Showing papers on "Sudden infant death syndrome published in 1977"
TL;DR: Cardiac arrhythias during wakefulness and sleep in 15 patients with sleep-induced obstructive apnea, and the effect of atropine and tracheostomy on these arrhythmias were studied by continuous overnight Holter electrocardiographic, respiratory and electroencephalographic recordings.
358 citations
TL;DR: It is concluded that infants who have had an episode consistent with sudden-infant-death syndrome have a defect in the regulation of alveolar ventilation.
Abstract: To test whether alveolar hypoventilation and an abnormal ventilatory response to inhaled carbon dioxide explains some episodes of sudden-infant-death syndrome, we assessed ventilatory control during quiet sleep in 12 normal infants and 11 infants who had required at least two resuscitations because of prolonged apnea (>20 seconds) during sleep (aborted form of the syndrome). Infants with the aborted syndrome hypoventilated during quiet sleep (alveolar partial pressure of carbon dioxide, 38.9±3.5 mm Hg) as compared to normal infants (35.1±1.9, P<0.01). In addition, the ventilatory response to carbon dioxide breathing during quiet sleep was impaired (mean change in minute ventilation per change in partial pressure of carbon dioxide 22.1±8.9, as compared to 63.1±19.1 ml per kilogram per minute per millimeter of mercury in controls [P<0.001]). Three infants with the "aborted syndrome" subsequently died during sleep at home; autopsy, done in two, revealed no apparent cause of death. We conclude that i...
178 citations
TL;DR: Maturational descent of the epiglottis, found to occur between 4 and 6 months of age, is verified by cineradiography, and represents a discrete developmental event manifesting the potential for oral tidal respiration from a pattern of obligate nasal breathing.
Abstract: The function of the epiglottis in adult man is unclear. However, during early infancy the epiglottic cartilage appears to play an important role in separating the upper respiratory tract from the upper digestive tract. This separation is accomplished by approximation of the epiglottis to the palate, providing a continuous airway from the nose through the larynx into the trachea. This structural arrangement, however, is uniquely lost in man during postnatal development. Maturational descent of the epiglottis, found to occur between 4 and 6 months of age, is verified by cineradiography. This structural change, requiring a reorganization of respiratory function, represents a discrete developmental event manifesting the potential for oral tidal respiration from a pattern of obligate nasal breathing. This period, four to six months postnatally, interestingly coincides with the peak incidence of sudden infant death syndrome (crib death), which similarly occurs at 3 to 5 months of age.
148 citations
TL;DR: Three infants are presented who had withdrawal symptoms after prolonged, intrauterine exposure to diazepam; one infant died at six weeks of age; death was attributed to the sudden infant death syndrome.
146 citations
TL;DR: The parents' perceptions of intervention are discussed, and recommendations are made about how best to help such families after their loss of an infant by sudden infant death syndrome.
Abstract: Nineteen families were interviewed after their loss of an infant by sudden infant death syndrome. Their bereavement responses are described. The outcome after 13 months is studied in terms of resumption of normal living, and health changes. The parents' perceptions of intervention are discussed, and recommendations are made about how best to help such families.
82 citations
50 citations
Journal Article•
TL;DR: The hypoventilation-apnea hypothesis is also attractive because it fits most of the unique epidemiologic features of SIDS.
Abstract: When deaths during the first year of life are sudden, unexpected, and unexplained by any clinical or routine postmortem finding, they are placed in the category of sudden infant death syndrome (SIDS). The syndrome may have many causes, but there are probably only a few final pathways to death. Much recent evidence supports sleep apnea as the most common of these final pathways. Several SIDS victims have had reccurent episodes of sleep apnea prior to death. Such episodes are associated with chronic underventilation of the lungs in other disorders, and more than half of SIDS victims have postmortem markers of antecedent chronic underventilation and hypoxemia. The hypoventilation-apnea hypothesis is also attractive because it fits most of the unique epidemiologic features of SIDS.
42 citations
TL;DR: Based on the reversible "near miss," apnea is likely as the primary event in SIDS, and the crucial aspect appears to be the failure of the immature infant to resume respiration.
