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What does ALTE stand for?
apparent life threatening event
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What does CSHCN stand for?
children with special health care needs
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What does DUMBELS stand for?
- Diarrhea/Diaphoresis
- Urination
- Miosis
- Bradycardia/Bronchoconstriction
- Emesis
- Lacrimation
- Salivation/Swelling
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What does LANE stand for?
- Lidocaine
- Atropine
- Narcan
- Epinephrine
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What does PHAILS stand for?
- Pesticides
- Hydrocarbons
- Acid/Alkali/Alcohol
- Iron
- Lithium
- Solvents
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What does RSV stand for?
- Respiratory Syncytial Virus
- virus that usually causes bronchiolitis
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What does TICLS stand for?
- Tone
- Interactivity
- Consolability
- Look (gaze)
- Speech (cry)
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What is the Wong Baker faces scale?
Pediatric pain scale
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What is the STARR program?
- developed by the NHTSA
- See the problems with safety
- Talk to the family
- Assess adverse home environment
- Remedy situation
- Review and monitor over time
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What is the EMSC program?
- Emergency Medical Services for Children
- national program designed to ensure that all children and adolescents, no matter where they live, attend school, or travel, receive appropriate care in a health emergency
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What is respiratory distress?
abnormal physiologic condition identified by increased work of breathing
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What is respiratory failure?
- the infant or child exhausts energy reserves or can no longer maintain oxygenation and ventilation
- may occur when chest wall muscles get tired or when there is a failure of central respiratory drive from injury or toxicity
- identified by abnormal appearance or cyanosis in a child with an increased work of breathing
- also identified by an abnormally low respiratory rate and decreased respiratory effort usually with bradycardia
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What is respiratory arrest?
absence of effective breathing
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What is a unique sign/symptom of bacterial tracheitis?
A cough with pus
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What is a unique sign/symptom of croup?
Barking cough
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What are some unique signs/symptoms of epiglottitis?
- Drooling and dysphagia
- Sudden onset
- Muffled voice
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What disease is RSV often associated with?
Bronchiolitis
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What is Bronchopulmonary Dysplasia?
Chronic lung disease associated with premature birth
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How do we treat exascerbated BPD?
- PPV
- High flow O2
- Consider nebulized epinephrine
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What is the VS that differentiates between compensated and decompensated shock in children?
BP
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What percentage of TBW fluid loss compromises cardiac output and perfusion in a child?
>5% TBW
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What percentage of TBW fluid loss compromises cardiac output and perfusion in an adolescent?
5-7%
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What is cardiomyopathy?
- Any disease of the heart muscle that causes a reduction in the force of heart contractions
- Decreases the amount of blood circulated to the lungs and to the rest of the body
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What does cardiomyopathy usually result from?
- Congenital abnormalities that affect both ventricles
- Viral infection
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What are the symptoms of cardiomyopathy?
- Fatigue
- Chest pain
- Dysrhythmias
- SXS of heart failure and cardiogenic shock
- (Crackles, JVD, Hypotension, Peripheral Edema)
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How do we manage cardiomyopathy?
- ABCs
- If decompensated, IV with antidysrhythmics, diuretics, or vasopressors
- Avoid fluid resuscitation to avoid volume overload
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What are the four major causes of pediatric dysrhythmias?
- Hypoxia
- Acidosis
- Hypotension
- Structural heart disease
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What is the first cause you should think of when observing bradycardia in a child?
Hypoxia
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What are some causes of bradycardia besides hypoxia?
- Hypoxemia
- Acidosis
- Hypotension
- Hypoglycemia
- CNS injury
- Excess vagal stimulation
- Toxic ingestion
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What is the most common nonarrest rhythm in kids?
SVT
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What is the heart rate that can distinguish SVT from sinus tach in infants?
210 bpm
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What is the heart rate that can distinguish SVT from sinus tach in kids?
180 bpm
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What are some causes of VTach with a pulse in kids?
- Congenital heart disease
- Cardiomyopathies
- Myocarditis
- Reversible causes
- Metabolic causes
- Hypothermia
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What does "DOPE" stand for?
- Dislodged
- Obstruction
- Pneumothorax
- Equipment
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What is the normal tidal volume in a pediatric patient?
8cc/kg
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What are some signs of impending cerebral herniation?
- Unequal or dilated unresponsive pupils
- Hypertension
- Bradycardia
- Respiratory irregularities or apnea
- Reduced response to stimulation
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What are some things we can consider doing if suspecting impending cerebral herniation?
- Elevate head of bed to 30 degrees if BP is adequate
- Keep head midline
- Short periods of hyperventilation
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Under what age is a positive Babinski's reflex considered normal?
6 months
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What is the Monroe-Kellie doctrine?
- Basic principle that there is limited space in the cranium allocated to CSF/blood and brain matter
- If the brain begins to swell, it forces CSF/blood out
- If excessive CSF/blood is present, it forces the brain out
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What are some characteristics of febrile seizures?
