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Review
. 2009 Aug 20;361(8):795-805.
doi: 10.1056/NEJMra0803836.

The sudden infant death syndrome

Hannah C Kinney  1 , Bradley T Thach
Affiliations
Review

The sudden infant death syndrome

Hannah C Kinney et al. N Engl J Med. .
No abstract available

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Figures

Figure 1
Figure 1. Five Steps in the Putative Terminal Respiratory Pathway Associated with the Sudden Infant Death Syndrome
Death results from one or more failures in protective mechanisms against a life-threatening event during sleep in the vulnerable infant during a critical period. Complex genetic and environmental interactions influence the pathway.
Figure 2
Figure 2. Cardiorespiratory Recordings in Infants, Showing the Results of Successful and Unsuccessful Autoresuscitation
Complete autoresuscitation (Panel A) is compared with ineffectual gasping (Panel B) in cardiorespiratory recordings from infants who died suddenly while being monitored at home.68 In Panel A, the tracing starts with a gasp (G1), which is followed by a gradual increase in the heart rate (subpanel a). (The spikes in heart rate that are simultaneous with gasps are probably recording artifacts.) The second gasp (G2) results in an increased heart rate, at more than 100 beats per minute. After an interruption of 6 minutes 40 seconds, eupneic breaths are noted (subpanel b). Each large breath (B1–B6) is preceded and followed by smaller breaths. Larger breaths may be sighs. In Panel B, hyperpneic breaths (B1–B7) are followed by 35 seconds of primary (hypoxic) apnea (subpanel a). Gasps (G1–G3) follow this apnea. G1 is an abnormally complex, triple gasp. A period of terminal gasps (G6–68) occurs about 10 minutes after the onset of primary apnea, with decreasing amplitude and altered configuration (subpanel b). SIDS denotes sudden infant death syndrome.
Figure 3
Figure 3. The Serotonergic System and Possible Effects on Homeostatic Function
The serotonergic system is considered to be critical for the modulation and integration of diverse homeostatic functions. The medullary level of the brain stem (black line in Panel A) includes regions involved in the regulation of upper-airway control, respiration, temperature, autonomic function, and the sympathetic nervous system. In the medulla of an infant with the sudden infant death syndrome (SIDS), tissue autoradiography that was performed with the use of a specific radioligand shows a generalized reduction in binding to the 5-hydroxytryptamine type 1A receptor (Panel B), as compared with that in a control infant at the same postconceptional age (Panel C). ARC denotes arcuate nucleus, DMX dorsal motor nucleus of the vagus nerve, GC ganglion cells, HG hypoglossal nucleus, NA noradrenaline, NTS nucleus tractus solitarius, PGCL paragigantocellularis lateralis, PreBot pre-Bötzinger complexes, and ROb raphe obscurus. Modified from a figure in Paterson et al.
See this image and copyright information in PMC

Comment in

  • Sudden infant death syndrome.
    Porzionato A, Macchi V, De Caro R. Porzionato A, et al. N Engl J Med. 2009 Dec 24;361(26):2580; author reply 2581-2. doi: 10.1056/NEJMc0909324. N Engl J Med. 2009. PMID: 20032331 No abstract available.
  • Sudden infant death syndrome.
    Klitz W, Niklasson B. Klitz W, et al. N Engl J Med. 2009 Dec 24;361(26):2580-1; author reply 2581-2. N Engl J Med. 2009. PMID: 20050315 No abstract available.
  • Sudden infant death syndrome.
    Mage DT, Cohen M, Donner M. Mage DT, et al. N Engl J Med. 2009 Dec 24;361(26):2581; author reply 2581-2. N Engl J Med. 2009. PMID: 20050322 No abstract available.

References

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