Sudden Infant Death Research Articles

Gather together in the name of our next generation: A scoping review of the essence and implementation of community baby showers

Introduction: Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) collectively represent one of the leading causes of infant mortality worldwide. There are a range of evidence-based modifiable risk factors for both, particularly related to the infant’s sleep environment. Oftentimes, social determinants of health impact optimization of an infant’s sleep environment, thereby compromising their safety and elevating their risk for SIDS and SUID. Many kinds of community interventions that include campaigns and programs have sought to address these environmental modifiable risk factors that contribute towards heightened risk for SIDS and SUID. However given resource limitations, reach and access considerations, and scarcity of a streamlined harmonized process to draw on the strengths of a community in SUID and SIDS reduction, there is mixed success with these interventions. Methods: Although community baby showers are rising as a trending health promotion intervention to optimize access to care, resources and support to infants and their caregivers as well as optimize infant growth and development, there is no review paper to date that consolidates the strengths and limitations in the quality, delivery and evaluation of community baby showers as a continued focus for future public health interventions surrounding the infant population which informs the development of this scoping review. Results: Specifically, this review synthesizes the commonalities, differences, key findings, intervention components as well as gaps in research and practice on community baby showers across published studies (n=20) and secondary sources (n=4). Conclusion: Clinical and public health implications are also closely examined and further inform recommendations for future directions that draw on the strengths and build off the limitations of findings from this review to heighten the clinical and public health impact and further assess the efficacy of community baby showers as an evidence-based community engagement and health promotion intervention for our next generation of infants and their families.

Cardiac rhabdomyoma: an uncommon culprit in sudden infant death

Sudden death in infants remains a common and poorly understood cause of childhood mortality in the USA. Pediatric cardiac tumors, although rare, may underlie some cases of unexplained sudden infant death. Autopsy is a crucial diagnostic step in these cases, as both gross and microscopic examination of the heart may uncover occult cardiac tumors. Rhabdomyomas are the most common cardiac tumors in childhood and may result in arrythmia and sudden death. We present a case of sudden death in a healthy 5-month-old infant which initially appeared “SIDS-like” until thorough histological analysis revealed an underlying cardiac rhabdomyoma. The case is of particular importance in that the gross examination of the heart was considered completely normal, and the tumor only involved certain portions of the heart microscopically. Had a single random section of myocardium been the only heart section examined microscopically, the diagnosis might have been missed. This case emphasizes the importance of thorough microscopic examination in infant cases, especially in cases where the heart appears grossly normal.

Severe Hypoplasia/Aplasia of the Medullary Arcuate Nucleus in a 4-Month-Old Patient with Sudden Infant Death Syndrome

AbstractThe aim of this study was to verify and confirm the close correlation between the absence of the medullary arcuate nucleus and sudden death in a 4-month-old infant. Careful neuropathological examination of the cerebral hemispheres, basal ganglia, and cerebellum demonstrated no relevance to the death. The brainstem region, normally occupied by the nuclei, was cut into several serial sections so as not to lose any details. The largest median part of the medullary arcuate nucleus was completely absent, and only very small groups of residual neurons in its most lateral part were still detectable; the rest of the brainstem showed no abnormalities. In the absence of other lesional, degenerative, or malformative causes, the sudden and unexpected death of this infant was likely due to severe hypoplasia/aplasia of the medullary arcuate nucleus. The anatomo-functional development of the nucleus and its crucial role in the control of respiratory and cardiac autonomic reactivity in sleep during the first year of life may provide an important contribution to the pathogenic interpretation.