40 citations
TL;DR: It is concluded that QT interval prolongation does not play a major role in the genesis of the aborted SIDS, and the QT intervals of the subsequent actual SIDS infants were not significantly different from those of the normal population.
Abstract: To evaluate the role of QT interval prolongation in the genesis of the sudden infant death syndrome (SIDS), the post-resuscitation electrocardiograms of 21 aborted SIDS infants were reviewed. The infants had been found apneic, cyanotic, limp and unresponsive during sleep and required vigorous physical stimulation and mouth-to-mouth resuscitation. Three subsequently experienced repeat similar episodes from which they could not be resuscitated. Extensive studies eliminated all "known" etiologies for death. The QT intervals of these infants were compared to age and sex matched normal infants as well as to established normal values in the literature; in both the aborted and the subsequent actual SIDS infants, the QT intervals were not significantly different from those of the normal population. Thus, we conclude that QT intervals prolongation does not play a major role in the genesis of the aborted SIDS.
37 citations
TL;DR: ECG studies in a total of 108 first-degree relatives of 26 patients with this syndrome in comparison with 99 such subjects from 22 control families failed to show any significant differences in the QT interval in these two groups.
Abstract: Genetically determined prolongation of the QT interval on ECGs has been proposed as one basic pathogenetic mechanism for the sudden infant death syndrome (SIDS). ECG studies in a total of 108 first-degree relatives of 26 patients with this syndrome in comparison with 99 such subjects from 22 control families failed to show any significant differences in the QT interval in these two groups. Hereditary prolongation of the QT interval is therefore unlikely to be a significant factor in the etiology of the vast majority of cases of SIDS.
33 citations
TL;DR: In this article, a possible study that can be immediately implemented to test the probability of identifying couples who might be at increased risk for experiencing the tragedy of sudden infant death syndrome (SIDS) is presented.
Abstract: This letter is directed to those persons who are conducting research in sudden infant death syndrome (SIDS). Dr. Tonkin9s anatomical evidence implicating pharyngeal relaxation during rapid eye movement (REM) sleep as a cause for SIDS is an important contribution to the literature (55:650, May 1975). Her work suggests a possible study that can be immediately implemented to test the probability of identifying couples who might be at increased risk for experiencing the tragedy of SIDS.
TL;DR: Analysis of age comparable infant homicide rates (United States, 1950-1974) and consideration of current theory regarding SIDS pathogenesis provides no support for the hypothesis that a majority of sudden infant death syndrome cases are actually infanticides.
Abstract: The hypothesis, advanced by Asch (Mt Sinai J Med NY 35:214-220, 1968), that a majority of sudden infant death syndrome (SIDS) cases are actually infanticides, is addressed by examination of age comparable infant homicide rates (United States, 1950-1974) and consideration of current theory regarding SIDS pathogenesis. The analysis provides no support for the hypothesis.
TL;DR: Placentas from the SIDS victims had an increased frequency of acute funisitis, acute chorioamnionitis, lymphocytic infiltration of the decidua and macrophages in the fetal membranes and were associated with preterm deliveries.
Abstract: Placentas from 79 victims of the sudden infant death syndrome (SIDS) were compared with placentas from 30,640 controls who survived in a search for evidences of infections or other disorders that might have damaged the SIDS victims before birth Placentas from the SIDS victims had an increased frequency of acute funisitis, acute chorioamnionitis, lymphocytic infiltration of the decidua and macrophages in the fetal membranes The acute funisitis and chorioamnionitis were associated with preterm deliveries and were probably related to amniotic fluid bacterial infections which are a common cause of premature delivery
TL;DR: Little pathologic evidence is found to suggest that SIDS and ASH are commonly associated, although a rare coexistence of these two conditions is possible.
Journal Article•
TL;DR: Examination of the postnatal age of death revealed that infants in the Nasopharyngitis Group tended to be older than those in the No Nasopharian Group, consistent with a prediction derived from the hypothesis that prolonged sleep apnea is part of a pathophysiologic process resulting in SIDS.