- No evidence of other causes
- Usually between 6 mos and 5 years
- Occur with rapid rise in fever
- May be tonic-clonic or more subtle
- Duration usually <5 mins
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How is epilepsy defined?
Seizure disorder involving >2 afebrile seizures
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What is considered hypoglycemia in infants and children?
<60
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What is considered hypoglycemia in newborns?
<40
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What is the level at which we consider a fever dangerous and may cause brain damage?
105 degrees
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How do we manage hyperglycemia in a child?
- ABCs
- IV fluid therapy if signs of dehydration are present
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What is a common complication of alcohol ingestion in young children?
Hypoglycemia
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What are the "One-Pill Killers"?
- Camphor
- Chloroquine
- Clonidine
- Glyburide
- Imipramine (Tricyclics)
- LIndane
- Disphenoxylate/atropine
- Propranolol
- Theophylline
- Verapamil
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What is "QUEST" and what does it stand for?
- Outlines the steps to take to evaluate pain in young children
- Question
- Use pain scale
- Evaluate behavior and physiological signs
- Seek parents' input
- Take action and assess results
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What are some known risk factors for SIDS?
- Maternal smoking or drugs
- Mother <20 y/o
- No prenatal care
- Social deprivation
- Premature births
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What are the hours during which SIDS usually occurs?
Midnight to 6 am
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Most SIDS deaths occur within what age group?
- Most (85%) under 6 months
- Typical age range is up to 1 year
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What complications can be seen with tracheostomy tubes?
- Obstruction
- Bleeding
- Air leakage
- Dislodgement
- Infection
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How do we manage a tracheostomy tube that has become blocked and cannot be cleared?
- Replace with another tube
- Suction first
- Replace temporarily with ET tube if necessary
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What is a VAD?
- Vascular access device
- Seen in patients who need prolonged access to venous circulation for drug or fluid therapy
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What are some complications of VADs?
- Cracked line
- Air embolism
- Bleeding
- Obstruction
- Local infection
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How do we manage local infection of a VAD?
- Sterile technique
- Remove old bandages
- Cleanse the sight
- Replace clean bandages
- Transport
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How do we manage hemorrhage at the site of a VAD?
- Gentle, direct pressure with aseptic technique
- Transport
- Fluid replacement if hypovolemic
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How do we manage a suspected air embolus from a VAD?
- Stop the infusion
- Left side head down position
- High flow O2
- MCEP
- Rapid transport
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How do we manage obstruction of a VAD?
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What is the neonate/pediatric dose and concentration for epinephrine for cardiac use?
- 0.01 mg/kg 1:10,000 IV/IO q 3-5 mins
- 0.1 mg/kg 1:1000 ETT
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What is the NS bolus amount for a neonate?
10 cc/kg
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What is the dose and concentration for dextrose for a neonate?
D10 0.2g/kg SIVP
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What is the neonate/pediatric dose for Narcan?
0.1 mg/kg SIVP
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What is the neonate/pediatric dose for sodium bicarbonate?
1 mEq/kg SIVP
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What is the neonate/pediatric dose for IV valium?
0.1 - 0.2 mg/kg SIVP
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What is the neonate/pediatric dose for dopamine?
1 mcg/kg/min IVD
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What is the pediatric dose for rectal valium?
0.5 mg/kg
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What is the pediatric dose for APAP?
10-15 mg/kg PO
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What is the pediatric dose for activated charcoal?
1 g/kg PO
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What is the pediatric dose for adenosine?
- 0.1 mg/kg RIVP max 6 mg 1st dose
- 0.2 mg/kg RIVP max 12 mg 2nd and 3rd doses
- All followed by 5-10cc flush
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What is the pediatric dose of albuterol?
- 2.5 mg via nebulizer max 5 mg
- Must be on the monitor at 5 mg
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What is the pediatric dose for amiodarone in VTac with a pulse?
5 mg/kg IV/IO over 20 minutes
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What is the pediatric dose for amiodarone in pulseless VTac/VFib?
5 mg/kg IV/IO max 15 mg/kg IV/IO
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What is the minimum age of a child to give atropine for bradycardia?
1 y/o preferably 2 y/o
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What is the dose of atropine for symptomatic bradycardia in a child?
0.02 mg/kg IV/IO max 0.5 mg single dose max 1.0 mg total dose
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What is the dose of atropine for symptomatic bradycardia in an adolescent?
0.02 mg/kg IV/IO max 1 mg single dose max 2.0 mg total dose
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What is the ETT dose for atropine in a pediatric?
0.04 - 0.06 mg/kg
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What is the pediatric dose for atropoine in an organophosphate OD?
0.05 mg/kg IV/IO
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What is the pediatric joule setting for synchronized cardioversion?
1 J/k first dose, 2 J/k subsequent doses
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What is the pediatric joule setting for defibrillation?
