SIDS—Can It Be Prevented?
“Home monitoring of infants who are considered to be at high risk for sudden infant death syndrome (SIDS) has been increasingly used in recent years in an attempt to prevent sudden infant death.”—Pediatrics, June 1986.
HOME monitoring has increasingly been used, but does it prevent SIDS? Thousands of parents have used or are using home monitors. The monitor, attached to the baby, gives a warning signal when there is threatening irregularity in cardiac activity or breathing. Science News reports that an estimated 40,000 to 45,000 home monitors are in use in the United States and from 10,000 to 15,000 are manufactured each year. Since the danger period is the first year of life, the monitor does not have to be used for years. But are these devices really effective in saving lives?
Dr. Ehud Krongrad and Linda O’Neill, RN, of the Babies Hospital of Columbia University, New York, studied 20 babies considered to be at high risk. Their study indicates that it is extremely difficult to identify accurately a baby that is at risk and therefore really in need of a home monitor. They state: “No test is available to indicate with a high degree of specificity or sensitivity, or with a reasonable predictive value, that an infant is at high risk.”
They argue that parents are naturally very subjective in diagnosing their child’s reactions and state: “Most alarms perceived by parents as being true alarms associated with physical changes are not accompanied by cardiac electrical instability.” In fact, their data “suggest that the overwhelming majority of infants who die suddenly and unexpectedly do not exhibit any notable and or clinically useful symptoms.” As a result, George A. Little of Dartmouth Medical School stated: “If the criteria in the consensus panel report are applied by physicians, I’d anticipate a significant drop in home monitor use for infantile apnea.”
This conclusion serves to support the counsel of the medical examiner to Tottie, quoted in our opening article: “There was nothing you could have done to prevent it. Even if you had been standing by the crib with a monitor, you could not have saved her. You cannot anticipate it and you cannot prevent it. In certain cases, everything just shuts down at once, and at present there is no way of knowing the cause.” Unfortunately, in many fields, science and medicine do not have all the answers, and SIDS is one such field.
Another factor to bear in mind is that home monitors are electrical apparatuses, and therefore, as stated in an article in Pediatrics, “health professionals and consumers need to be aware that the presence of a monitor in a home represents potential risks, especially when the home includes a toddler or preschool child.” A loose cable is a temptation to any child, and a nearby connection can be the next simple step to an electrocution or a burn accident. Therefore, where a home monitor is used, extreme caution should be exercised when there are other children around.
A near-miss baby is one that has stopped breathing and is apparently dead but is caught in time. Perhaps a parent suddenly noted that the baby had ceased breathing and scooped it up to run for help or rush to the nearest hospital. Sometimes that sudden action and movement has served to trigger the heart and the breathing, and the baby has been saved without the need for any heart massage or CPR (cardiopulmonary resuscitation).
In some cases these near misses have been noted in babies that eventually died of SIDS. Dr. Marie Valdes-Dapena says that ‘near-miss infants are at special risk for sudden death.’ Therefore, doctors deduce that “these functions of breathing and heart rate are related to the autonomic nervous system and it seems almost certain that SIDS babies and potential cot deaths have some malfunction of this automatic part of the central nervous system.” But the cause remains a mystery.
So SIDS is used to define the death of a baby in circumstances that cannot be explained. An autopsy fails to produce a valid reason or cause for the death. And at the present stage of research and investigation, SIDS cannot usually be foreseen or prevented. So when a baby dies—whether of SIDS or of any other cause—how do parents cope with such a loss? How do they face their grief?
[Picture on page 9]
Baby attached to a home monitor to check breathing