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Plötzlicher Kindstod und anscheinend lebensbedrohliche Ereignisse

Sudden infant death syndrome and apparent life-threatening events

Zusammenfassung

Der plötzliche Kindstod („sudden infant death syndrome“, SIDS) ist dank Primärprävention, v. a. der Aufklärung aller Eltern über vermeidbare Risikofaktoren, seltener geworden; diese muss fortgeführt werden. Anscheinend lebensbedrohliche Ereignisse (ALE) sind mit einer Inzidenz von ca. 2/1000 Lebendgeborene nicht seltener geworden. Ihre Differenzialdiagnose ist umfangreich und reicht von Atemwegsinfektionen bis zum nichtakzidentellen Ersticken, einer Sonderform des Münchhausen-Stellvertreter-Syndroms. Zur Ursachenabklärung ist ein Ereignismonitoring über 4 bis 6 Wochen entscheidend, das direkt nach stationärer Aufnahme beginnen sollte, weil ein Auftreten weiterer Ereignisse dann am wahrscheinlichsten ist. Noch wenig bekannt ist, dass ALE und SIDS schon direkt postnatal auftreten können; dann spielt v. a. eine Verlegung der oberen Atemwege eine Rolle. Daher benötigen Neugeborene postnatal eine engmaschige Überwachung; Eltern sollten darauf hingewiesen werden, bei ihrem Kind stets auf freie Atemwege zu achten.

Abstract

The incidence of sudden infant death syndrome (SIDS) has decreased by >80% since 1990 due to primary prevention, particularly the advice given to all parents on avoidable risk factors that must be continued. Apparent life-threatening events (ALTE), however, have remained at an incidence of approximately 2 in 1000. The differential diagnosis is extensive and ranges from upper respiratory tract infections to non-accidental suffocation, a variant of Munchausen syndrome by proxy. Documented monitoring over 4–6 weeks is decisive for clarification of the cause, which should begin immediately following hospital admission because the occurrence of further ALTE is most probable in this period. A relatively new entity is SIDS or ALTE in the first few postnatal days, possibly related to positional upper airway obstruction. Neonates should therefore undergo close postnatal surveillance and parents should be informed about the importance of keeping their baby’s airway unobstructed at all times.

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Correspondence to C. F. Poets.

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G. Hansen, Hannover

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Poets, C.F. Plötzlicher Kindstod und anscheinend lebensbedrohliche Ereignisse. Monatsschr Kinderheilkd 165, 316–324 (2017). https://doi.org/10.1007/s00112-017-0252-x

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Schlüsselwörter

  • Pulsoxymetrie
  • Transkutanes Sauerstoffmonitoring
  • Herzfrequenz
  • Atmung
  • Heimmonitoring

Keywords

  • Pulse oximetry
  • Transcutaneous oxygen monitoring
  • Heart rate
  • Respiration
  • Home monitoring