International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action

Hauck, Fern R.; Tanabe, Kawai O.

doi:10.1542/peds.2007-0135

Cited by 128 publications

(128 citation statements)

References 40 publications

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“…The arguments for supine sleep are based on epidemiological association to SIDS. These are well supported by international data from 13 countries that implemented supine sleep campaigns (2).…”

Section: Aap Policy and Triple Risk Modelsupporting

confidence: 57%

“…In the USA, Hauck et al (2) demonstrate that increased compliance to supine sleep recommendations could lower SIDS rates by 47%; however, the same data demonstrate that even if supine sleep was absolute, the USA SIDS rate would still be between 0.28 and 0.39/1,000, (compared to 0.10 in Netherlands). More progress will almost certainly be made with a broader approach addressing other risk factors.…”

Section: Implications Of the Hypothesismentioning

confidence: 98%

“…The lethality of the defect is likely to be at least "moderate", as it is modifiable by supine sleep. Based on extrapolations by this author (almost all cases show a defect, none yet found in controls), perhaps a 2/1,000 incidence of the defect with a 50% lethality (1/1,000 SIDS rate) has been modified by the "Back to Sleep" campaign from 1.2 to the current level of 0.6/1,000 in the USA (2). There may also be increasing allostatic load over time (35), as well as known risk factors such as nicotine (54), increasing the severity of the defect, as evidenced by further reduced serotonin gene expression in older SIDS cases (76).…”

Section: Epidemiological Aspects Of Sids Association To Supine Sleepmentioning

confidence: 99%

“…There is however inadequate understanding of the underlying pathophysiological etiology for SIDS (2), and hence for the protective mechanism conferred by supine sleep. One currently accepted explanation for SIDS is the "Triple Risk Model" proposed by Filiano and Kinney (3), based on pathological studies of brainstems from SIDS victims.…”

Section: Aap Policy and Triple Risk Modelmentioning

confidence: 99%

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Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Bergman

2014

Pediatr Res

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Supine sleep decreases sudden infant death syndrome (SIDS) incidence, however the mechanisms for this are unclear. The triple risk model for SIDS requires that one or more underlying abnormalities of breathing or autonomic control are present; these are rare, but brainstem defects are found in most SIDS cases. Supine sleep increases sympathetic nervous system tone, and level of state organization, and may therefore act as a stressor. This is evidenced by physiological arousal, and by delayed neurodevelopment in supine compared to prone sleepers. It is argued here that prone sleep position is the biological normative standard in healthy infants, supporting autonomic regulation. During rapid eye movement (REM) sleep (and other circumstances), a parasympathetic-mediated adverse autonomic event (AAE) may be spontaneously triggered. In healthy infants, gasping initiates autoresuscitation and recovery. Hypothesis: the underlying vulnerability to SIDS is specific to autoresuscitation from an AAE, the initial serotonin-dependent gasp is commonly compromised. Serotonin metabolism defects also influence sleep architecture, increasing the likelihood of AAE. The mechanism whereby supine sleep decreases SIDS may therefore be a stressor effect, disturbing sleep architecture to decrease REM and AAEs, and increasing sympathetic tone, which may prevent and counteract the purely parasympathetic-mediated AAE, thereby decreasing the risk of SIDS.

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Section: Aap Policy and Triple Risk Modelsupporting

confidence: 57%

Section: Implications Of the Hypothesismentioning

confidence: 98%

Section: Epidemiological Aspects Of Sids Association To Supine Sleepmentioning

confidence: 99%

Section: Aap Policy and Triple Risk Modelmentioning

confidence: 99%

See 2 more Smart Citations

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Bergman

2014

Pediatr Res

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“…The Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants younger than one year of age in most Western countries and in some developing countries [1]. SIDS is most recently defined as "the sudden and unexpected death of an infant under one year of age, with onset of the lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy, and review of the circumstances of death and the clinical history" [2].…”

Section: Introductionmentioning

confidence: 99%

The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we—and where are we going?

