Sudden death syndrome. What parents should know

In any case, the death of a person becomes a severe shock for relatives. If the death was the result of a long-term illness, loved ones are partly prepared for a tragic ending. However, the death of a completely healthy baby or an adult who has not shown any health complaints can occur completely unexpectedly, for no apparent reason.

General information

Sudden death syndrome is an unexplained and unexpected non-violent death that occurs instantly (sometimes within 2-6 hours), most often caused by respiratory arrest, cardiac or cerebral failure in an apparently healthy person.
Infants and children under one year of age are more susceptible. Usually an autopsy does not make it possible to determine the cause of the tragedy. Sudden death is also called one that is known not to have been violent, the cause of which cannot be determined, or death without signs of illness. Most often, such a diagnosis is made after excluding other possible causes of death, including injuries and diseases. So far, it has not been possible to develop a unified method for identifying sudden infant death syndrome (SIDS).

Another known name is “death in the cradle.” The problem began to be closely studied in the 60s of the last century, talking about its scale and unpredictability. According to statistics from European countries, sudden neonatal death syndrome occurs in approximately 20 cases per 1 thousand newborns. When the slogan “it is recommended that children sleep on their backs” (Peter Fleming) was massively popularized, this figure was reduced to 0.5, but this result is not accurate.

The etiology of sudden death syndrome is still unclear.

Why do men die more often?

If we summarize all of the above, we can conclude that men are more likely than women to suffer from one or another heart disease with a fatal outcome.

This is due to several factors:

1. Most genetically determined pathologies are transmitted according to an autosomal dominant mode of inheritance. This implies the transmission of symptoms and diseases from father to son.
2. In a woman’s body, the sex hormones estrogens are present in greater quantities, which have a beneficial effect on the development of atherosclerosis and arterial hypertension.
3. Men are more involved in heavy physical work and are thus more susceptible to overload.
4. The prevalence of alcoholism and drug addiction among men is greater than among women.
5. The cost of living of men in all countries of the world is lower than that of women.

Pathogenesis

Children commonly have abnormalities in serotonin , which is thought to impair the ability to regulate arousal and breathing normally, particularly in potentially life-threatening situations such as sleep and turning the baby onto his or her stomach. In addition, changes in the polymorphism of anti-inflammatory cytokines and reduced mandibular size are determinants of death. Another chain of mechanisms that causes sudden cessation of breathing is associated with the process of accumulation of high concentrations of carbon dioxide and insufficient blood oxygenation.

In general, there are several theories of the development of thanatogenesis mechanisms - respiratory, cardiac and metabolic.

Classification

Sudden death occurs as a result of respiratory arrest, as well as:

• cerebral - can be caused by epilepsy or other disorders of the vital functions of cerebral activity;
• as a result of acute extensive blood loss;
• arrhythmic - usually occurs with sick sinus syndrome , Wolff-Parkinson-White syndrome and various life-threatening arrhythmias , including ventricular tachycardia and ventricular fibrillation ;
• coronary - at its core is a true primary cardiac arrest as a result of a heart attack caused by coronary heart disease and electrical instability of the heart muscle.

Sudden death in athletes is considered a separate type - it is a consequence of hypertrophic cardiomyopathy .

Risk factors

Due to the fact that the main cardiogenic cause of instant death is ischemic disease, it is quite logical to assume that the syndromes accompanying this heart pathology can be fully attributed to conditions that can increase the likelihood of sudden death. With all this, it has been scientifically proven that this connection is mediated through the underlying disease. Clinical risk factors for the development of clinical death among patients with ischemic syndrome are:

• acute myocardial infarction;
• post-infarction macrofocal sclerosis;
• unstable angina;
• heart rhythm disturbance due to ischemic changes (rigid, sinus);
• ventricular asystole;
• myocardial damage;
• episodes of loss of consciousness;
• damage to the coronary (heart) arteries;
• diabetes;
• electrolyte imbalance (eg, hyperkalemia);
• arterial hypertension;
• smoking.

