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Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre's experience
Alessandro Vigo1, Silvia Noce1, Giulia Costagliola2
1The Centre for Paediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Turin, Italy.
Insights
Most infant sleep behavior concerns are benign. Capillary blood gas analysis and medical history are key to identifying infants at risk for fatal events during sleep.
Area of Science:
- Pediatrics
- Sleep Medicine
- Neonatology
Background:
- Sudden Infant Death Syndrome (SIDS) is unpredictable and occurs during sleep, causing parental anxiety.
- Infant sleep events can be frightening, but many are benign paraphysiological phenomena.
- Clinical features and instrumental examinations do not reliably predict SIDS.
Purpose of the Study:
- To describe clinical features and outcomes of infants with worrying sleep behavior.
- To aid physicians in identifying infants at risk for fatal events during sleep.
- To evaluate the utility of anamnesis and capillary blood gas analysis in these cases.
Main Methods:
- Retrospective analysis of medical records of infants under 12 months with reported worrying sleep behavior.
- Data collected from January 2009 to December 2015 at Regina Margherita Children's Hospital, Turin, Italy.
- Review of clinical presentation, emergency medical service/department activation, and diagnostic tests performed.
Main Results:
- 33 male infants analyzed, average age 55 days.
- 97% of infants were asymptomatic upon arrival at the emergency department.
- Capillary blood gas analysis was performed in 61% of cases as per regional guidelines.
- Two infants with an unsafe sleeping position showed an acid-base disorder; two patients had recurrent episodes.
Conclusions:
- Most worrying infant sleep behaviors are paraphysiological.
- Anamnesis and capillary blood gas analysis are crucial for risk assessment.
- These methods helped identify the two infants with concerning clinical findings.
Abstract:
This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants' behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children's Hospital, Turin, Italy. We analysed the medical records of infants < 12 months whose parents reported they had worrying behaviour during sleep in the period 1 January 2009- 31 December 2015. Regional guidelines suggest performing anamnesis and capillary blood gas analysis in case of apparent life-threatening events. There were 33 males, average age 55 ± 54.37 days. On arrival at the emergency medical service/emergency department 97 % infants were asymptomatic; 61 % patients had a capillary blood gas analysis as suggested by the regional guidelines. A clear acid-base disorder was observed in two infants, asymptomatic at medical evaluation, that had assumed an unsafe sleeping position. Two patients presented recurrence of the episode at 3 months.Conclusions: Most worrying infant behaviour during sleep can be related to paraphysiological phenomena; capillary blood gas analysis and anamnesis are pivotal to identify the cases at risk of fatal events.What is Known:• Events that happen during sleep often frighten the parents of newborns. This fear may be induced by the fact that Sudden Infant Death Syndrome typically occurs during sleep.• This tragic event is unpredictable by any clinical features or findings in instrumental examinations and cannot be prevented with an early resuscitation.What is New:• In our retrospective study, most worrying infant behaviour during sleep can be related to paraphysiological phenomena.• Capillary blood gas analysis and anamnesis collection were crucial to identify the only two life-threatening events.