Diurnal Temperature Range as a Novel Risk Factor for Sudden Infant Death

Objective To assess the relationship between diurnal temperature range （DTR） and sudden infant death （SID） between 2001 and 2004 in Shanghai,China.Methods We conducted a time‐stratified case‐crossover analysis to estimate the percent increase of SID associated with changes in DTR after adjustment for daily weather conditions （temperature and relative humidity） and outdoor air pollution.Results DTR was significantly associated with daily SID.An increase of 1 °C in the current‐day （L0） and in the 2‐day moving average （L01） DTR corresponds to a 1.56% （95% CI：0.97%,2.15%） and a 1.89% （95% CI：1.17%,2.60%） increase in SID,respectively.Conclusion An increased DTR was associated with an increased risk of SID in Shanghai.More studies are needed to understand the effect of DTR on infant deaths.

Unsuspected imported malaria in a case of sudden infant death

Here we describe the case of a 4-mo-old female who died suddenly without any apparent cause that was initially mistaken as a case of sudden infant death syndrome. Histologic observation of brain sections revealed blue-black bodies in erythrocytes of the blood vessels, suggestive of specific stages of the hematic schizogonic cycle. Further examinations revealed hemozoin and hemosiderin deposits in the parenchyma of all organs, leading to the diagnosis of malaria by Plasmodium falciparum(P. falciparum). The death occurred in Italy, the native country of the infant, two weeks after a Christmas holiday spent in Pakistan, the parents' birthplace, which has a high malarial endemicity. As this case demonstrates, the diagnosis of malaria should always be considered as a differential diagnosis in subjects, including infants, that die unexpectedly after returning from P. falciparum endemic areas.

Maternal Smoking During Pregnancy and Sudden Infant Death Using the National Maternal and Infant Health Survey: A Case-Case Study

We utilized data from the National Maternal and Infant Health Survey (NMHIS) to analyze the risk of SIDS and other infant deaths among women who smoke during pregnancy adjusting for potentially modifiable risk factors such as secondhand smoke exposure and breastfeeding. The following variables were assessed with respect to risk for SIDS and other infant deaths: smoking exposure, level of education, infant and maternal age, infant and maternal birthweight, maternal BMI, gender, secondhand smoke exposure, breast feeding, prenatal vitamins, WIC, multiple gestation, sleep apnea monitor prescription, sleep apnea incidents and maternal alcohol use. Univariate analysis and multivariate logistic regression were performed to identify variables significantly associated with the odds of mortality from SIDS. Analysis utilized weighted estimates using SUDAAN 9.0.0 to adjust for design effects. A p-value <0.01 was considered statistically significant. Women who smoked during pregnancy were 1.83 times more likely to give birth to an infant that died from SIDS versus some other cause of death, OR (95%) = 1.83(1.33, 2.51). Other Race infants and Black infants were more likely to suffer SIDS mortality than White infants, but the result was not significant in the final model. Other modifiable risk factors, such as secondhand smoke exposure and breast feeding, were not significant predictors of SIDS mortality. Independent of sociodemographic variables and other potential risk factors for SIDS death, maternal smoking was associated with an increased risk of SIDS death versus other death. This study highlights the importance of screening all pregnant women for tobacco use and emphasizes the importance of smoking cessation to decrease the risk of infant death from SIDS.

Hypothesis on supine sleep,sudden infant death syndrome reduction and association with increasing autism incidence

AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.

Prenatal and postnatal factors associated with sudden infant death syndrome:an umbrella review of meta-analyses