2 or 4 J/k first dose, 4 J/k subsequent doses
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What is the pediatric dose and concentration for dextrose?
0.5 - 1 g/kg SIVP
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What is the pediatric dose for diphenhydramine?
1-2 mg/kg
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What is the pediatric dose for fentanyl?
1-2 mcg/kg SIVP
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What is the pediatric dose for glucagon?
0.1 mg/kg IM max 1 mg
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What is the pediatric dose for a lidocaine bolus?
1 mg/kg IV/IO
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What is the pediatric dose for a lidocaine drip?
20-50 mcg/kg/min IVD
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What is the pediatric dose for lidocaine down the tube?
2-3 mg/kg ETT
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What is the pediatric dose for magnesium sulfate?
25-50 mg max 2 g SIVP
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What is the pediatric dose for morphine?
0.1 mg/kg max 10 mg SIVP
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What is the NS bolus amount for a pediatric?
20 cc/kg
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What is the Parkland Burn Formula?
- 4cc X kgs X BSA = Total CC/ 24 hrs
- Divide by 2 = First 8 hours
- Divide by 8 = CC/hr
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Break down the BSA burn % approximations for an infant by body area and percentage.
- Head = 18%
- Trunk = 18%
- Arms = 9% each
- Legs = 13.5% each
- Genetalia = 1%
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Break down the BSA burn % approximations for a child by body area and percentage.
- Head = 12%
- Trunk = 18%
- Arms = 9% each
- Legs = 16.5% each
- Genetalia = 1%
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Break down the BSA burn % approximations for an adolescent by body area and percentage.
- Head = 9%
- Trunk = 18%
- Arms = 9% each
- Legs = 18% each
- Genetalia = 1%
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What is the Moro reflex and when is it appropriate?
- In infants
- Make a loud noise near the infant, and the legs will flex, the arms will make an embracing gesture, and the infant will usually give a brief cry
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If the Moro and/or Babinski reflexes are found in an older child, what might it indicate?
Spinal cord damage
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What is the formula for typical systolic BP in children 1-10 years?
90 + age x2 = mmHg
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What is the lower range of normal systolic BP in children over 10 years?
90 mmHg
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What is the formula for the lower limit of systolic BP in children 1-10 years?
70 + age x2 = mmHg
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What is cystic fibrosis?
- AKA mucoviscidosis
- Inherited metabolic disease of the lungs and digestive system
- Manifests in childhood
- Causes the glands in the lining of the bronchi to produce excess thick mucus
- Predisposes the patient to chronic lung infections
- Pancreas also fails to produce enzymes required for breakdown of fats and absorb them
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What are the SXS of cystic fibrosis?
- Persistent cough and breathlessness
- Pneumonia, bronchiectasis, bronchitis
- Stunted growth
- Abnormally salty sweat
- Pale, greasy-looking, fowl-smelling stool
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What is cerebral palsy?
- Nonprogressive disorders of movement and posture
- Results from damage to the fetal brain
- Most common cause is cerebral dysgenesis
- No cure exists
- Widely varying range of functionality and disability
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What is muscular dystrophy?
- Inherited muscle disorder that results in slow but progressive deterioration of muscle fibers
- Incurable
- Respiratory failure/congestive heart failure are our main concerns
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What is spina bifida?
- Congenital defect which leaves a portion of the spinal cord exposed
- Wide range in severity
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What is Trisomy 21?
- AKA Down's syndrome
- Three of the 21st chromosome instead of a pair
- Mental disability, heart defects, hearing defects, and other illnesses are very common with it
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What is Trisomy 18?
- AKA Edward's syndrome
- Three of the 18th chromosome instead of a pair
- Congenital heart disease
- Airway issues/GI issues
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What is the AHA Chain of Survival for Pediatric Cardiac Arrest?
- Prevention
- Early CPR
- Early Access to the Emergency Response System
- Rapid PALS
- Integrated Post-Arrest Care
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What are the major types of acyanotic congenital heart defects?
- PDA
- ASD
- VSD
- Aortic stenosis
- Pulmonary stenosis
- Coarctation of aorta
- AV canal defect
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What are the major types of cyanotic congenital heart defects?
- Tetralogy of Fallot
- Tricuspid atresia
- Pulmonary atresia
- TAPVR
- Truncus arteriosis
- Hypoplastic left heart syndrome
- Transposition of the great vessels (D and L types)
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What type of medication is commonly prescribed to help close a PDA?
NSAIDs
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What type of medication is commonly prescribed to help keep a PDA open?
Prostaglandin therapy
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What defect do the Fontan and Hemi-Fontan procedures treat?
Single ventricle defects
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What has been discussed as a possible cause for SIDS in new research?
Low serotonin levels in the brain
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What are some risk factors associated with SIDS?
- Maternal smoking/smoking in house = 3x more likely
- Narcotic use during pregnancy = 10x more likely
- Sleep position
- Temperature
- Apnea hypothesis
- Asphyxiation
- Immune system disorders
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