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.

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.

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.

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.

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.

Breast Feeding Cuts Infant Death 20 Percent

[提示]母乳喂养,英语叫breast-fed。母乳喂养婴儿,好处可谓多矣!首先在诞生一年之內,婴儿的死亡率就比非母乳喂养者降低了20％。别的好处也很多,比如:Other studies have shown breast-fed babies are less likely to be overweight,have fewer behavioral problems and may show differences in intelligence.They also may grow up to have lower blood pressure(血压).调查还证明,当今美国母乳喂养的婴儿占婴儿总数之70％!笔者甚至怀疑,我国是否达到了这个标准,尤其是都市年轻母亲。

Validation of the China＇s maternal and child mortality surveillance in the diagnosis of infant deaths in two counties in Guizhou Province

The infant mortality rate in China declined from 50.2‰ to 13.8‰ between 1991 and 2009.1 Although China has made good progress,there were still about 190 thousand infants who died in 2009.Reliable birth and death registration and the causes of death in populations are essential for public health planning.The National Maternal and Child Mortality Surveillance System （MCMS） is the major system to register maternal and infant deaths.It samples 126 districts and 210 counties,totally 336 sites,covering 12% of counties and 9% of the population.Causes of deaths are determined by the attending clinician.For those who die out hospital or clinic,a community health provider will be asked to visit that family and make a decision as to the cause of death.

2018-2022年福建省泉州市围产儿死亡影响因素分析

目的 分析2018-2022年福建省泉州市围产儿死亡原因及影响因素,为制定针对性的干预措施提供依据。方法 收集2018年1月-2022年12月福建省泉州市30所医院的围产儿死亡资料及同期分娩的活产儿资料,采用单因素分析和logistic回归分析法对比分析围产儿死亡的影响因素。结果 2018-2022年泉州市共监测围产儿338 325例,围产儿死亡1 464例,围产儿死亡率为4.33‰。母亲居住地区为乡村(OR=3.956,95%CI:3.257~4.804)、患有妊娠合并症/并发症(OR=3.327,95%CI:2.639~4.194),以及出生缺陷(OR=125.297,95%CI:61.619~254.779)是围产儿死亡的危险因素(均P <0.001);母亲产检次数多是围产儿死亡的保护因素(OR=0.904,95%CI:0.880~0.929)。泉州市围产儿死亡原因前5顺位为出生缺陷、脐带因素、母亲因素、胎盘因素及出生窒息,占围产儿死亡的81.2%。结论 泉州市出生缺陷防控形势依然严峻,应将出生缺陷作为突破口,加强出生缺陷防控知识的普及,减少出生缺陷的发生;同时,应加强围产保健管理,及早识别围产儿死亡高危因素,及时干预,以进一步降低围产儿死亡率。

2013—2022年房山区5岁以下儿童死亡情况分析

目的 分析房山区5岁以下儿童死亡率变化趋势及不同年龄儿童死亡原因的变化情况,针对5岁以下儿童死亡的主要原因,制定综合有效的管理措施,降低新生儿及婴儿死亡率。方法 采用北京市妇幼信息系统5岁以下儿童死亡监测网络收集2013—2022年5岁以下儿童死亡个案报告卡,统计儿童死亡率及不同年龄段死亡构成比,分析新生儿、婴儿根本死因及顺位情况。结果 2019—2022年早期新生儿、新生儿、婴儿死亡率大体上呈下降趋势,早期新生儿死亡率下降幅度最大。2019—2021年早期新生儿死亡的构成比大体上呈下降趋势。10年期间持续年份较长的根本死因顺位第一位是早产或低出生体重、出生窒息的新生儿,早产或低出生体重的婴儿;第二位是早产或低出生体重、出生窒息的新生儿,出生窒息、先天性心脏病的婴儿;第三位是其他先天异常的新生儿及婴儿。结论 加强孕妇围产期保健管理及高危孕妇孕期早期干预,督促定期随诊,提高高危孕妇分娩前的评估水平,提升产科医生孕期及分娩时的诊治技术、新生儿科医生危重新生儿安全转运评估质量及新生儿复苏技术成功水平,是降低新生儿及婴儿死亡的关键措施。

