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Sudden death of the child

Syndrome of sudden death of a child is called the sudden death of a child younger than 1 year. The causes of death remain unclear even after a thorough post-mortem examination. It is necessary to distinguish simply the sudden (unexpected) death of a sick child in the absence of clinically pronounced signs of the disease from the syndrome of sudden death of a child. The causes of such sudden death can be: infectious diseases - respiratory diseases, intestinal infections, sepsis; congenital heart defects; disturbances of cardiac conduction; congenital and acquired disorders of the central nervous system, accompanied by convulsions and bouts of apnea; brain tumors; diseases and conditions associated with hypoglycemia; mechanical asphyxia; poisoning; injuries. If during the post-mortem examination or collection of anamnesis, signs of any of the listed diseases and conditions are revealed, then such deaths are not attributed to the syndrome of sudden death of a child. Thus, the frequency of the described syndrome largely depends on the qualified assessment and technical capabilities during the post-mortem examination.

In countries with a high level of health care, amid a general decline in infant mortality, the sudden death of a child syndrome is one of the leading causes of death for children aged 1 month to 1 year. In general, the frequency of this syndrome remains stable and even tends to increase (advances in nursing deeply premature babies have led to an increase in the cohort with a very high risk of developing a child’s sudden death syndrome). Currently, this figure is 1-5 per 1,000 live births. Syndrome of sudden death of a child is very rare in the first month and after the first 9 months. The peak of its frequency falls on the period from 2 to 6 months.

Death, as a rule, comes at night in a dream, which is reflected in the previous names of the syndrome (“death in the bed”, “death in the cradle”). However, despite the widespread fame of the former names, the specialists do not use them, since, in effect, any death of a child under 1 year of age occurs in the crib. In those rare cases when a catastrophe happens in front of their parents, they note that the child suddenly turns blue, stops breathing and dies without making attempts to move or scream. Numerous epidemiological studies have revealed factors that reflect the risk of developing sudden child death syndrome. The significance of hereditary factors in the occurrence of this syndrome is beyond doubt, although they are not yet detailed. Family and twin studies indicate a significant role for hereditary predisposition to the syndrome. The mother’s risk factors include: age under 20 years of age, low socioeconomic status, unregistered marriage, short period between pregnancies, multiple pregnancies, smoking, drug and alcohol use, urinary tract infections during pregnancy. We list the fruit factors: prematurity, low birth weight, male gender, intrauterine hypoxia, impaired thermoregulation (hypo-and hyperthermia), previous apnea episodes, and a respiratory infection shortly before death.

There are many theories of the pathogenesis of the syndrome of sudden death of a child, many of which are currently rejected or revised.
One of the most common concepts is apnea theory, according to which respiratory arrest is the main mechanism of death. Apnea of ​​central genesis is associated with the immaturity of the respiratory centers of the newborn, its hypersensitivity to hypoxia, hypercapnia (carbon dioxide content in blood and other tissues), changes in body temperature, and other factors. In children up to 6 months difficult to switch nasal breathing on the mouth, especially during sleep. Therefore, in case of swelling or hypersecretion of mucus in the nasopharynx, mechanical obstruction of the airways can occur.

However, apnea theory cannot explain all cases of a child’s sudden death syndrome. An important finding in this syndrome is the detection of abnormal glia in the brain of children, especially in the brain stem, in the areas responsible for the function of the cardiovascular and respiratory systems. Along with this, signs of immaturity of the brain were found in such children. In this regard, it is assumed that sudden death may be due to a violation of the integration of the autonomic functions of various organs, primarily the cardiovascular and respiratory systems. This theory is combined with the theory of apnea. She explains the frequency of the sudden death of a child in very premature, immature children. Other theories emphasize the impaired response of the body to hypoxia and hypercapnia, as well as sleep anomalies. It has been established that sleeping a child in a position on the abdomen significantly increases the incidence of sudden death syndrome. Great importance is attached to the pathology of the heart (impaired cardiac conduction, mitral valve prolapse, etc.). Congenital metabolic disorders presumably account for up to 10% of the causes of a child’s sudden death syndrome, but it is rarely possible to identify a specific defect. Obviously, the described syndrome is a heterogeneous group of diseases. Further research is needed to solve the problem of the pathogenesis of this syndrome.

In children who died of sudden death syndrome, morphological changes are observed, reflecting thenatogenesis (the mechanism of death). As a rule, signs of hypoxia are detected: dark liquid blood, diapedemic hemorrhages, dystrophy of parenchymal cells. The second group of pathological changes, often found in the sudden death of a child’s syndrome, includes slightly pronounced signs of an infectious process, often viral etiology: moderate lymphomacrophal organ infiltration, an increased number of alveolar macrophages in the lumen of the alveoli, distelectasis, as well as changes characteristic of a particular infection epithelium. However, these changes are not sufficient to explain the lethal outcome, they are considered the trigger for the development of the sudden death of the child. Some children who died suddenly at autopsy find an obvious cause of death associated with a serious disease that is not clinically diagnosed (meningococcal infection, bronchopneumonia, congenital heart disease) or has no clinical manifestations (aneurysm of the arteries of the brain). These cases do not relate to the sudden death of a child. Their frequency is 15-25% of all cases of sudden death.