Causes of sudden infant death syndrome

The main causes of sudden death syndrome are:

• autonomic NS serotonin-mediated deficiency and dysregulation;
• increased vulnerability to external stress;
• the absence of the ATON1 gene, a transcription factor encoding a protein responsible for building neural connections and responding to signals of changes in breathing rhythm in the event of CO2 accumulation in the bloodstream;
• failure in the functioning of the departments of the autonomous NS responsible for breathing and heart function, including underdevelopment of the respiratory rhythm driver, subject to attenuation as a result of a tragic singular stimulus;
• a combination of factors such as colds, hypothermia, contact with tobacco smoke with immaturity of the respiratory center can also provoke respiratory arrest.

Sudden infant death is diagnosed more often in families of emigrants and national minorities who have unfavorable living and socio-economic conditions.

Attention! It has been established that any type of vaccination is not a risk factor for sudden infant death.

Causes of adult sudden death usually lie in heart diseases such as ischemic, cardiomyopathic, hypertrophic, as well as recurrent syncope, arrhythmogenic dysplasia and WPW syndrome.

Risk factors for sudden death in the cradle

Factors that increase the risk of sudden infant death (SIDS) include:

• the child’s habit of sleeping on his stomach is the main provoking factor, because if the child burps, there is a high chance of choking;
• putting the child to bed with the parents;
• excessive insulation and wrapping during sleep, therefore it is recommended to insulate less and wear warm clothes for children; the use of thermal bags can also be dangerous, because carbon dioxide accumulates under it;
• hypothermia;
• failure to comply with medical recommendations for child care;
• super soft bed and use of pillows;
• previously occurred without a reason for respiratory or cardiac arrest, including a family history.

The condition and individual characteristics of the mother also significantly influence:

• absence of husband;
• age under 20 years;
• bad habits (smoking, alcohol, drugs, especially cocaine );
• illnesses during pregnancy;
• breech presentation of the fetus and labor with complications or prolonged.

In addition, the risk group includes children who had problems in prenatal development (especially N.S. shocks), lesions as a result of prenatal stress, premature babies, unable to latch on to the mother’s breast, those on artificial feeding, males (61% of boys suffer), in age 2-6 months (tragedies happen in 90% of cases), especially when it is winter with an increased risk of contracting respiratory syncytial virus infection .

Until what age is there a risk of sudden death?

Since the diagnosis of sudden death syndrome is made after excluding all other possible causes, it can be diagnosed to a patient of any age. However, sudden infant death syndrome is usually detected in infants 2-6 months old in approximately 90% of cases, so it is believed that infants are at risk and require the most careful care and attention.

Weak children

Modern children have a special way of life compared to past generations. On the one hand, they have more opportunities, because... they have access to global sources of information, more clubs and hobbies, but on the other hand, they go out less, communicate less often with peers, and eat poorly.

In addition, medical progress also contributes to the deterioration of children’s health. Indeed, today, young mothers often give birth at very early stages. Doctors have learned how to care for such babies: they can even grow babies born weighing 1 kg! Over time, these kids catch up with their peers, but they still remain quite fragile, and they need to be approached with special attention: they should be examined by doctors more often, and not ignore even seemingly harmless health problems. Naturally, you shouldn’t overload them. Also, various infections pose a separate danger to the fragile bodies of modern teenagers. Due to the mutation of viruses and widespread parental self-medication, even common colds can be much more difficult for children to tolerate. Doctors are especially concerned about infections when the symptoms include only fever and nothing more. All this, naturally, greatly weakens the immune forces of the child’s body.

And we shouldn’t forget about the period of hormonal changes, which has shifted today, and children begin growing up earlier. And this also becomes a serious test for a fragile organism.

Article on the topic

Evgeniy Yamburg: There are almost no healthy children left

Symptoms

Conditions preceding sudden death are characterized by the presence of “small” clinical manifestations and, more often than not, the disaster happens so suddenly that no scientist can find the root cause. Therefore, close attention of clinicians and regular health examinations are extremely important, especially in young patients.

Manifestations of obvious life-threatening events

In infants, the harbingers of a tragic outcome are usually episodes of events - obvious and life-threatening, from which the child can be easily removed with the simplest resuscitation procedures - patting, artificial respiration, etc. Such conditions are usually expressed by a combination of symptoms:

• apnea – can be central or obstructive;
• changes in skin color - most often towards cyanosis or pallor, in more rare cases - erythematous coloration;
• decreased muscle tone;
• choking and gagging.