Abstract: Epidemiological studies repeatedly have demonstrated the importance of a
number of variables in affecting the incidence of the sudden infant death
syndrome (SIDS).1.2 Characteristically, the peak risk of SIDS is
within the second to third month of life, with relatively few cases in the
first month of life or after the first year. Another consistent observation is
the association between minor upper respiratory tract inflammatory processes
(nasopharyngitis) and SIDS: relatively more SIDS victims than controls have
had clinical symptoms referable to the upper respiratory tract one to two
weeks prior to death. Furthermore, histologic examinations have revealed upper
respiratory tract
TL;DR: No evidence was found to support the view that cases of SIDS are subjected to chronic hypoxia before death as significantly more medial muscle tissue in the pulmonary arterioles and small arteries was found in the chronic hypoxic group compared to the SIDS, non-hypoxic, and acute hypoxic groups.
Abstract: The pulmonary arterioles and small arteries were studied and their musculature and its nuclei were quantified in 90 neonates, infants, and young children who had suffered from a variety of clinical and hypoxic conditions immediately before death. Among the 90 cases investigated in this study, 30 were of sudden infant death syndrome (SIDS). No evidence was found to support the view that cases of SIDS are subjected to chronic hypoxia before death as significantly more medial muscle tissue in the pulmonary arterioles and small arteries was found in the chronic hypoxic group compared to the SIDS, non-hypoxic, and acute hypoxic groups. Furthermore, there was no statistically significant difference in the amount of medial muscle tissue of the pulmonary vessels as between the SIDS, non-hypoxic, and acute hypoxic groups. With other signs of acute hypoxia found at the necropsy of SIDS, the results of this study could be considered to support the view that cases of SIDS succumb as a result of an acute episode of hypoxia, or possibly repeated short-duration episodes of acute hypoxia which do not produce pulmonary vascular changes.
TL;DR: Among Alaskian natives the sudden infant death syndrome (SIDS) occurs at a rate somewhat less than that reported for native Americans indigenous to temperate latitudes, and no striking male predisposition was evident.
Abstract: Among Alaskian natives the sudden infant death syndrome (SIDS) occurs at a rate somewhat less than that reported for native Americans indigenous to temperate latitudes. Cases occurred in both the arctic and subarctic regions of the state and among all but one of the ethnically distinct native population groups. No striking male predisposition was evident. These findings are, in general, similar to previously reported accounts from the states of California and Washington. Any theory of SIDS epidemiogenesis must take into account its wide geoethnic and peculiar sex distribution.
TL;DR: In none of the 102 cases of sudden infant death syndrome (SIDS) included in the study did the toxicological results affect the diagnosis, and it is felt that this diagnosis should be made promptly based on investigative and autopsy findings.
Abstract: One hundred thirty cases of sudden infant death occurring in Wayne County, Michigan, (population 2.7 million) were analyzed for possible drugs. The toxicological protocol has been outlined. Six cases were found to be positive, and in five of these the drugs found had been prescribed for a variety of illnesses. In one case methadone was found in the blood of an infant whose mother was undergoing methadone treatment for drug addiction, the drug being transmitted through breast milk. In none of the 102 cases of sudden infant death syndrome (SIDS) included in the study did the toxicological results affect the diagnosis. In our study, toxicological analyses never contradicted an initial diagnosis of SIDS, and, therefore, we feel that this diagnosis should be made promptly based on investigative and autopsy findings.
Journal Article•
TL;DR: Adrenocortical hypoplasia was found to be the cause of sudden death in a 9-month-old infant, which is not a well-recognized cause ofudden infant death.
Abstract: Adrenocortical hypoplasia was found to be the cause of sudden death in a 9-month-old infant. Most sudden infant deaths in the first year of life are related to the sudden infant death syndrome, in which no specific pathologic changes are found at autopsy. Although specific causes for sudden death in infancy are well documented, adrenocortical hypoplasia is not a well-recognized cause of sudden infant death.
