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Sudden death in pediatric populations
1Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Sudden death (SD) in children is rare, with cardiac issues being a significant factor. Early cardiac screening may help manage risks, but its effectiveness requires further study.
Area of Science:
- Pediatric Cardiology
- Epidemiology
- Public Health
Background:
- Sudden death (SD) in children is uncommon, accounting for less than 10% of pediatric deaths.
- Sudden Infant Death Syndrome (SIDS) historically showed lower incidence in Asian countries, but educational campaigns have reduced these disparities.
- Post-infancy pediatric SD incidence ranges from 1.3 to 7.5 per 100,000, with significant geographical variations noted.
Purpose of the Study:
- To analyze the epidemiological profile of sudden death in children.
- To investigate potential ethnic and geographical differences in pediatric sudden death incidence.
- To explore the role of cardiac causes and screening in preventing pediatric sudden death.
Main Methods:
- Review of population-based studies on pediatric sudden death.
- Comparison of incidence rates between different countries (e.g., USA and Taiwan).
- Analysis of potential contributing factors, including cardiac conditions.
Main Results:
- Pediatric SD incidence varies globally; a 2009 study showed rates of 7.5 per 100,000 in the US versus 2.7 per 100,000 in Taiwan.
- Cardiac causes account for approximately 40% of pediatric sudden deaths.
- While implantable cardioverter-defibrillators (ICDs) are considered for risk stratification, their primary prevention use in children remains challenging.
Conclusions:
- Cardiac screening in children, from newborns to school-age, may aid in early detection of risks for sudden death.
- The efficacy of widespread cardiac screening for preventing pediatric sudden death is still under investigation and debated.
- Further research is needed to confirm ethnic differences and optimize strategies for preventing sudden death in children.
Abstract:
Sudden death (SD) in children is rarer than in adults. In the pediatric population, SD accounts for less than one tenth of deaths from all causes. SD in infants is a separate entity commonly termed "sudden infant death syndrome (SIDS)". Previous studies on SD in pediatric patients primarily focused on infants and showed that the incidence of SIDS was much lower in Asian countries than in Western ones. However, these differences diminished after educational campaigns such as the back to sleep act in the late 1980s to early 1990s. The incidence of SIDS from Western reports has decreased from 2.69 to around 0.5-0.24 per 1,000 live births. Beyond infancy, the annual incidence of SD ranges from 1.3 to 7.5 per 100,000. In 2009, two population-based studies, one from Taiwan and the other from the US, explored the epidemiological profile of SD in children. The child health care indexes of these two countries are similar, but the annual incidence of pediatric SD was 7.5 and 2.7 per 100,000 in the USA and Taiwan, respectively. The implications of ethic-related differences requires further confirmation. Around 40% of pediatric SD could be from cardiac causes, either diagnosed or undiagnosed. Risk stratification for cardiac SD and patient selection for implantable cardioverter-defibrillator (ICD) therapy are recommended. However, the adoption of ICD as primary prevention for SD in children is still a challenging issue. Early detection of undiagnosed cardiac risk may be facilitated by cardiac screening either in newborns or the school-age population to better manage the risk of SD. However, the efficacy of such screening remains still controversial.
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