Resuscitate of SIDS

[Dustdevil]

I ask why, would someone want to attempt ?

Two words: Intubation practice. :wink:

But yeah, no resuscitation for me either.

[emt3225]

No i wouldn't especially, if there is obvious signs of death..I would comfort the parents and make sure someone from the family/friend stay with them for support... :wink:

[jmac]

sorry to see that so many people here would not resus a baby, when you say signs of life, are you talking in a BLS scenario where there is no signs of life and begin CPR ??, or are you talking about signs incompatible with life IE lividity, rigur mortis ect.

as for calling on scene, there is a chain of evidence to be observed for death outside a DR's care and where better to do this then in an ED plus the fact there has to be an investigation, better to transport and commence things rather then the baby being taken from the parents in the home to be taken to the coroner.

having resussed my neighbours child of 8wks a fortnight ago till the arrival of transport and driving them to the ED where the parents had their chance to say goodbye, the police could document unobtrusivly and the baby could carry on down the chain of investigation and be released for burial ASAP, what i witnessed was was parents surrounded by caring professionals and councilling members from the ED, the death may never be accepted and i am notsaying it was any easier to bear but at least the traumas and guilt were eased by witnessing that everything that could be done....was done.

as for the charge for transport, in my service we do not charge so i cant argue ageinst that, if there were signs incompatible i would not resus but if not i would go the whole hog, if not for the child...for the parents,

just my take on it.

[Scaramedic]

I agree, do not work the code.

The moment you start working it, or the moment you put the child in the back of the unit, the parents start thinking " oh he'll be ok." It's putting them on a roller coaster of emotions. I have done both, worked and not worked an infant code. Neither is a win situation, but I think honesty is better than false hope. I think some medics work a infant code for themselves as much for the parents. When I would precept new medics I had many that would say "I'll work any kid you have to try" I just wonder if they felt that way after their 5th or 6th infant code. Telling anyone their child is dead is tough, I had one young woman who went nuts and started hitting me on the chest. I didn't take it personally and I just let her do it, she was angry and hurt, she needed an outlet. Also I think it can be dangerous for the medic. If you pronounce them you can tell yourself there was nothing I could do. If you work it then you end up playing the blame game "it's my fault I should have done something different."

[hfdff422]

No one is arguing that you fail to act if there is even the slightest chance of resuscitation. I would even say that you would set a higher standard for children than most cases. It is when there are definitive signs that you then focus on treating the true patients which are the parents.

[Ace844]

sorry to see that so many people here would not resus a baby, when you say signs of life, are you talking in a BLS scenario where there is no signs of life and begin CPR ??, or are you talking about signs incompatible with life IE lividity, rigur mortis ect.

as for calling on scene, there is a chain of evidence to be observed for death outside a DR's care and where better to do this then in an ED plus the fact there has to be an investigation, better to transport and commence things rather then the baby being taken from the parents in the home to be taken to the coroner.

having resussed my neighbours child of 8wks a fortnight ago till the arrival of transport and driving them to the ED where the parents had their chance to say goodbye, the police could document unobtrusivly and the baby could carry on down the chain of investigation and be released for burial ASAP, what i witnessed was was parents surrounded by caring professionals and councilling members from the ED, the death may never be accepted and i am notsaying it was any easier to bear but at least the traumas and guilt were eased by witnessing that everything that could be done....was done.

as for the charge for transport, in my service we do not charge so i cant argue ageinst that, if there were signs incompatible i would not resus but if not i would go the whole hog, if not for the child...for the parents,

just my take on it.

"JMAC,"

I don't believe any of us were/are advocating not working a "viable" pedi arrest, and I believe that all of us are more likely to treat abit more aggressively with a pedi pt in instances where we may call an adult.... This is further evidenced by "Ridryder@others" postings here. It's my MHLO/understanding from reading this thread that the intent was what would you do with "obviously non-viable, and or little chance of a + outcome/survival situation."

