History:
- A 39-year-old gravida 7 para 5 ab 2 woman had delivered a term baby who was 3500 gm. The baby's Apgar scores had been 8 and 10 at birth. Both mother and baby had been sent home on postpartum day 2. The baby had been doing well, with only a minor respiratory infection noted at age 3 months. Mother and father left the baby with a babysitter one Saturday evening while they attended the Utah Symphony. Upon returning home, they found paramedics in the house who related to them that their child was dead. The babysitter said that she had noticed nothing wrong with the baby, and put the baby in the crib at about 10:00 pm. She went to check on the baby at 10:30 and noted that the baby was prone and was not
breathing, at which time she called the paramedics.
- Autopsy was performed and revealed no gross pathologic findings. There was no evidence for injury except for a bruise on the right forehead. Radiography revealed no fractures.
- What is your diagnosis?
Sudden infant death syndrome (SIDS). SIDS occurs between 1 month and 1 year of age, with a peak incidence at 3 to 4 months. The cause is unknown, but may relate to delayed neurologic development. The rate varies from about 0.5 to 5 per thousand livebirths.
- What possibilities have to be ruled out?
Child abuse, or possibly a natural cause (congenital heart disease, infection, etc.). It is common to drop a child accidentally, so a simple bruise on the forehead does not necessarily indicate abuse. The babysitter and the parents could be interviewed to better determine the circumstances.
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