A 2-week-old girl is brought to the office for a weight check. She was born at 36 weeks gestation due to preterm labor. The patient has been gaining weight appropriately, and her parents have no concerns. When questioned about the home environment, the mother says that she started smoking cigarettes after delivery due to the stress of sleep deprivation. The mother did not smoke during pregnancy, and the father is a nonsmoker. Support is provided, and the mother is counseled regarding the risks of secondhand smoke exposure. Which of the following conditions is the patient at increased risk for developing due to this exposure?
Risks of secondhand smoke exposure in children | |
Risks | Pathophysiology |
Respiratory disease |
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Recurrent otitis media |
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Prematurity & |
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Sudden infant |
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Secondhand smoke (SHS) exposure can adversely affect nearly every organ system, most notably the respiratory tract (eg, pneumonia, asthma). One of the most serious effects of SHS exposure is the increased risk for sudden infant death syndrome (SIDS).
SIDS refers to the unexpected death of a previously healthy infant with an inconclusive postmortem examination. Almost all cases are associated with at least 1 risk factor, such as prematurity, an unsafe sleep environment, and smoke exposure. Smoke exposure likely contributes to SIDS by causing impaired arousal and cardiovascular response to stimuli (eg, hypoxemia).
The risk of SIDS is further increased in cases of maternal cigarette use during pregnancy, which is associated with impaired fetal oxygenation and direct exposure of the fetus to toxins (eg, nicotine, carbon monoxide). The degree of risk correlates with the amount of cigarette use, suggesting a dose-response relationship between smoking and SIDS.
(Choice A) Because maternal smoking during pregnancy (not seen here) increases the risk of preterm delivery, the risk of prematurity-associated complications (eg, apnea of prematurity) is also increased. However, these risks do not increase with postnatal SHS exposure. Moreover, apnea of prematurity typically presents with apneic episodes in the first 2-3 days of life.
(Choice B) SHS increases the risk for respiratory tract disease and recurrent otitis media in children; parents who smoke outside the home should be counseled on cessation because chemicals from cigarette smoke are adsorbed and retained by clothing, skin, and hair and therefore still pose a risk to children. SHS is not associated with an increased risk for epilepsy.
(Choice C) SHS does not increase the risk for failure to thrive in infancy. In fact, SHS may be associated with childhood obesity.
(Choice E) SHS exposure in childhood increases the risk for atrial fibrillation in adulthood but is not associated with ventricular arrhythmias.
Educational objective:
Maternal tobacco use during pregnancy and secondhand smoke exposure are associated with an increased risk for sudden infant death syndrome (SIDS). Pathophysiology of the association between smoke exposure and SIDS may relate to impaired arousal and cardiovascular response to stimuli (eg, airflow obstruction).