TL;DR: The epidemiology of SIDS and its aetiology and pathogenesis are comprehensively discussed and current literature on the Sudden Infant Death Syndrome is given.
Abstract: A detailed review of current literature on the Sudden Infant Death Syndrome is given. Following an historical introduction, the epidemiology of SIDS and its aetiology and pathogenesis are comprehensively discussed.
TL;DR: The morphological findings as well as the accompanying information of anamnesis and the bacteriological findings are discussed and it is considered, it advisable, to make use of the described additional investigational methods.
Abstract: Es werden erweiterte Sektionsverfahren des Schadels vorgestellt. Damit lassen sich ohne erheblichen zusatzlichen Zeitaufwand pathomorphologische Veranderungen in der Nasen-Rachenregion darstellen und histologisch untersuchen. Bei 25 von 30 plotzlichen Kindstodesfallen waren dadurch Entzundungsprozesse unterschiedlicher Auspragung bis zur nekrotisierenden Rhinitis nachzuweisen. Die morphologischen Befunde sowie die jeweils zugehorigen anamnestischen Angaben und bakteriologischen Untersuchungsergebnisse werden erortert. Wir halten diese erganzenden Untersuchungsmethoden fur zweckmasig.
[...]
TL;DR: It is now abundantly clear that maternal cigarette smoking contributes to an infant's risk of dying from SIDS.
Abstract: The data of Bergman and Wiesner and of Steele and Langworth have confirmed the data of this investigator demonstrating an increased incidence of maternal cigarette smoking in sudden infant death syndrome (SIDS). A recent prospective study confirms the relationship found in these 3 retrospective studies. It is now clear that maternal cigarette smoking contributes to an infants risk of dying from SIDS. This increased susceptibility to SIDS may explain in part the increased mortality in the 1st year of live of infants whose mothers smoked during pregnancy. SIDS accounts for about 40% of the total infant mortality in most reports.
TL;DR: Sudden infant death syndrome (SIDS) is a peculiar entity in that the self-condemning reactions of the surviving family go far beyond the death itself and the psychologic environment for subsequent children will be healthier.
Abstract: Understanding and compassion, together with factual information, are required in dealing with parents who have lost a child to SIDS, in reassuring surviving siblings, and in improving the potential for a healthy psychologic environment for subsequent children.
Journal Article•
TL;DR: Data from six geographically dispersed metropolitan areas in the United States in which special sudden infant death syndrome surveillance programs for detection and autopsy diagnosis existed during the period 1965 through 1974 reveal considerable diversity in overall SIDS incidence rates as well as in annual rate distribution patterns.
Abstract: Data from six geographically dispersed metropolitan areas in the United States in which special sudden infant death syndrome (SIDS) surveillance programs for detection and autopsy diagnosis existed during the period 1965 through 1974 reveal considerable diversity in overall ten-year incidence rates as well as in annual rate distribution patterns. A downward trend in SIDS incidence occurred in some areas but not in others. Non-SIDS postneonatal death rates, which were used for comparison, also decreased in some areas. Rate trends for whites and nonwhites were not consistent. During the same period, the fertility rate in the United States decreased by about a third for both whites and nonwhites. To explain the observed trends we postulate that concomitants of the fertility rate decline may have reduced the number of "high mortality risk babies" to a variable degree in different places and at different times.
TL;DR: Much current research focuses on the possibility of centrally mediated respiratory failure related to sleep apnea, functional abnormality of the ponto-medullary respiratory centers, and inappropriate operation of the oxygen-conserving reflex (“diving reflex”) in SIDS.
Abstract: Many investigators have considered the possible role of asphyxia in sudden infant death syndrome (SIDS). Suggested mechanisms have included those which might mechanically compromise the airway, such as smothering, laryngospasm [1], and nasal obstruction from upper respiratory tract infection in the obligate nasal breathing infant [2]. Much current research focuses on the possibility of centrally mediated respiratory failure related to sleep apnea, functional abnormality of the ponto-medullary respiratory centers [3], chemically induced laryngeal apnea [4], and inappropriate operation of the oxygen-conserving reflex (“diving reflex”) [5].
