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Paediatrician experience of management of Sudden Unexpected Death in Infancy
Anne Morris1, Elizabeth Elliott1, Heather Jeffery2
1The University of Sydney, Faculty of Medicine and Health, The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
Insights
Sudden unexpected death in infancy (SUDI) assessments by paediatricians in NSW are hampered by low awareness of policy and limited confidence. Revision of the current NSW Health policy is needed for improved infant death management and parental support.
Area of Science:
- Pediatric Medicine
- Public Health
- Forensic Pathology
Background:
- Sudden unexpected death in infancy (SUDI) necessitates comprehensive investigations, including history, scene examination, and autopsy.
- Paediatricians in New South Wales (NSW) manage approximately 45 infant deaths annually, requiring detailed medical, social, and family history, alongside family support.
Purpose of the Study:
- To evaluate paediatricians' experiences with SUDI assessments in NSW.
- To assess adherence to and identify barriers regarding the current NSW Health policy for SUDI management.
Main Methods:
- A two-part questionnaire survey was distributed to NSW paediatricians registered with the Australian Paediatric Surveillance Unit (APSU).
- The first survey gathered data on knowledge, confidence, policy awareness, and management recommendations.
- The second survey targeted paediatricians who had managed a SUDI case in the preceding five years.
Main Results:
- A 44% response rate (234/524) was achieved for the first survey; 61% of aware paediatricians had read the SUDI Policy Directive.
- Only 27% received education on the Policy Directive or SUDI management.
- Of paediatricians who attended a SUDI case (33/36), 29% did not utilize the policy's history protocol.
Conclusions:
- Limited paediatrician awareness of the SUDI Policy Directive and confidence in management were identified.
- Perceived issues with the current policy and insufficient training highlight the need for policy revision.
- The study recommends revising the NSW model to align with international best practices for SUDI diagnosis, management, and parental support.
Abstract:
Sudden unexpected death in infancy (SUDI) requires a thorough process of inquiry including a detailed history, death scene investigation and autopsy by appropriate and informed health professionals to identify aetiology. Paediatricians are required to conduct the medical, social and family history as well as provide support to the family for the approximately 45 deaths each year in New South Wales (NSW). The aim of this study is describe paediatricians' experience in conducting SUDI assessments with reference to current NSW Health policy and identify barriers to its implementation.
Methods:
Paediatricians in NSW who participate in the Australian Paediatric Surveillance Unit (APSU) were invited to complete a questionnaire requesting information about their knowledge and confidence in managing an infant presenting with SUDI, awareness and use of the NSW Health Policy Directive, and their own recommendations for management. A second questionnaire was completed by paediatricians who had attended a SUDI in the previous five years.
Results:
The first survey was completed by 234/524 (44%) NSW paediatricians. Half the respondents (118/234) were aware of the SUDI Policy Directive and of those 72/118 (61%) had read it. Few paediatricians (63/234) 27% had received education on the Policy Directive or about SUDI management 55/234 (24%). The second survey was completed by 33/36 (92%) who had attended a SUDI, of whom 29% had not used the history protocol within the Policy Directive.
Conclusion:
Lack of awareness, perceived problems with the current Policy, and limited confidence suggests the model in NSW needs revision to meet international recommendations for best management and diagnosis and also supportive and preventive practices for parents.
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