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Sudden death of the child

  1. Syndrome of sudden death of children
    Syndrome of sudden death of children - sudden death is not due to a serious illness ("death in a bed", usually at the age of 2-4 months). ETIOLOGY AND PATHOGENESIS The reason for the sudden death of a child is considered weakness in the regulation of respiration: apnea with bradycardia leads to hypoxia of the brain, making it difficult to restore breathing. Children at the age of 2–4 months die suddenly. Risk factors for the sudden death of the child’s syndrome
    For many years in the scientific literature of our country and abroad there is a discussion about the causes of sudden death syndrome in children (SIDS). In the Anglo-American literature several terms are used synonymously: "death in a crib" (cot death), syndrome of unexpected or unexplained death (sudden infant death syndrome). Under the SAFID suggest the unexpected, sudden death of children in
  3. Conductive tissue and sudden infant death syndrome
    The suggestion that a fatal arrhythmia may be responsible for some of the innumerable cases of sudden infant death is not without reason and of preventive significance [103]. However, histological studies of conductive tissues in suddenly deceased children did little to solve this problem. Irreconcilable disputes around her can seriously impede the movement forward [104], which was
  4. Syndrome of the sudden cessation of blood circulation (clinical death)
    Clinical death is a transitional state between life and biological death. Its duration is 3-5 minutes. If death occurs in conditions of gyrothermia, the duration of clinical death increases. If the resuscitation measures are late, biological death occurs (cadaveric spots, rigor mortis, softening of the eyeballs, decrease in body temperature to
  5. Sudden circulatory arrest (sudden death)
    Diagnosis The main causes of sudden death: - ventricular fibrillation; - asystole; - arrest of blood circulation in case of massive pulmonary thromboembolism (PE); - circulatory arrest during myocardial rupture and cardiac tamponade. Ventricular fibrillation develops suddenly. Pulse on carotid arteries disappears, loss of consciousness develops instantly. Appears once
  6. Sudden death in children
    In the literature of recent years, much attention is paid to the syndrome of sudden death in infants, and this syndrome is highlighted in a separate pediatric problem. This syndrome is characterized by the unexpected death of a practically healthy child aged from 7 days to 1 year, in which a thoroughly performed autopsy does not explain the cause of death. Currently existing two
    Natural death due to cardiac pathology, which was preceded by a sudden loss of consciousness within one hour after an acute change in cardiovascular status. Prior heart disease may not be known, but the time and method of death is unexpected (Myerburg RJ, Castellanos A., 2007). Fig. 1. Epidemiology of sudden death (Myerburg RJ, et al., 1998). PV
  8. Sudden cardiac death
    Holter monitoring is very useful in determining the arrhythmogenic mechanisms of sudden cardiac death. After receiving Bleifer et al. [14] the first monitor recording documenting sudden death, similar registration was carried out in many clinical centers [38-43]. Denes et al. [44] in their observation in 5 patients identified an increase in the QT interval, probably
    D-ka: Lack of consciousness and pulse in the carotid arteries, a little later - cessation of breathing. Diff d-ka: In the process of conducting cardiopulmonary resuscitation on ECG: ventricular fibrillation (in 80% of cases), asystole or electromechanical dissociation (10-20%). If it is not possible, emergency ECG recordings are guided by the onset of clinical death and reaction to cardiopulmonary resuscitation.
  10. Sudden cardiac death
    A distinctive feature of the course of hcmp is susceptibility to sudden stop of blood circulation. Its possible pathophysiological mechanisms for this disease are very diverse. These include: • primary electrical instability of the ventricular myocardium; • bradyarrhythmias as a result of sinus node dysfunction and heart block; • acute hemodynamic disorders. Main cause
  11. Other causes of sudden death
    A sudden cardiovascular collapse can result from a variety of disorders other than coronary atherosclerosis. The cause may be severe aortic stenosis, congenital or acquired, with a sudden arrhythmias or pumping function of the heart, hypertrophic cardiomyopathy and myocarditis or cardiomyopathy associated with arrhythmias. Massive pulmonary embolism leads to
  12. Modern clinical terminology of sudden cardiac death
    The term “sudden cardiac death” has been used for several centuries and the same time the controversy has been going on about its definition. The reason for the debate was always the question of when the unexpected death should be called sudden and how to establish the cardiac origin of death. Several criteria have been proposed for the association of sudden cardiac death with a certain kind of one.
  13. Sudden cardiac death
    DIAGNOSTICS Absence of consciousness and pulse in the carotid arteries, a little later - cessation of breathing. DIFFERENTIAL DIAGNOSTICS In the course of CPR, on an electrocardiogram (ECG): ventricular fibrillation (more than 80% of cases), asystolia or electromechanical dissociation. When it is impossible to register an emergency ECG, they are guided by the manifestations of the onset of clinical death and reaction.
  14. Prevention of sudden cardiac death in HCM
    HCM is a common heart disease, the prevalence of which among adults is 1: 500. Sudden unexpected death in this disease is the most terrible consequence that occurs in different periods of life, but especially often at a young age and in patients without symptoms of the disease. The main task of cardiologists is to identify a small
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