TL;DR: It is concluded that epithelioid change represents a definite pathologic alteration of germinal centers associated with total destruction of a whole population of cells and probably represents an acutely acquired immunologic deficit and therefore may well contribute to the thus far uniformly fatal outcome of the associated diseases.
Abstract: The histologic structure of lymphoid tissue in cases of fatal infection was reviewed, and epithelioid germinal centers, completely devoid of the usual dark zone of rapidly dividing blast cells, were found in 16 infants and children, one of whom also had Reye’s syndrome. Epithelioid change has been previously reported to occur in various childhood infections and in the sudden infant death syndrome. All reported cases have been fatal. In four additional cases there was toxic follicle alteration, or massive necrosis of germinal center cells. Toxic follicle alteration and epithelioid change have been found in childhood infections and sudden infant death syndrome, and some evidence of a pathogenetic relationship between the two was found in this study. It is concluded that epithelioid change represents a definite pathologic alteration of germinal centers associated with total destruction of a whole population of cells. It probably represents an acutely acquired immunologic deficit and therefore may well contribute to the thus far uniformly fatal outcome of the associated diseases.
TL;DR: Perspectives in Pediatric Pathology is a new periodical designed to fill the void "between individual studies published in a monthly journal and the necessarily concise and frequently dated material in the texts."
Abstract: Perspectives in Pediatric Pathology is a new periodical designed to fill the void "between individual studies published in a monthly journal and the necessarily concise and frequently dated material in the texts." Its content, edited by a distinguished board of pediatric pathologists, is aimed at a broad audience of pediatricians, pediatric surgeons, radiologists, obstetricians, perinatologists, and pathologists. Each volume consists of nine or ten chapters, written by authorities in the field. Each review serves to synthesize and clarify the pathogenesis of recognized pediatric diseases and, in addition, helps define evolving knowledge. Volume I offers reviews in the areas of immunology and infectious disease (the phagocytic system, postsplenectomy sepsis, and intrauterine rubella), nephrology (hereditary disorders of the kidney, childhood nephritis), developmental defects (tracheobronchial anomalies, coarctation of the aorta), oncology (mesoblastic nephroma), and laboratory methods (electron microscopy). There is also a thorough review of the histiocytosis syndromes. The second volume includes material from the areas of perinatology (hyaline membrane disease, placental pathology), neurology (leukodystrophy), oncology (peripheral neuroectodermal tumors), immunology and infectious disease (DiGeorge9s syndrome), and developmental defects (Hirschsprung9s disease). In addition, the unique problems of sudden infant death syndrome and cystic fibrosis are discussed. Each of the chapters provides helpful photographs of gross and microscopic material. Clinicopathologic correlations are made effectively and major points are summarized at the end of most of the articles. The reviews and their excellent bibliographies provide a balanced emphasis on laboratory investigation and clinical studies. Where applicable, the importance of tissue sampling to patient management is also discussed.
TL;DR: After exclusion of infants not prompdy immunised because of illness, birth order and inter–birth interval remained significant predictors of prompt immunisation, suggesting that these factors are acting to increase immunisation delay through pathways unrelated to their potential effect on infant illness rates.
TL;DR: A synthesis, a provisional paradigmatic set of variables, is developed which not only serves as an explanation of the funding difference between the two cases, but also represents a contribution toward more adequate understanding of other cases.
Abstract: The disproportionate difference in the levels of federal funding for crib death (sudden infant death syndrome) research and cancer research before 1972 provides a quasi-experimental opportunity to explore the social determinants of differential allocation of resources to disease research. The detailed comparative analysis undertaken is intended to explain the funding difference between the two cases, drawing upon previous discussions pertaining to the social genesis of priorities in the allocation of resources among areas in biomedical science. In examining the focal cases the author integrates the factors identified in the earlier work, making refinements where necessary. Thus, a synthesis, a provisional paradigmatic set of variables, is developed which not only serves as an explanation of the funding difference between the two cases, but also represents a contribution toward more adequate understanding of other cases.