Toit-Prinsloo

Dempers

Wadee

et al. 2010

Forensic Sci Med Pathol

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Abstract:Purposes: Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants under one year of age in many countries. Unfortunately, a paucity of published research data exists in South Africa, with regard to the incidence of and investigation into the circumstances surrounding Sudden Unexplained Deaths in Infants (SUDI) and/or SIDS. Currently, even though most academic centers conform to a protocol consistent with internationally accepted standards, there exists no nationally accepted infant death investigation protocol in South Africa. It is the aim of this study to review the current practice of infant death investigation in two representative but geographically and demographically distinct centers. Methods:Retrospective case audit over a five-year period (2000 to 2004) was conducted at two large medico-legal mortuaries in Pretoria (Gauteng) and Tygerberg (Cape Town). Case files on all infants younger than one year of age were reviewed. The outcome measures included number of deaths, demographic details and the nature and final outcome of the post mortem examinations.Results: A total of 512 cases were identified as possible SIDS cases and of these, 171 was classified as SIDS. The study showed marked inter-case and inter-divisional variation in terms of the investigation of infant deaths at the two institutions. Conclusions:It is envisaged that this study will focus attention on the current lack of usable data regarding sudden/unexplained/unexpected infant deaths in South Africa, and aid in the formulation and implementation of a practical (yet internationally accountable) infant death investigation protocol, which could facilitate comparisons with other countries and initiate further structured research in this field.

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Brainstem Serotonergic Deficiency in Sudden Infant Death Syndrome

Duncan¹

2010

JAMA

276

267

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Context Sudden infant death syndrome (SIDS) is postulated to result from abnormalities in brainstem control of autonomic function and breathing during a critical developmental period. Abnormalities of serotonin (5-hydroxytryptamine [5-HT]) receptor binding in regions of the medulla oblongata involved in this control have been reported in infants dying from SIDS. Objective To test the hypothesis that 5-HT receptor abnormalities in infants dying from SIDS are associated with decreased tissue levels of 5-HT, its key biosynthetic enzyme (tryptophan hydroxylase [TPH2]), or both. Design, Setting, and Participants Autopsy study conducted to analyze levels of 5-HT and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA); levels of TPH2; and 5-HT1A receptor binding. The data set was accrued between 2004 and 2008 and consisted of 41 infants dying from SIDS (cases), 7 infants with acute death from known causes (controls), and 5 hospitalized infants with chronic hypoxia-ischemia. Main Outcome Measures Serotonin and metabolite tissue levels in the raphé obscurus and paragigantocellularis lateralis (PGCL); TPH2 levels in the raphé obscurus; and 5-HT1A binding density in 5 medullary nuclei that contain 5-HT neurons and 5 medullary nuclei that receive 5-HT projections. Results Serotonin levels were 26% lower in SIDS cases (n = 35) compared with age-adjusted controls (n = 5) in the raphé obscurus (55.4 [95% confidence interval {CI}, 47.2–63.6] vs 75.5 [95% CI, 54.2–96.8] pmol/mg protein, P = .05) and the PGCL (31.4 [95% CI, 23.7–39.0] vs 40.0 [95% CI, 20.1–60.0] pmol/mg protein, P = .04). There was no evidence of excessive 5-HT degradation assessed by 5-HIAA levels, 5-HIAA:5-HT ratio, or both. In the raphé obscurus, TPH2 levels were 22% lower in the SIDS cases (n = 34) compared with controls (n = 5) (151.2% of standard [95% CI, 137.5%–165.0%] vs 193.9% [95% CI, 158.6%–229.2%], P = .03). 5-HT1A receptor binding was 29% to 55% lower in 3 medullary nuclei that receive 5-HT projections. In 4 nuclei, 3 of which contain 5-HT neurons, there was a decrease with age in 5-HT1A receptor binding in the SIDS cases but no change in the controls (age × diagnosis interaction). The profile of 5-HT and TPH2 abnormalities differed significantly between the SIDS and hospitalized groups (5-HT in the raphé obscurus: 55.4 [95% CI, 47.2–63.6] vs 85.6 [95% CI, 61.8–109.4] pmol/mg protein, P = .02; 5-HT in the PGCL: 31.4 [95% CI, 23.7–39.0] vs 71.1 [95% CI, 49.0–93.2] pmol/mg protein, P = .002; TPH2 in the raphé obscurus: 151.2% [95% CI, 137.5%–165.0%] vs 102.6% [95% CI, 58.7%–146.4%], P = .04). Conclusion Compared with controls, SIDS was associated with lower 5-HT and TPH2 levels, consistent with a disorder of medullary 5-HT deficiency.

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International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action

Cited by 128 publications

References 40 publications

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we—and where are we going?

Brainstem Serotonergic Deficiency in Sudden Infant Death Syndrome

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