Differentials
Accidental suffocation or asphyxia
SIGNS / SYMPTOMS
Signs of entrapment between 2 firm surfaces, strangulation, or suffocation against bedding or soft surface.
INVESTIGATIONS
Autopsy, although it is often unable to distinguish between SIDS and accidental suffocation.
Nonaccidental trauma or abusive injury, including Munchausen syndrome by proxy
SIGNS / SYMPTOMS
Signs of trauma, including bruising in unusual places, rib fractures, spiral fractures of long bones, and retinal hemorrhages.
Recurrent episodes of cyanosis, apnea, or apparent life-threatening event.
Previous history of unexplained infant deaths in siblings.[119]
Recurrent medical visits for unusual and/or multiple different symptoms for which definitive causes are not found or for which caregiver's concerns exceed clinical findings.
Respiratory syncytial virus
SIGNS / SYMPTOMS
Upper respiratory symptoms of cough and nasal congestion.
Apnea, which may be the only presenting symptom.
Contact with an infected individual.
INVESTIGATIONS
Can be rapidly tested for via nasal swab (culture or enzyme-linked immunosorbent assay-based).
Pertussis
SIGNS / SYMPTOMS
Upper respiratory symptoms of cough and nasal congestion.
Apnea, which may be the only presenting symptom.
Contact with an infected individual.
INVESTIGATIONS
Can be rapidly tested for via nasal swab (culture or enzyme-linked immunosorbent assay-based).
Inborn errors of metabolism (especially fatty oxidation disorders, mitochondrial disorders, and urea cycle defects)
SIGNS / SYMPTOMS
Failure to thrive/poor feeding.
Persistent vomiting.
Lethargy.
Altered mental state: may be acute or subacute onset.
History of a sibling with similar metabolic disorder or prior unexplained death.
INVESTIGATIONS
Serum and urine tests: particularly acylcarnitine profile, serum ammonia and amino acid concentrations, and urine organic acids concentrations. Results are disorder-specific.
Specific genetic enzyme assays as clinically indicated. Results are disorder-specific.
Muscle biopsy for histology. Confirmatory for mitochondrial disorders. Histologic changes are disorder-specific.
Cardiac dysrhythmia
SIGNS / SYMPTOMS
Lethargy or irritability, poor feeding, pallor.
INVESTIGATIONS
Difficult to diagnose postmortem. A family history or diagnosis in family member of dysrhythmia or disorder predisposing to dysrhythmia is often needed.
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