Part of the reason I am posting these particular studies wasn't only for the "SIDS" aspect but due to the fact that it covered all alot of the "causes" for pedi-arrest and gave Outcome-viability data..... This evidenced by this statement from the study, read on below::;

Presentation and Survival of Prehospital Apparent Sudden Infant Death Syndrome; Matthew P. Smith A1' date= Amy Kaji A1, Kelly D. Young A1, Marianne Gausche-Hill A1; Abstract:]

Background. Prehospital providers are often involved in the resuscitation of apparent sudden infant death syndrome (SIDS) victims; however, data are few on the presentation and outcome of these patients.Objectives. To describe the presentation and determine the survival rate of infants who have an unwitnessed, prehospital arrest consistent with SIDS (apparent SIDS), and to compare the presentation of infants with a final diagnosis of SIDS with those who presented as apparent SIDS but had a different final diagnosis.Methods. This was a secondary analysis of data from a controlled trial whose methodology has been previously described. The setting was two large, urban emergency medical services (EMS) systems of Los Angeles and Orange Counties, California. The population included 113 apparent SIDS victims from the original interventional study who had a prehospital, unwitnessed arrest consistent with SIDS, defined by the scenario of an infant aged ≤12 months being placed to sleep and later found in full arrest (pulseless and apneic). Data collected included ethnicity, gender, arrest etiology, signs of death (lividity, rigor mortis), prehospital interventions, return of spontaneous circulation (ROSC), arrest rhythm, code 3 transport (lights and sirens), and survival to hospital discharge.Results. One hundred ten of 113 apparent SIDS patients had survival data; 0 of 110 (95% CI 0% to 3.3%) survived, although ROSC was achieved in 5%; for three patients data on survival were missing. Arrest rhythms were determined in 94% of the subjects: asystole 87%, pulseless electrical activity (PEA) 8%, and ventricular fibrillation 4%. Only 50 of 113 (44%) of the EMS records documented code 3 transport; the remainder of the records were ambiguous. SIDS was the final coroner's diagnosis for 79 of 113 (70%) of the cases. Other causes of death in these apparent SIDS victims included respiratory causes (12%), asphyxiation (3%), abuse (2%), congenital heart disease (2%), sepsis (2%), other (4%), and unknown (5%). Apparent SIDS victims with a final diagnosis of SIDS were more likely to show signs of death (27/79, 34% vs. 5/34, 15%, p = 0.035) and were less likely to have a rhythm of PEA (4/77, 5% vs. 5/31, 16%, p = 0.08), although the latter result was not statistically significant.Conclusions. Apparent SIDS victims have a dismal prognosis; all infants presenting with apparent SIDS died, even the 30% whose final diagnosis was not SIDS. Given that there were no survivors, new prehospital policies are needed governing the use of lights and sirens, resuscitation decisions including termination of resuscitation, provision of grief support to families, and incident stress debriefing for prehospital personnel.

FAMILY PERSPECTIVE OF MEDICAL CARE AND GRIEF SUPPORT AFTER FIELD TERMINATION BY EMERGENCY MEDICAL SERVICES PERSONNEL: A PRELIMINARY REPORT

Elizabeth A. Edwardsen A1, Sharon Chiumento A1, Eric Davis A1

A1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Abstract:]

Objective. To determine the acceptance by family members regarding nontransport of patients in cardiac arrest following unsuccessful resuscitation occurring in private residences. Methods. This was a survey with a structured telephone interview. Inclusion criteria included adult patients in asystolic nontraumatic cardiac arrest. The setting was an urban multitiered emergency medical services (EMS) system. Termination of field resuscitation efforts was authorized by an emergency medicine physician at a medical control base station after set protocol criteria. Support services were provided by trained personnel. Results. Thirty-three follow-up interviews were completed with a family member. Thirty-two (97%) of the contacted family members expressed satisfaction with the services provided by EMS personnel. Twenty-one (64%) patients were not transported to the hospital. All 21 family members of the nontransported were satisfied with both the medical care and the emotional support provided by EMS. Additionally, family members of three of the 12 (25%) transported patients stated they would have preferred to have the patient die at home instead of being transported. Conclusions. In this small sample, family members accept the nontransport of patients by trained EMS personnel after asystolic nontraumatic cardiac arrest occurring in private residences. This may positively impact emergency department resources for other critically ill patients.

PREHOSPITAL CARE AND OUTCOME OF PEDIATRIC OUT-OF-HOSPITAL CARDIAC ARREST

Raymond Pitetti A1, Joseph Z. Glustein A1, Mananda S. Bhende A1

A1 Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh/University of Pittsburgh School of Medicine (RP, JZG, MSB), Pittsburgh, Pennsylvania.

