From the Guidelines
To minimize the risk of Sudden Infant Death Syndrome (SIDS) and address the parents' concerns, I strongly recommend that the infant be placed on her back to sleep, on a firm, flat surface in a safety-approved crib or bassinet, with no soft bedding, pillows, or toys, and that the parents stop smoking in the home or around the baby immediately. The infant's sleep environment and household practices need to be adjusted to reduce SIDS risk. The parents should provide a safe sleep surface and ensure the baby sleeps in their room but on a separate surface for at least the first 6 months. The use of a pacifier for sleep is beneficial for SIDS prevention, but the practice of having the baby sleep on the mother's chest, even when awake, should be avoided due to the risk of the mother falling asleep. The periodic breathing pattern described is normal for newborns and typically resolves by 2-3 months of age, as noted in studies on infant breathing patterns 1. Breastfeeding should be continued as it helps protect against SIDS. Overheating should be avoided by dressing the baby appropriately for the environment. Additionally, the parents should be aware of the risks associated with secondhand smoke exposure, as highlighted in studies on SIDS risk factors 1. It's also important to note that while the infant's symptoms do not currently indicate a high risk for sleep disorders like obstructive sleep apnea (OSA) or central sleep apnea (CSA), monitoring for signs of these conditions, such as snoring, labored breathing, or witnessed apnea, is crucial, especially given the potential risks associated with premature birth and maternal smoking 1. However, the current evidence does not suggest an immediate need for polysomnography (PSG) or other diagnostic tests for sleep disorders in this infant, unless specific risk factors or symptoms develop. The parents should be reassured that with proper sleep practices and a smoke-free environment, they can significantly reduce the risk of SIDS and promote a healthy sleep environment for their infant.
From the Research
Concerns and Questions from Families about SIDS
- The patient's parents are concerned about her varied breathing pattern, which includes rapid, shallow breaths followed by 5-10 second pauses, and are wondering if there is anything they should do differently to prevent SIDS 2.
- The family's concern is heightened due to a neighbor's 2-month-old infant recently passing away in her sleep.
Risk Factors for SIDS
- The patient was born at 37 weeks gestation via cesarean delivery due to a nonreassuring fetal status secondary to fetal growth restriction, which may increase her risk for SIDS 3.
- The patient's parents occasionally smoke cigarettes, which is a known risk factor for SIDS.
Home Cardiorespiratory Monitoring
- Home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but also SIDS, although its effectiveness in preventing SIDS is still debated 3, 4.
- The American Academy of Pediatrics does not recommend the use of home cardiorespiratory monitors for SIDS prevention, but they may be useful for infants at increased risk of sudden death or intermittent hypoxia 4.
Cardiorespiratory Events in Infants
- A study found that preterm infants, siblings of infants who died of SIDS, and infants who have experienced an idiopathic, apparent life-threatening event have a greater risk of cardiorespiratory events than healthy term infants 5.
- Another study found that home apnea monitoring in 'near-miss' SIDS and in siblings of SIDS victims can detect apnea and prolonged apnea, but its effectiveness in preventing SIDS is still unclear 6.