More than just a crib: Assessing the prevalence of partnerships between Cribs for Kids and children’s hospitals in the United States

Introduction: Cribs for Kids is a national organization with a mission to reduce sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID) nationwide through adaptation of best practices in infant safe sleep, community engagement, and increased access to resources in assuring infant safety during time of sleep. One integral partnership that enables Cribs for Kids to cast a wider net in yielding the potential to reach many more infants and their families across the country involves attainment of hospitalwide certification by Cribs for Kids across both academic and community healthcare systems that provide care to infants for up to one year of age. Methods: However to date, the prevalence of these partnerships remains unclear. It follows that the present study sought to uncover this prevalence across the nation. Utilizing the U.S. News and World Report, the researcher acquired a random sample of 110 children’s hospitals. Next utilizing the map locator of hospitals certified at the Gold, Silver and Bronze levels by Cribs for Kids on the organization’s website, prevalence of presence and level of certification was ascertained across this sample of children’s hospitals. Results: Notably, the vast majority of this sample (n=78) had not attained hospitalwide certification with Cribs for Kids. Among the hospitals that had attained certification, there was substantial variation across levels based on a range of health promotion and community engagement practices. Conclusion: Recommendations for harnessing the potential of this collaboration are presented to inform directions in examining these partnerships as a point of intervention for future planning considerations across community engagement and health promotion practices surrounding SIDS reduction.

Organ weights and length anthropometry measures at autopsy for sudden infant death syndrome cases and other infant deaths in the Chicago infant mortality study.

Organ weights are a possible diagnostic or pathophysiological clue to distinguishing sudden infant death syndrome (SIDS) cases from other infant deaths but suffer from major confounding. Using autopsy data from the Chicago Infant Mortality Study, a majority African-American case-control study of deceased infants under 1 year conducted 1993-96, we assessed differences in the weights of brain, thymus, kidneys, lungs, liver, spleen, total body, and four length anthropometry measures in SIDS-diagnosed infants compared to controls. Using exact and coarsened matching, we ran Bayesian linear models with these anthropometry outcomes and repeated the analyses substituting the corresponding fitted allometrically-scaled organ weight indices to account for body size. After detailed analysis and adjustment for potential confounders, we found that matched SIDS infants were generally bigger than controls, with higher mean brain, liver, spleen, thymus, lung, and total body weights, and higher mean head and chest circumference, crown-heel, crown-rump lengths. SIDS infants also had higher mean thymus, liver, spleen, lung and total body weight indices. The association with thymus weight was proportionately greater in magnitude than any other outcome measure and independent of body size. The results of these more detailed analyses are consistent with recent findings from other studies with differing racial compositions, and substantially confirm the primary organ sites for more detailed mechanistic research into the biological dysregulation contributing to underlying pathophysiology of SIDS.

Infant and child mortality in Afghanistan: A scoping review.

Since 1990, global child and infant mortality rates have typically stabilized or decreased due to improved healthcare, vaccination rollouts, and international funding. However, Afghanistan continues to face the highest child and infant mortality rates globally, with 43 deaths per 1000 live births. This study aims to examine the factors contributing to this high mortality rate and propose interventions to address the issue. A comprehensive literature search was conducted using databases such as Google Scholar and PubMed, focusing on articles published in English within the last 10 years (2013-2023). The search terms included "Child mortality," "Infant mortality," "SIDS," "COVID-19," and "Afghanistan." Original studies, systematic reviews, case studies, and reports meeting the inclusion criteria were selected for analysis. Additional sources from organizations such as UNICEF, the World Bank Group, WHO, and EMRO were also reviewed. The study findings reveal significant challenges contributing to Afghanistan's high infant and child mortality rates. These challenges include birth defects, preterm birth, malnutrition, sudden infant death syndrome (SIDS), traumatic injuries, fatal infections, infanticide, and abuse. The ongoing conflict, insecurity, and humanitarian crises further exacerbate the situation, leading to increased child casualties. Despite efforts by international agencies like UNICEF to provide vaccines and maternal education, the infant mortality rate remains high. In conclusion, Afghanistan's child and infant mortality rates are of significant concern, and it is imperative that action be taken to reduce the incidence of child and infant mortality rates.

Change-point detection using diffusion maps for sleep apnea monitoring with contact-free sensors

Change-point detection using diffusion maps for sleep apnea monitoring with contact-free sensors

New Step in Understanding the Pathogenetic Mechanism of Sudden Infant Death Syndrome: Involvement of the Pontine Reticular Gigantocellular Nucleus.