Literature:

1. Sodium hydroxybutyrate: Neuropharmacological and clinical research / Ed. valid member USSR Academy of Medical Sciences V. V. Zakusova. - Moscow: Medicine, 1968. - 135 p.
2. Drug complications and ways to eliminate them: handbook. for doctors / I. B. Mikhailov, I. V. Markova. - M.; St. Petersburg : DILYA, 2004. – 329 p.
3. Drugs: properties, action, pharmacokinetics, metabolism: textbook / N. V. Veselovskaya - 3rd ed., revised, corrected. and additional - Moscow: Narkonet, 2008. - 262 p.

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Tests and diagnostics

In approximately a third of cases of preliminary diagnosis of sudden death, an autopsy reveals congenital malformations, various types of tumors, or advanced severe infections. The following are most often found in the body:

• signs of chronic prolonged hypoxia;
• significantly reduced concentrations of serotonin and tryptophan ;
• increased number of serotinergic neuron cells and decreased number of serotonin 1A receptor connections in the brainstem.

Important! In some cases, during the course of detective investigations, it turned out that the established sudden death was the result of parental intentional or accidental actions, therefore it is extremely important that the post-mortem examinations and examinations are carried out with the utmost care. Indeed, in the USA there were cases when up to 5 children in one family died from SIDS, but now it is considered that the death of a second, and even more so a third child from this diagnosis is an incredible case.

In addition, there are tables for determining the high risk of sudden death of newborns, which takes into account the composition of the family, the presence of bad habits in the parents, what kind of child/pregnancy and what age of the woman, her state of health, the child’s Apgar score, his weight, the duration of the gestational period etc. Depending on the data obtained, they draw up a medical examination plan for the baby, a list of prohibited drugs, and also teach responsible fatherhood and motherhood, including basic emergency medical care.

Drug withdrawal

The ability of the crocodile to depress mental and physical health does not allow you to leave it on your own. After the first dose, an irresistible desire arises to try desomorphine again. The fight against crocodile addiction is also complicated by the fact that most drug addicts have a significant history of drug addiction with other psychoactive substances before using them.

Signs

Any attempts to “get off” the drug lead to the development of a severe clinical picture of withdrawal syndrome, which is characterized by:

• constant thoughts about the drug;
• aggression;
• lack of control over thoughts and actions;
• hallucinations;
• excessive salivation;
• tearfulness, runny nose;
• chills;
• sweating;
• increased body temperature;
• convulsions;
• unbearable pain in muscles and joints;
• grinding teeth;
• skin itching;
• increased heart rate;
• insomnia.

Desomorphine withdrawal is so unbearable that the drug addict literally tears out the hair on his head, tears his skin, and his mental state becomes critically difficult - the person hides in the corner of the room, locks himself and screams.

Antidotes

Since desomorphine is prepared with codeine preparations, it is classified as an opioid. Therefore, to facilitate “withdrawal”, remove the drug from the body, and also in case of overdose, opioid receptor antagonists are administered to drug addicts in a state of anesthesia. These include Naloxone, Naltrexone, Nalorphine, which block the effect of crocodile on receptors. In acute conditions caused by the use of crocodile, it allows you to restore respiratory and cardiac activity and return a person to consciousness.

Naloxone and other opioid receptor antagonists are included in emergency kits in some countries where opioid use is critical.

Antidotes are administered intramuscularly, intravenously or intranasally. Parenteral administration is considered the most effective, in which the drugs begin to act within 1-2 minutes. In case of acute poisoning, a single injection is not enough, so antidotes are repeated at regular intervals. In this case, the first injection is always intravenous, and subsequent ones can be either intravenous or intramuscular, which is necessary to prolong the effect.

How to ease withdrawal

It is impossible to cope with desomorphine withdrawal on your own, since the toxic composition poisons the body already from the first dose, and it is simply impossible to remove crocodile at home. To cleanse yourself from opioids, you should seek help from a drug treatment clinic or call a narcologist to your home, who will carry out the necessary manipulations to alleviate the condition.

