration and heart.
Assume that a certain head position of the crumbs in a dream led to the clamping of the artery and insufficient development of the neck muscles would not allow him to change position and turning the head. Such skills are formed after 4 months therefore also confirms this theory.
Poor blood flow to the brain occurs when laying the children on the side, which reduces the flow of blood through the cerebral arteries to the trunk, it slows down the pulse and breathing.
Some scientists are inclined to think that SIDS is a result of the effects of stress on the body of infants, and leads to post-mortem changes of the body, which is found in all the dead children. The proof of their opinion they point to:
- Small hemorrhages (bleeding) in the region of the thymus and lung
- Defeat the outer shell of the heart,
- Stress ulceration and erosion of the digestive tract,
- Shrinkage of lymphoid elements
- The reduction in blood viscosity.
Similar phenomena are formed on the background of massive release of adrenal in the blood stress hormones – cortisol, adrenaline and noradrenaline.
According to the researchers, external manifestations such stress syndrome in children could be a manifestation of runny nose and watery eyes, changes in liver size and spleen, hypertrophy of the tonsils, weight loss or a slight rash. Such changes are typical for children 2-3 weeks before the onset of SIDS, but often they are not detected, he searched for a transient physiological phenomenon.
Theory of the influence of infectious and immune changes
For the majority of children who died unexpectedly, physicians were observed for a week or even earlier manifestation of any kind of infections, and children under the supervision of a physician could receive antibiotics. According to scientists, supporting these ideas, microbes, toxins, or certain factors leading to blocking of protective mechanisms and reflexes (awakening from sleep during hypoxia), making SIDS more likely. Most often blamed in the development of the death of the toxins of Staphylococcus aureus, which is intensified or provoked inflammatory changes in the body, and children because of their age and immaturity of the immune system is not able to protect against the suppressive effects of their reflex response.
Another group of scientists compared the presence of antibodies to pathogens in children who died from SIDS and other infants. Have a significant number of the victims revealed antibodies to enterobacteria and clostridia, and these antibodies do not provide full immune protection, as it belonged to the class A. On the background of provocateurs, such as the event of overheating, tobacco smoke, toxins, mechanisms of protection to these germs were blocked, which could result in respiratory suppression and cardiac arrest.
A number of authors finds a link between infection of the stomach of children, aswa-producing bacteria (Helicobacter pylori) with SIDS. These conclusions were made on the grounds that the children who died from the syndrome, stomach tissue was massively infected by this microbe, in comparison with children who had other factors of death in infancy. These bacteria are capable of producing nitro compounds (ammonium), which block the respiratory center. With regurgitation, the children were able to breathe a certain number of microbes with the contents of the stomach, which led to the absorption of ammonium in the blood and suppress them the centre of respiration.
The theory of mutations in genes
Has just published the results of research DNA of healthy children and those that died as a result of SIDS. These data have shown a sharp increase in the risk of death among those babies who had a particular mutation in the genes responsible for the formation of the immune system and certain of its links. But by itself this mechanism cannot be realized, it is necessary to influence of precipitating factors in the form of external influences and disorders of metabolism inside the body.
Theory of problems of thermoregulation
According to scientists, the basic vital centers of the medulla oblongata to the birth of immature and maturation occurs for a period of three months. If an area is responsible for thermoregulation in the brain stem area is imperfect, then the temperature may be below normal, and also typical sharp fluctuations in values. The stability of the temperature of the body reaches to 4 months of life (critical age for SIDS). In the period of the second-fourth month until the changes come to the stable operation, fluctuations can be significant, giving inadequate temperature reaction.
Against the background of problems with the climate of the room and when too much wrap kids corny overheat that inhibits the activity of the centres of respiration and heart in the medulla, this leads to SIDS.