Sudden infant death while awake

Abstract

Epidemiologic data suggest that SIDS is related to the sleep state, but exiguous literature has addressed infants who had been awake at the time of sudden catastrophic deterioration and subsequent death. The aims of this study are to: (1) Report five infants who were awake at the onset of the lethal event, and (2) Discuss potential lethal pathophysiological events that may lead to these circumstances. The demographic and pathologic profiles of these cases are similar to SIDS. Altered responses to severe hypotension, bradycardia, and apnea, perhaps elicited by aspiration and mediated by cerebellar and vestibular structures, might be involved in the pathogenesis of these deaths. Comprehensive medical history review, investigation of the circumstances of death, thorough postmortem examination with ancillary studies, and preservation of tissues for gene testing, are crucial to explaining these deaths. Careful attention should be given to the awake or sleep state immediately prior to the sudden clinical collapse, and death of infants; those who were awake should be reported to enhance understanding of this phenomenon.

Fatal breathing dysfunction in a mouse model of Leigh syndrome

“…The cerebellum, FN, and VN are responsible for maintaining balance as well as modulation of breathing, coordination of breathing and swallowing, and adjustment of breathing to postural changes (49). The importance of the cerebellum and brain stem for regulation of automatic ventilation is also manifest in sleep apneas (50)(51)(52). These structures also mediate autonomic breathing dysfunction in sudden infant death syndrome and other sleep disorder breathing and cardiovascular syndromes (51,53).…”

“…The importance of the cerebellum and brain stem for regulation of automatic ventilation is also manifest in sleep apneas (50)(51)(52). These structures also mediate autonomic breathing dysfunction in sudden infant death syndrome and other sleep disorder breathing and cardiovascular syndromes (51,53). Electrical stimulation of VN neurons modulates firing properties of neurons in the preBötC (34,54).…”

Gastroesophageal Reflux Disease and Sudden Infant Death: Mechanisms behind an Under-Recognized Association

“…Despite the fact that SIDS is usually described to occur during sleep, a recent study by Krous and colleagues [16] described 5 cases of sudden catastrophic deterioration and subsequent death occurring while the children were awake. The authors suggested that ALTE response to severe hypotension, bradycardia, and apnea (perhaps elicited by gastric aspiration and mediated by cerebellar and vestibular structures) may be involved in the pathogenesis of these deaths.…”

SIDS Risk Factors: Time for New Interpretations. The Role of Bacteria

“…Given that babies of 3-4 months of age spend much of their life asleep it would be an understandable mistake to put too much weight on failure of arousal as the underlying mechanism in SIDS. Indeed SIDS that have occurred in fully awake babies (Krous et al 2008) seems to demolish the arousal-failure hypothesis. Whereas, if due consideration is given to cardiogenic effects (supported by good evidence of profound bradycardia) and hypoxaemia and the precipitants thereof (i.e.…”