The Postnatal Risk, Resuscitation Success Rate and Outcomes of Pediatric Sudden Death in Taiwan

Abstract

Background: The epidemiology of pediatric potentially sudden death (SD) events and the rescue rate remain unclear.

Methods: We established a birth cohort (2000-2014) from a national database 2000-2015.

Results: Of 3,097,277 live births, we identified 3126 children (56.1% male) with potentially SD events, including 887 who were rescued. The cumulative risk of potentially SD events for each neonate was 0.30, 0.62, 0.91, 1.05, and 1.13 per 1000 by 2 months, 0, 5, 11 and 14 years of age, respectively. Overall, 28.3% of the children were rescued from SD events, with a higher rate in neonates (69.6%) but lower rate in postneonatal infants. A cardiac diagnosis was noted in 596 (19.1%) patients, including congenital heart disease (CHD) (388), cardiac arrest (151), cardiomyopathy (23), myocarditis (12), Kawasaki disease (7) and arrhythmia (36). Coexisting severe CHD and events in postneonatal infancy were associated with a lower chance of resuscitation, whereas events within 1 week of age had a higher chance of resuscitation. Anoxic brain damage was noted in 174 (19.7%) patients and late death occurred in 348 (39.3%) patients after being rescued from SD. Late death was more common in males, those with anoxic brain damage, those with coexisting severe CHD, and postneonatal infants.

Conclusions: In this birth cohort study, the postnatal cumulative risk of potentially SD events was 1 in 885 newborns by 14 years of age. Postneonatal infants and those with coexisting severe CHD had the highest risk and worst outcomes.

Keywords: Adolescent; Children; Infant; Potentially sudden death event; Rescued sudden death.

Figure 1

The annual incidence of potentially SD event was particularly high (62.2/100 000) during infancy. During the infancy, the annual risk of potentially SD events increased to a peak at age 2 months and then decreased gradually. SD, sudden death.

Figure 2

The cumulative risk of potentially SD events for each neonate was 0.30, 0.62, 0.91, 1.05, and 1.13 per 1000 newborns by age 2 months, 0, 5, 11 and 14 years of age, respectively. Male gender was associated with higher risk of potentially SD events. SD, sudden death.

Figure 3

(A) The overall rescued/potentially SD events from birth till 14 year-old was 28.3%. (B) During the whole infancy, the chance of successful rescues was highest in the first month of life. (C) During the newborn stage, the chance of successful rescues was highest in first week of life. SD, sudden death.