Abstract:]

Cardiac arrest in children outside the hospital is associated with high mortality rates. Recent investigations have suggested that the use of advanced life support (ALS) measures by emergency medical services (EMS) personnel may decrease survival. These studies have used the pediatric Utstein style of defining ALS and basic life support (BLS) measures. The pediatric Utstein style defines BLS as "an attempt to restore effective ventilation and circulation" using noninvasive means to open the airway but specifically excludes the use of bag-valve-mask devices. Advanced life support is defined as the "addition of invasive maneuvers to restore effective ventilation and circulation." The authors of the study described below believe that using this definition would categorize some patients into an ALS group who would otherwise be categorized as having received BLS (i.E., "bag-valve-mask only"). Objective: To compare survival rates among children receiving BLS or ALS following out-of-hospital cardiac arrest using amended definitions of prehospital life support measures. Specifically, the definition of BLS was expanded to include the use of bag-valve-mask devices only. Methods: This was a retrospective chart review in an urban, pediatric emergency department. Patients included all children presenting to the emergency department between January 1, 1986, and December 31, 1999, following out-of-hospital cardiac arrest. The main outcome measure was survival to hospital discharge. Results: Two hundred ten children were identified. Twenty-one patients were excluded from further analysis because of absent or incomplete medical records. One hundred eighty-nine patients were studied. Five children (2.6%) survived to discharge from the hospital. Of 189 children, 39 (20.6%) were provided BLS measures by prehospital personnel; 150 (79.4%) received ALS. There was no significant difference between groups in survival to hospital discharge. Patients who survived to hospital discharge were more likely to be in sinus rhythm upon arrival in the emergency department (p < 0.001) and to have received fewer doses of standard-dose epinephrine in the emergency department (p < 0.001). Conclusion: The use of ALS by prehospital personnel for children with out-of-hospital cardiac arrest did not improve survival to discharge from the hospital when compared with the use of BLS.

Pro/con ethics debate: When is dead really dead?

Leslie Whetstine1 , Stephen Streat2 , Mike Darwin3 and David Crippen4

1Health Care Ethics Center, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA

2Department of Critical Care Medicine, Auckland Hospital, Private Bag 92-024, Auckland, New Zealand

3Independent Critical Care Consultant, PO Box 1175, Ash Fork Arizona 86320, USA

4Department of Critical Care Medicine, University of Pittsburgh Medical Center, 644a Scaife Hall, 3550 Terrace Ave, Pittsburgh, PA 15261

Critical Care 2005, in press doi:10.1186/cc3894

Published 31 October 2005

Abstract]

Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment. Not only is the distinction between sapient life and prolongation of vital signs blurred but the concept of death itself has been made more complex. The demand for organs to facilitate transplantation promotes a strong incentive to define clinical death in a manner that most effectively supplies that demand. We consider the problem of defining death in the ICU as a function of viable organ availability for transplantation

Also, here's a study that uses/derrived from some of the OPALS calls::

(OPALS Pediatric Study: What Is the Impact of Advanced Life Support on out-of-hospital Cardiac Arrest?

Ian G. Stiell @ Lisa P. Nesbitt, Martin H. Osmond, Starla Campbell, Rick Gerein, Douglas P. Munkley, Lorraine G. Luinstra, Justin P. Maloney, George A. Wells for the OPALS Study Group

University of Ottawa: Ottawa, Ontario, Canada, Queen's University: Kingston, Ontario, Canada, University of Western Ontario: London, Ontario, Canada, Niagara Regional Base Hospital: Niagara Falls, Ontario, Canada, Ontario Ministry of Health: Toronto, Ontario, Canada, University of Arizona: Tucson, AZ

ABSTRACT)

