SIDS, licensed care centers, and Helicobacter pylori.

Abstract

To the Editor. Gershon and Moon (Pediatrics. 1997;100:75–78) have pointed out a very interesting piece of the puzzle regarding sudden infant death syndrome (SIDS) epidemiology: a disproportionately high percentage of SIDS occurs in organized child care settings. That nearly half of the centers surveyed were unaware of the association of prone infant sleep position and SIDS is alarming, but even in countries widely adhering to a “back to sleep program,” the rates of SIDS have only fallen approximately 50%. Moreover, the precise mechanism(s) linking prone sleep position with SIDS has yet to be defined.Recent studies have shown a high prevalence of Helicobacter pylori infection in young children in day care centers serving low socioeconomic populations1 as well as a close association between the presence of H pylori, detected in both gastric antrum and trachea, and SIDS.2 We have previously hypothesized that H pylori-induced interleukin-1 may produce fever, activation of the immune system, and increased deep sleep leading to SIDS.3 Intravenous and intrathecal injections of IL-1β in piglets prolong apnea and modify autoresuscitation.4 Perhaps, more importantly, H pylori produces large amounts of urease which, if aspirated in gastric juice, could reach the alveolae, react with plasma urea, and produce enough ammonia to have local and/or systemic effects; the latter may be more pronounced with the aforementioned contribution of IL-1β.3 It should also be noted that the esophageal inlet is below the upper air passages in the erect and supine positions but above them in the prone position. Moreover, a study in adults with colds revealed increased bacterial growth in the upper respiratory tract (by nasal swabs) in individuals lying prone versus supine.5We believe the possible interrelationships between day care center-related SIDS, prone sleep position, and H pyloriinfection merit further investigation from multiple scientific disciplines.