Background Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome(SIDS)effects is lacking.We investigated the risk and protective factors related to SIDS.Methods We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors.PubMed/MEDLINE,Embase,EBSCO,and Google Scholar were searched from inception until January 18,2023.Data extraction,quality assessment,and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines.According to observational evidence,credibility was graded and classified by class and quality of evidence(CE;convincing,highly suggestive,suggestive,weak,or not significant).Our study protocol was registered with PROSPERO(CRD42023458696).The risk and protective factors related to SIDS are presented as equivalent odds ratios(eORs).Results We identified eight original meta-analyses,including 152 original articles,covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents.Several risk factors,including prenatal drug exposure[eOR=7.84(95%CI=4.81–12.79),CE=highly suggestive],prenatal opioid exposure[9.55(95%CI=4.87–18.72),CE=suggestive],prenatal methadone exposure[9.52(95%CI=3.34–27.10),CE=weak],prenatal cocaine exposure[4.38(95%CI=1.95–9.86),CE=weak],prenatal maternal smoking[2.25(95%CI=1.95–2.60),CE=highly suggestive],postnatal maternal smoking[1.97(95%CI=1.75–2.22),CE=weak],bed sharing[2.89(95%CI=1.81–4.60),CE=weak],and infants found with heads covered by bedclothes after last sleep[11.01(95%CI=5.40–22.45),CE=suggestive],were identified.On the other hand,three protective factors,namely,breastfeeding[0.57(95%CI=0.39–0.83),CE=non-significant],supine sleeping position[0.48(95%CI=0.37–0.63),CE=suggestive],and pacifier use[0.44(95%CI=0.30–0.65),CE=weak],were also identified.Conclusions Based on the evidence,we propose several risk and protective factors for SIDS.This study suggests the need for further studies on SIDS-related factors supported by weak credibility,no association,or a lack of adequate research.

Incidence and determinants of sudden infant death syndrome:a population-based study on 37 million births

Background:The objective of our study is to measure the incidence of sudden infant death syndrome(SIDS),estimate the birth to death interval,and identify associated maternal and infant risk factors.Methods:We carried out a population-based cohort study on 37418280 births using data from the Centers for Disease Control and Prevention's"Linked Birth-Infant Death"and"Fetal Death"data files from 1995 to 2004.Descriptive statistics and cox-proportional hazard models were used to estimate the adjusted effect of maternal and newborn characteristics on the risk of SIDS.Results:There were 24101 cases of SIDS identified for an overall 10-year incidence of 6.4 cases per 10000 births.Over the study period,the incidence decreased from 8.1 to 5.6 per 10000 and appeared to be most common among infants aged 2-4 months.Risk factors inchuded maternal age<20 years,black,non-Hispanic race,smoking,increasing parity,inadequate prenatal care,prematurity and growth restriction.Conclusions:While the incidence of SIDS in the US has declined,it currently remains the leading cause of post-neonatal mortality,highlighting an important public health priority.Educational campaigns should be targeted towards mothers at increased risk in order to raise their awareness of modifiable risk factors for SIDS such as maternal smoking and inadequate prenatal care.

Meta‑analysis of the Association between Serotonin Transporter Polymorphisms and Sudden Infant Death Syndrome

The serotonin transporter(5‑HTT)gene has been considered one of the risk factors for sudden infant death syndrome(SIDS),but the association remains unconfirmed.This meta‑analysis was performed to quantitatively summarize the evidence for such a relationship.PubMed,EMBASE,and China National Knowledge Infrastructure databases were searched for eligible studies within a range of published years from 1990 to December 2015.The odds ratios(ORs)with 95%confidence intervals(CIs)were used to assess the different associations.A total of 8 studies with 624 cases and 796 controls were included for 5‑HTT promoter polymorphism,5 studies with 418 cases and 542 controls for intron 2,and 3 studies with 253 cases and 334 controls for haplotype.The pooled examinations showed an overall increased SIDS risk for the 5‑HTT promoter polymorphism(OR=1.65,95%CI=1.03–2.63,P=0.035 for LL vs.LS and SS;OR=1.46,95%CI=1.04–2.04,P=0.028 for L vs.S),but no association(OR=1.00,95%CI=0.75–1.33,P=0.994 for 10+9 carriers vs.12/12;OR=0.97,95%CI=0.79–1.19,P=0.753 for 10+9 vs.12)for intron 2 polymorphism,and an unreliable association(OR=0.52,95%CI=0.31–0.87,P=0.013)for S‑9 and S‑10 haplotypes.This meta‑analysis suggests that the L allele or LL homozygote of 5‑HTT promoter polymorphism has an increased risk for SIDS,while intron 2 polymorphism has no association with SIDS.