Background: The Ontario Prehospital Advanced Life Support (OPALS) Study is designed to evaluate emergency medical services (EMS) interventions for critically ill and injured patients. Objective: The OPALS Pediatric Study tested the impact on children with out-of-hospital cardiac arrest of adding a full advanced life support (ALS) program to existing basic life support–defibrillation (BLS-D) EMS systems. Methods: This multicenter before–after controlled clinical trial was conducted in 17 communities (population 20,000 to 750,000) and enrolled all children (< 16 years of age) with out-of-hospital cardiac arrest during the 36-month BLS-D phase and the subsequent 36-month ALS phase. Paramedics were fully trained to ALS standards including endotracheal intubation and administration of intravenous (IV) drugs. The primary outcome was survival to hospital discharge. Standard univariate chi-square and t-test analyses were performed. Results: The 163 children enrolled during the BLS-D (N = 91) and ALS (N = 72) phases were well matched and had these characteristics: mean age 3.3 years (range 0–15), male 52.87%, respiratory etiology 65.6%, unwitnessed 73.6%, bystander cardiopulmonary resuscitation 18.4%, initial rhythm not recorded 86.5%, defibrillator at scene < 8 minutes 85.0%, and defibrillated 1.8%. During the ALS phase, intubation was only attempted for 8 children, with 87.5% success; IV access was only attempted for 14 children, with 50% success. From the BLS-D to the ALS phase, there was no increase in any outcome, including hospital discharge (3.3% vs 2.8%; p = 0.85), hospital admission (11.0% vs 12.5%; p = 0.61), or return of spontaneous circulation (11.0% vs 13.0%; p = 0.69). There was no survival improvement for any subgroup, including cases witnessed by bystander (10.5% vs 0%; p = 0.25) or by EMS (20.0% vs 0%; p = 0.34); BLS vs ALS paramedic (4.1% vs 1.5%; p = 0.36). Conclusions: The OPALS Pediatric Study is the first controlled trial to evaluate full ALS programs for out-of-hospital cardiac arrest in children. The addition of a system-wide EMS ALS program did not improve pediatric survival, although few children actually received ALS interventions.

Etiology of Pediatric Out-of-hospital Cardiac Arrest by Coroner's Diagnosis

Marcus E.H. Ong, Ian G. Stiell, Martin H. Osmond, Lisa Nesbitt, Rick Gerein, Starla Campbell and Barry McLellan

University of Ottawa: Ottawa, Ontario, Canada, Office of the Chief Coroner for Ontario: Toronto, Ontario

ABSTRACT]

Background: Determining the etiology of pediatric out-of-hospital cardiac arrest (OHCA) based on clinical impression has limitations, and autopsy remains the criterion standard. Objectives: To determine the etiology of pediatric OHCA in a population-based sample from autopsy and coroner's diagnosis. Methods: As part of the Ontario Prehospital Advanced Life Support (OPALS) study, we conducted a prospective cohort study including children below the age of 19 years with OHCA in 20 cities. Deaths were matched with provincial coroner's office records, autopsies and investigation notes were reviewed, and descriptive statistics were compiled. Results: From 1992 to 2002, there were 474 cardiac arrests in children, giving an annual incidence of 59.7 per million children. Characteristics were mean age 5.8 yr, < 1 year of age 43.0%, male 59.1%, bystander-witnessed 25.1%, bystander cardiopulmonary resuscitation 20.3%, and survival to discharge 2.3%. 439 matched to coroner's office records. Estimated annual incidence rates per million by age groups were: 175.0 (age 1–4 years), 33.0 (age 5–14 years), and 61.6 (age 15–18 years). Annual incidence rates per million according to coroner's cause of death were: natural (26.2), accidental (17.4), suicide (3.7), and homicide (1.9). The postmortem rate was 84.3% and mean Injury Severity Score was 31.4 (SD 16.5). The most common causes of natural death were sudden infant death syndrome (30.3%), cardiovascular (19.2%), respiratory (18.3%), neurologic (8.7%), and perinatal (7.2%). The most common causes of accidental death were drowning (27.5%), residential accidents (18.8%), fire (13.0%), motor vehicle collision (12.3%), pedestrian (7.2%), and bicycle (4.3%). Conclusions: This is the largest study looking at the causes of pediatric OHCA from coroner's diagnosis. Besides "medical" causes of mortality, up to 52.6% of these deaths were from "unnatural" causes (accidental, suicide, homicide, undetermined) and may be amenable to prevention or intervention. Our findings will be useful for planning prevention, treatment, and future research of pediatric OHCA.