In addition to the low effectiveness of relieving “withdrawal” at home, there is also a danger of complications.

The following activities can help cope with withdrawal symptoms:

• Infusion therapy to naturally cleanse the body of toxins. The drug addict is prescribed droppers with glucose solution, sodium hypochlorite, and vitamins.
• Hardware therapy. It is used for severe conditions, as well as when there are contraindications to drug detoxification. Involves extrarenal purification of blood plasma using special devices.
• Symptomatic therapy to relieve severe withdrawal symptoms. For these purposes, antipyretics, analgesics, antihypertensives, diuretics, sedatives, hypnotics, and blood thinners may be prescribed.

After the physical signs of desomorphine “withdrawal” syndrome are relieved, the physical craving for the drug decreases, but the mental dependence remains the same. Constant thoughts about the drug force you to return to it again. Therefore, after successful detoxification, the drug addict must undergo a course of mental rehabilitation, which will eliminate the mental attraction to the crocodile and completely cope with the addiction.

Prevention

Sudden infant death can be prevented when parents follow basic preventive measures, including:

• placing the child on his back during sleep;
• avoidance of prenatal stress and, in general, good prenatal conditions for the mother;
• breastfeeding, provided that the mother does not drink alcohol and the baby does not come into contact with tobacco smoke;
• compliance with sleep hygiene rules, including sleeping in a cool room, without a pillow, toys and close to parents;
• regular medical examinations of the child;
• using a pacifier at night.

What is butyrate

Sodium butyrate is a synthetic compound from the GHB group.

. In the circles of drug addicts, the drug is known under the names “Ksyukha”, “but”, “oksik”, “traffic jams”, etc.

Normally, a small amount of gamma-hydroxybutyric acid is synthesized in the human body independently, after which it is transformed into an inhibitory neurotransmitter

and creates conditions for the release of dopamine. A similar effect is achieved after using butyrate, but here it depends on the size of the dose taken.

Sudden adult death syndrome

In the adult human body, a fairly complex and reliable system of multiple pacemakers has been developed, regulating breathing, blood circulation, etc.

Most often, an adult does not experience immediate death, but a developing terminal condition within 4-6 hours with acute changes in clinical status in the presence of the victim and witnesses. Usually, the condition of people before this was stable and the autopsy does not reveal signs of arrhythmia or other morphological disorders.

At risk are individuals prone to cardiac or cerebral function disorders, with autonomic dystonia, diagnosed heart defects and other cardiomyopathies. The most alarming symptoms in adults are

• frequent heartbeats;
• syncopation;
• chest pain;
• presence of risk factors in the family history, for example, WPW syndrome.

How to recognize a desomorphine addict

Signs of desomorphine use appear after the first use of the drug. These are not only changes in the emotional and behavioral sphere, but also external signs. So the first alarming symptom is the appearance of injection marks that fester, become crusty, and the smell of chemicals and pharmaceutical drugs from a drug addict. Along with these external symptoms, the person becomes secretive, often leaves home for no reason and does not appear in it for a long time. You can also recognize a drug addict by the following symptoms:

• mood swings, aggression, irritability;
• persecution mania, panic attacks;
• redness of the eyes, lack of pupillary reaction to light;
• trembling of hands, legs;
• muscle and joint pain;
• deterioration of sleep, with a predominance of morning rest;
• a sharp decrease in body weight;
• cyanosis, pale skin;
• crumbling of teeth;
• lethargy;
• lethargy.

Diet to prevent sudden death syndrome

Mom's diet while breastfeeding

• Efficacy: no data
• Timing: entire breastfeeding period
• Cost of products: 1400-1500 rubles per week

Sudden infant death often occurs in premature babies in families with low responsibility and material income, when the mother, due to circumstances, does not provide decent care for the baby, has various types of addictions and cannot find a permanent partner for life. Therefore, for the well-being of the child, it is necessary to exclude all of the above factors, take care of his sleep hygiene and establish a healthy life schedule - with walks and good nutrition for both mother and child, which can provide all nutrients, vitamins and minerals. Often, due to the mother’s lack of breast milk, it is necessary to resort to artificial feeding, the main thing is that it is of high quality and meets the needs of the child.