A MEMS Design for an Intelligent Pacifier for Preventing Sudden Infant＇s Death Syndrome （SIDS Alarm）

Sudden Infant Death Syndrome （SIDS） is an unexpected death of infants under one year old. SIDS is the most common cause of death for infants after the first month of birth, commonly between two and four months. MEMS （Micro-Electro-Mechanical Systems） technology can be very useful to help us to avoid this horrible tragedy. In the present work, using a MEMS technology, an intelligent pacifier is designed to alarm any unusual changes in breathing during sleeping. A PZT （Piezoelectric） sensor is utilized to detect the force generated by breathing and convert it to a measurable voltage and alarm the risky breathing during infant＇s sleeping. This voltage can subsequently drive some simple alarm and make parents aware of hazard.

Study on Pulmonary Surfactant of Sudden Death of Infant

Objective To find the pathogenesis of sudden infant death syndrome (SIDS) from changes of pulmonary surfactant. Methods By means of thin layer chromatography technique, surfactant in whole lung specimens of 10 infants with SIDS and 10 control infants without SIDS (dead of nonrespiratory diseases) were examined qualitatively and quantitatively. Results Eleven components in pulmonary surfactant were examined qualitatively, including lysophosphatidylcholine, sphingomyelin, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, phosphatidic acid, cholesterol and neutral lipids. Quantitative examination showed that the amount of surfactant of whole lung specimens in sudden death group [(8.9±1.0) mg/g wet lung weight] was significantly less than that in control group [(12.6±1.4) mg/g wet lung weight, P<0.01]. Qualitative variance showed that the percentages of phosphatidylcholine (49.4%±2.0%) and phosphatidylglycerol (2.6%±0.7%) decreased markedly in sudden death group compared with those in control group (61.5%±3.0% and 4.3%±1.5%, P<0.01). Conclusion Before death there is serious defect on metabolism of pulmonary surfactant in sudden death infants, with the amount decreasing and the ratio of its components being disturbed, which is one of the important pathogenies of SIDS.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

婴儿猝死综合征的法医学鉴定

近20多年来,婴儿猝死综合征(sudden infant death syndrome,SIDS)一直是西方发达国家医学界尤其是法医学和儿科学领域研究的热点。目前,随着对SIDS广泛而深入的研究,对其病因、发病特点、危险因素以及致病机制等都有了更明确的认识。虽说近年来SIDS的发病率已有明显下降,在欧美洲、澳洲等发达国家,SIDS仍然是导致1个月到1岁婴儿死亡的首要原因。在亚洲国家和地区,尤其是发展中国家SIDS的报道很少见。本文通过总结文献并结合美国马里兰州近20年(1990—2006)来对SIDS的调查研究资料,介绍SIDS的发展历史、研究现状和新的发展趋势,并对SIDS法医学鉴定程序及鉴定要素进行讨论。

预防婴儿猝死综合征的安全睡眠环境证据总结

目的:检索、评价并整合预防婴儿猝死综合征的安全睡眠环境相关证据。方法:计算机检索BMJ最佳临床实践、UpToDate临床顾问、JBI图书馆、Cochrane图书馆等网站中关于婴儿安全睡眠环境相关的临床决策、推荐实践、证据总结、临床实践指南、技术报告、专家共识、系统评价,进行方法学质量评价后,根据主题对证据进行提取与汇总。结果:根据纳入标准筛选出证据11篇,包括技术报告1篇、临床决策2篇、临床实践指南1份、系统评价7篇。通过阅读、提取和归类,总结了睡眠姿势、睡眠位置、睡眠环境和辅助睡眠工具4个领域的9条证据。结论:医务人员和婴幼儿监护人应遵循最佳证据,规范婴儿照护行为,保证婴儿睡眠安全,预防婴儿猝死综合征。

婴儿猝死综合征研究现状

婴儿猝死综合征(sudden infant death syndrome,SIDS)是婴儿死亡的重要原因。2013年HRS/EHRA/APHRS专家共识将不明原因的婴儿猝死纳入遗传性心律失常范围。约12%的SIDS由长QT综合征导致,与SIDS相关的离子通道病还包括Brugada综合征、儿茶酚胺敏感性多形性室速、短QT综合征。此外,研究发现早期复极常伴随长QT综合征、Brugada综合征、短QT综合征疾病出现,并且进一步增加心律失常事件的风险。心电图描记术简单、无创、廉价、易行,对遗传性心律失常诱发的SIDS有重要的筛查、预警和诊断意义。