Pediatric Pre Hospital Arrest Survival Evaluation (PHASE): A Large' date= Prospective Population-based Study of Cardiac and Respiratory Arrest: Analysis of Respiratory Arrests Michael Tunik, Neal Richmond, Marsha Treiber, Andrew Skomorowsky, Sandro Galea, David Vlahov, Monique Kusick, Shannon Blaney, Robert Silverman and George Foltin

New York University School of Medicine: New York, NY, Center for Urban Epidemiologic Studies of the New York Academy of Medicine: New York, NY, Fire Department of New York: New York, NY, Albert Einstein College of Medicine: New York, NY, Saint Vincent Hospital and Health Center: Indianapolis, IN

ABSTRACT]

Objective: To describe the demographics, epidemiology, and characteristics associated with survival of children < 18 years who had an out-of-hospital (OOH) respiratory arrest (RA). Methods: A prospective observational cohort of consecutive children < 18 years with OOH RA and cardiac arrest (CA), conducted in the New York City (NYC) 9-1-1 emergency medical services (EMS) system from April 12, 2002, to March 31, 2003. Following resuscitative efforts, data were collected from prehospital providers by trained paramedics utilizing a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses utilized descriptive statistics and bivariate association with survival. Results: Resuscitation was attempted on 255 pediatric CAs or RAs in NYC during the study period. RAs accounted for 109 (42.8%). The mean age was 7.1 years; 52% were male. Lay bystanders witnessed 56%; most occurred at home (76%). Witnesses were family members in 60%. Bystander cardiopulmonary resuscitation (CPR) was performed in 30% of all RAs. A chronic medical condition existed in 28%. Mean EMS response time was 4.9 min (range 0–12 min). Overall survival was 78% to hospital discharge; this is over 15 times the 5% survival rate documented for pediatric CA in the same study. Time interval to EMS arrival, witnessed arrests, bystander CPR, chronic medical conditions, and ventilation method (BVM vs. ETI) were not associated with survival in bivariate analyses. Conclusions: We found a high proportion of RA vs. CA. The majority of children in RA survived. Most arrests occurred at home. Bystander CPR occurred infrequently. Strategies to increase the rate of bystander CPR, especially by family members, are needed. Future pediatric arrest studies should include both RA and CA.

Pediatric Pre Hospital Arrest Survival Evaluation (PHASE): A Large' date= Prospective Population-based Study of Cardiac and Respiratory Arrest: Analysis of Cardiac Arrests

George Foltin, Sandro Galea, Marsha Treiber, Andrew Skomorowsky, David Vlahov, Neal Richmond, Monique Kusick, Shannon Blaney, Robert Silverman and Michael Tunik

New York University School of Medicine: New York, NY, Center for Urban Epidemiologic Studies of the New York Academy of Medicine: New York, NY, Fire Department of New York: New York, NY, Albert Einstien College of Medicine: New York, NY, Saint Vincent Hospital and Health Center: Indianapolis, IN

ABSTRACT]

Objective: To describe the demographics, epidemiology, and characteristics associated with survival from out-of-hospital (OOH) cardiac arrest (CA) in children < 18 years old. Methods: A prospective observational cohort of consecutive children < 18 years with OOH CA and respiratory arrest (RA), conducted in the New York City (NYC) 9-1-1 emergency medical services (EMS) system from April 1, 2002, to March 31, 2003. Following resuscitative efforts, data were collected from prehospital providers by trained paramedics utilizing a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses utilized descriptive statistics and bivariate association with survival. Results: Resuscitation was attempted on 255 OOH pediatric CAs or RAs in NYC during the study period. CAs accounted for 119 (46.7%). The mean age was 3.5 years; 55% were male. Most occurred at home (81%). Lay bystanders witnessed 33% of all CAs; 79% of witnesses were family members. Bystander cardiopulmonary resuscitation (CPR) was performed in 29%. Initial rhythm identified by EMS: ventricular fibrillation 3%, asystole 56%, pulseless electrical activity 10%, other rhythm 12%; no rhythm was recorded in 19%. Mean EMS response time was 4.3 min (range 1.4–12.9 min). Overall survival was 5% to hospital discharge. Only witnessed arrest was associated with survival (6/43 witnessed, vs. 0/62 unwitnessed, p = 0.0038). Conclusions: Pediatric CA survival rate is low, consistent with other studies. Ventricular fibrillation was an uncommon rhythm in pediatric CA. Witnessed arrest was the most important determinant of survival. The majority of arrests occurred at home. The rate of bystander CPR was low. Strategies to increase the rate of bystander CPR for children, especially by family members, are needed.