2011-2021年无锡市梁溪区婴儿死亡因素分析

目的:研究无锡市梁溪区2011年至2021年婴儿死亡率变化趋势、主要死因构成情况,为制定干预政策以降低婴儿死亡率提供实践依据。方法:回顾性分析梁溪区2011年至2021年的婴儿死亡资料,通过线性拟合计算婴儿死亡率的年估计百分比(EAPC)变化,分析婴儿死亡率变化趋势,采用卡方检验分析其年龄、危险因素和死因等分布特征。结果:2011-2021年婴儿死亡率和新生儿死亡率的EAPC均无统计学差异,分别为-0.003%(95%CI为-4.78%~4.39%)和-1.784%(95%CI为-7.96%~4.71%);低出生体质量儿死亡发生率大于非低出生体质量儿(χ~2=1326.559,P<0.05);早产儿死亡发生率大于非早产儿(χ~2=909.733,P<0.05)。比较婴儿死亡7个死因在各年龄组别的死亡率,新生儿窒息(χ~2=45.094,P<0.05)、早产低出生体质量(χ~2=9.955,P<0.05)和RDS(χ~2=26.143,P<0.05)在0-6日龄死亡率最高;意外(χ~2=21.900,P<0.05)在28日-11月龄死亡率最高。结论:2011-2021年梁溪区婴儿死亡率稳定在较低水平,死亡率变化趋势平稳;不同年龄组婴儿死因死亡率存在差异。提示应借鉴发达地区或国家经验,结合中国国情,制定降低婴儿死亡的干预措施。

Does Breastfeeding Have an Effect on Infant Mortality in India? An Analysis of National Family Health Survey Data

Introduction: Sub-optimal infant and early childhood feeding practices in India contribute to the high burden of child under-nutrition and infant death. Objective: To study the effect of breast-feeding duration on the survival of infants along with other demographic, socioeconomic and service related factors and to compare the decadal changes in the association. Methods: A total of 36,754 and 26,782 births less than 3 years of age from two rounds of the National Family Health Survey (NFHS) carried out in India during 1992-1993 (NFHS-1), and 2005-2006 (NFHS-3) respectively comprised the sample. Infant mortality was examined against a set of variables and breastfeeding as a time dependent covariate using multivariate extended Cox regression model. Results: Hazard of infant death observed in NFHS-3 (2005-2006) was 18 percent less [HR = 0.82;95% CI = 0.759 - 0.879] as compared to that observed in NFHS-1 (1992-1993). After adjustment of other factors, the risk of infant death was 97% less amongst children who were breastfed [HR = 0.03;95% CI = 0.029 - 0.033] as compared to those who were not breastfed. In contrast to rural area, babies belonging to urban area had an 18 percent less hazard of death during the infancy period [HR = 0.82]. Hazard of infant death was less among births to mothers with higher maternal education levels [HR = 0.93] and in those who were in gainful occupation [HR = 0.91]. The risk of infant death was higher in babies perceived to be small at birth [HR = 1.40] and belonging to states with medium post neonatal mortality rate (PNMR) [HR = 1.23;95% CI = 1.112 - 1.371] and high PNMR [HR = 1.46;95% CI = 1.327 - 1.609] in contrast to those born to women belonging to states with low post neonatal mortality. Conclusion: Promotion and implementation of evidenced based strategies are needed in India to combat the high rates of child under-nutrition and infant and child mortality.

