Sids and rsv
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SIDS and RSV. Sudden Infant Death Syndrome . Ricci, p. 1439, 1928. 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

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SIDS and RSV

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Sids and rsv

SIDS and RSV


Sudden infant death syndrome

Sudden Infant Death Syndrome

Ricci, p. 1439, 1928


Incidence and etiology

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


Pathophysiology

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


Risk factors

Risk Factors

  • Maternal smoking

  • Maternal age

  • Poor prenatal care

  • Co-sleeping

  • Suffocation hazards (soft bedding or surfaces, “overlaying”)

  • Overheating

  • Prone position


Immediate care

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


Care after death

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)


Teaching

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


Respiratory syncytial virus

Respiratory Syncytial Virus

Ricci, pp. 1412-1414


Sids and rsv

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


Etiology and pathophysiology

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.


Risk factors1

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


Manifestations

Manifestations

  • Profuse clear runny nose

  • Pharyngitis

  • Low grade fever

  • Cough, wheeze

  • Poor feeding, listless, uninterested

  • Air hunger, respiratory distress with grunting, nasal flaring, retractions


Diagnostics

Diagnostics

  • Abnormal pulse ox, blood gases

  • CXR—hyperinflation with atelectasis, possible infiltration

  • Nasal-pharyngeal washings or nasal culture positive for RSV

  • + ELISA, + IFA


Management

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


Parent education

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


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