New and Lingering Controversies in Pediatric End-of-Life Care

Solomon, Mildred Z., Sellers, Deborah E., Heller, Karen S., Dokken, Deborah L., Levetown, Marcia, Rushton, Cynda, Truog, Robert D., and Fleischman, Alan R.]

Objectives. Professional societies, ethics institutes, and the courts have recommended principles to guide the care of children with life-threatening conditions; however, little is known about the degree to which pediatric care providers are aware of or in agreement with these guidelines. The study's objectives were to determine the extent to which physicians and nurses in critical care, hematology/oncology, and other subspecialties are in agreement with one another and with widely published ethical recommendations regarding the withholding and withdrawing of life support, the provision of adequate analgesia, and the role of parents in end-of-life decision-making. Methods. Three children's hospitals and 4 general hospitals with PICUs in eastern, southwestern, and southern parts of the United States were surveyed. This population-based sample was composed of attending physicians, house officers, and nurses who cared for children (age: 1 month to 18 years) with life-threatening conditions in PICUs or in medical, surgical, or hematology/oncology units, floors, or departments. Main outcome measures included concerns of conscience, knowledge and beliefs, awareness of published guidelines, and agreement or disagreement with guidelines. Results. A total of 781 clinicians were sampled, including 209 attending physicians, 116 house officers, and 456 nurses. The overall response rate was 64%. Fifty-four percent of house officers and substantial proportions of attending physicians and nurses reported, "At times, I have acted against my conscience in providing treatment to children in my care." For example, 38% of critical care attending physicians and 25% of hematology/oncology attending physicians expressed these concerns, whereas 48% of critical care nurses and 38% of hematology/oncology nurses did so. Across specialties, [~]20 times as many nurses, 15 times as many house officers, and 10 times as many attending physicians agreed with the statement, "Sometimes I feel we are saving children who should not be saved," as agreed with the statement, "Sometimes I feel we give up on children too soon." However, hematology/oncology attending physicians (31%) were less likely than critical care (56%) and other subspecialty (66%) attending physicians to report, "Sometimes I feel the treatments I offer children are overly burdensome." Many respondents held views that diverged widely from published recommendations. Despite a lack of awareness of key guidelines, across subspecialties the vast majority of attending physicians (range: 92-98%, depending on specialty) and nurses (range: 83-85%) rated themselves as somewhat to very knowledgeable regarding ethical issues. Conclusions. There is a need for more hospital-based ethics education and more interdisciplinary and cross-subspecialty discussion of inherently complex and stressful pediatric end-of-life cases. Education should focus on establishing appropriate goals of care, as well as on pain management, medically supplied nutrition and hydration, and the appropriate use of paralytic agents. More research is needed on clinicians' regard for the dead-donor rule (Pediatrics 116[4], 872-883 1-10-2005)

Hope this helps, 8)

ACE844

[jmac]

thanks for that ace, read a lot of reports like that and ressussed nad not ressussed a good few babys, also know of two babys locally that are being studied by the national childrens hospital here because they survived SIDS and were resussed, any chance, and i mean any chance i will go with the resus, and i am not a young newbie,

thats the way i look at it.

[bandaidpatrol]

JMAC,

What else does "Obvious signs of death" mean? If the three "Or's" are present; rigor, algor, and livor.. It's probably too late.

[Ridryder 911]

thanks for that ace, read a lot of reports like that and ressussed nad not ressussed a good few babys, also know of two babys locally that are being studied by the national childrens hospital here because they survived SIDS and were resussed, any chance, and i mean any chance i will go with the resus, and i am not a young newbie,

thats the way i look at it.

Sorry You CANNOT survive SIDS. That is an erroneous statement. SIDS is only diagnosed, after an autopsy revealing there is no appearant cause of death. Thus the clinical definition of SIDS. There are trends but none conclussively.. the etilogy of SIDS is unknown. That is why it is a syndrome.

R/R 911

[Scaramedic]

Just on a side note, I thought they were going to do away with term SIDS for cause of death.