新生儿序贯器官衰竭评估评分对极低/超低出生体重儿晚发型败血症死亡风险预测价值

目的 探索新生儿序贯器官衰竭评估(nSOFA)评分对极低/超低出生体重儿晚发型败血症死亡风险的预测价值。方法 回顾性分析2017年1月至2021年12月收治的诊断为晚发型败血症的极低/超低出生体重儿的临床资料。在败血症确诊前后的5个时间点(T-24、T-12、T0、T12、T24)计算nSOFA评分,利用受试者工作特征(ROC)曲线分析nSOFA评分对患儿死亡风险的预测价值。结果 纳入患儿135例,男66例、女69例,败血症诊断年龄为21.0(13.5~25.0)d。113例患儿存活,死亡22例(病死率16.3%)。存活组与死亡组之间在T-12、T0、T12、T24时间点nSOFA评分差异均有统计学意义(P<0.05)。ROC曲线分析显示,T-12、T 0、T 12、T 24时间点nSOFA评分预测极低/超低出生体重儿晚发型败血症死亡风险的灵敏度分别为59.1%、81.8%、93.2%、98.3%,特异度分别为63.6%、71.7%、73.7%、89.9%,曲线下面积分别为0.64、0.79、0.89、0.95。T 24时nSOFA评分的灵敏度、特异度、曲线下面积均最大。结论 nSOFA评分对极低/超低出生体重儿晚发型败血症死亡风险具有预测价值,nSOFA评分越高,败血症患儿死亡风险越大。

超早产儿死亡原因和对策建议

随着国内围生和新生儿医学的发展,超早产儿(胎龄<28周早产儿)整体救治意愿提升,数量增加,已成为国内新生儿重症监护室(NICU)新生儿死亡的重要原因。按照国外发达国家经验,随着我国社会经济发展水平提高,超早产儿在NICU死亡病例中的占比会进一步增高。因此超早产儿管理是当前及未来新生儿救治的重点和难点问题。降低超早产儿死亡风险,有赖于建立、健全围生医学中心、危重新生儿救治中心和新生儿转运体系,实施早产儿综合管理方案,综合产前、产时和产后因素,广泛开展产儿科合作。

早发型极长链酰基辅酶A脱氢酶缺乏症3例临床及遗传学分析

目的 探索早发型极长链酰基辅酶A脱氢酶缺乏症(VLCADD)的临床与遗传特征,提高对该疾病的认识。方法 回顾性分析2017年9月至2020年4月在上海交通大学医学院附属新华医院新生儿监护室诊治的3例早发型VLCADD患儿的基因型、临床表型及其预后情况。结果 3例经分子诊断的早发型VLCADD患儿中男2例,女1例,均无阳性家族史。3例患儿均在新生儿期以代谢危象或消化道症状起病。新生儿筛查2例C14:1增高,1例未行筛查。3例患儿均存在ACADVL基因变异,都为复合杂合子,变异来自父母,其中c. 1615 C> T、c. 231-232 insAATG未见报道。1例患儿生后母乳喂养,2日龄呼吸心跳骤停;另2例患儿因新生儿筛查异常,诊断后立即开始富含中链三酰甘油的特殊奶粉喂养,分别于3月龄、4月龄发生猝死。结论 早发型VLCADD为新生儿期、婴儿期潜在猝死性疾病之一,尽管积极开展早期诊断与治疗,但总体预后仍不佳,因此对先证者家系进行产前诊断、避免患儿出生至关重要。

淄博市孕产妇系统管理情况分析

目的研究淄博市孕产妇系统管理现状,为母婴安全保障工作提供依据。方法利用淄博市妇幼卫生信息三级网络,收集淄博市2017—2022年孕产妇保健和健康、围产儿死亡相关数据,汇总分析孕产妇保健管理,高危孕产妇管理,孕产妇、围产儿死亡率,围产儿死亡原因。结果淄博市2017—2022年产前检查率、孕早期检查率、产后访视率、产妇系统管理率呈上升趋势;高危孕产妇确诊率呈现上升趋势;孕产妇死亡率呈下降趋势,围产儿死亡率小幅波动差异无统计学意义(P>0.05)。结论重视孕产妇系统管理,提升孕产期保健服务质量,可有效降低孕产妇死亡率,保障母婴安全。