接种乙型肝炎疫苗偶合婴幼儿猝死综合征1例

目的调查某病例在接种乙型肝炎疫苗后发生死亡是否由注射乙型肝炎疫苗所引起。方法对病例开展个案调查,收集病例出生病历资料、就诊资料、尸检资料,汇总分析后提出诊断意见。结果该病例于2013年12月20日上午接种第二剂次乙肝疫苗后,当天16:00开始发热,T 38.6℃,当地村级卫生室医学处置效果不佳,于2013年12月27日3时死亡;山东法医司法鉴定中心根据尸检结果 ,鉴定意见为符合婴幼儿猝死综合征。经市级预防接种异常反应调查诊断专家组诊断,不属于预防接种异常反应。结论该病例接种疫苗偶合了婴幼儿猝死综合征,与预防接种无关。

婴儿猝死综合征规范化诊断的建议和思考

婴儿猝死综合征(SIDS)的诊断包括死亡性质和直接死因的判断,是当前法医学诊断领域的一个难点。国内对婴儿尸体检查不规范,对婴儿死亡现场环境和病史资料的搜集不够全面,直接导致SIDS的诊断不规范。在围绕如何规范化诊断SIDS,提两点建议:一是婴儿的解剖检查应当规范化,检查项目要做到全面细致;二是重视婴儿资料的收集,使用婴儿死亡调查表搜集死亡现场和婴儿病史资料。

脑干功能障碍与婴儿突然死亡综合征

目的 探讨婴儿突然死亡综合征 (SIDS)的病理机制。 方法 SIDS和对照组各 16例脑标本 ,通过常规神经病理检查、胶原纤维酸性蛋白 ( glialfibrillaryacidicprotein ,GFAP)、酪氨酸羟化酶 (tyrosinehydorxylase ,TH)免疫组织化学染色 ,观察脑组织病理变化、胶质细胞增生和脑干TH活性的改变。 结果 16例SIDS中 7例可见白质软化坏死 ,白质区GFAP阳性胶质细胞增生明显 ,与对照组比较差别显著。在SIDS组 ,桥脑滑车神经核、延髓迷走神经核和腹外侧网状结构GFAP阳性胶质细胞明显增加 ,与对照组比较差别显著 ;中脑黑质GFAP阳性胶质细胞虽然也增加 ,但与对照组比较 ,差别不显著。迷走神经核和腹外侧网状结构中或强阳性TH免疫反应在SIDS组明显低于对照组 ,但在中脑黑质和滑车神经核 ,两组间差别不显著。 结论 慢性缺氧或缺血可能引起脑干儿茶酚胺神经元的改变 ,从而导致睡眠时呼吸或循环中枢调节功能障碍 ,成为SIDS的一个重要促发因素。

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征(LQTS)、短QT综合征(SQTS)、Brugada综合征(BrS)和儿茶酚胺敏感性多形性室性心动过速(CPVT),总结它们在发病机制及诊治方面的进展。

睡眠姿势及环境与婴儿猝死综合征

目的：探讨睡眠姿势及环境与婴儿猝死综合征的关系。方法：查阅、分析、归纳多篇国外文献。结果：婴儿睡眠姿势、环境与婴儿猝死综合征存在相关性。结论：婴儿俯卧睡眠、过热、被动吸烟为婴儿猝死综合征的高危因素。

婴儿猝死综合征的研究现状及其法医学检验

婴儿猝死综合征(dudden infant death s yndrome,SIDS)一直是法医学和儿科学领域的研究热点。相对于北美、欧洲、澳洲以及日本等地对SIDS广泛深入的研究,来自中国的报道相对较少。本文通过总结文献,介绍SIDS的发展历史、研究现状和新的发展趋势,并结合2004年各国学者在美国圣地亚哥公布的SIDS分型,讨论实际检案中需注意的问题以及推进其调查研究的可行性。

婴儿急死综合征(SIDS)颈动脉体的超微结构

作者利用透射电镜对8例婴儿急死综合征死亡及4例其他原因死亡的婴儿的颈动脉体进行观察。发现婴儿急死综合征与非婴儿急死综合征死亡的婴儿,其颈动脉体的主细胞形态结构相似。两组检材的主细胞内均含大量致密颗粒,其大小及数量无明显不同。认为有必要进一步应用生化技术对婴儿急死综合征颈动脉体主细胞中致密颗粒物质进行定性和定量研究。