This study aimed to investigate, for the first time, the potential role of the gigantocellular nucleus, a component of the reticular formation, in the pathogenetic mechanism of Sudden Infant Death Syndrome (SIDS), an event frequently ascribed to failure to arouse from sleep. This research was motivated by previous experimental studies demonstrating the gigantocellular nucleus involvement in regulating the sleep-wake cycle. We analyzed the brains of 48 infants who died suddenly within the first 7 months of life, including 28 SIDS cases and 20 controls. All brains underwent a thorough histological and immunohistochemical examination, focusing specifically on the gigantocellular nucleus. This examination aimed to characterize its developmental cytoarchitecture and tyrosine hydroxylase expression, with particular attention to potential associations with SIDS risk factors. In 68% of SIDS cases, but never in controls, we observed hypoplasia of the pontine portion of the gigantocellular nucleus. Alterations in the catecholaminergic system were present in 61% of SIDS cases but only in 10% of controls. A strong correlation was observed between these findings and maternal smoking in SIDS cases when compared with controls. In conclusion we believe that this study sheds new light on the pathogenetic processes underlying SIDS, particularly in cases associated with maternal smoking during pregnancy.

Added value of postmortem mri in sudden unexpected infant death cases.

We aimed to investigate the potential added value of postmortem MRI (PMMRI) in sudden unexpected infant death (SUID) cases referred to our center between September 2020 and June 2023. Ultimately, 19 SUID cases underwent PMMRI alongside standard autopsy procedures, which included technical examinations such as postmortem CT (PMCT). Four radiologists, two with prior PMMRI experience, provided structured reports following consensus. For each case, the responsible forensic medicine specialist documented the cause of death before and after reviewing the PMMRI report. Additionally, they assessed the overall impact of the PMMRI report and had the opportunity to provide written comments. The results of our study indicate that none of the PMMRI reports altered the prior determined cause of death, which included cases of infection, asphyxia, and sudden infant death syndrome (SIDS). However, we observed a moderate impact in one case and a low impact in 10 cases. The moderate impact arose from the PMMRI report identifying hypoxic-ischemic changes, where histologic examination of the brain was perceived as normal. Conversely, in the 10 cases with a low impact, the PMMRI reports supported the autopsy findings, specifically indicating brain injury and intra-alveolar cellular infiltrates. In conclusion, our study suggests that while PMMRI may not be pivotal in determining the cause of death in SUID cases, it could aid in detecting hypoxic-ischemic changes and reinforcing brain and lung observations. However, distinguishing genuine lung pathology from postmortem changes using PMMRI remains challenging. Further research is warranted to clarify the role of PMMRI in forensic SUID investigations.

Known pathogenic gene variants and new candidates detected in sudden unexpected infant death using whole genome sequencing.

The purpose of this study is to gain insights into potential genetic factors contributing to the infant's vulnerability to Sudden Unexpected Infant Death (SUID). Whole Genome Sequencing (WGS) was performed on 144 infants that succumbed to SUID, and 573 healthy adults. Variants were filtered by gnomAD allele frequencies and predictions of functional consequences. Variants of interest were identified in 88 genes, in 64.6% of our cohort. Seventy-three of these have been previously associated with SIDS/SUID/SUDP. Forty-three can be characterized as cardiac genes and are related to cardiomyopathies, arrhythmias, and other conditions. Variants in 22 genes were associated with neurologic functions. Variants were also found in 13 genes reported to be pathogenic for various systemic disorders and in two genes associated with immunological function. Variants in eight genes are implicated in the response to hypoxia and the regulation of reactive oxygen species (ROS) and have not been previously described in SIDS/SUID/SUDP. Seventy-two infants met the triple risk hypothesis criteria. Our study confirms and further expands the list of genetic variants associated with SUID. The abundance of genes associated with heart disease and the discovery of variants associated with the redox metabolism have important mechanistic implications for the pathophysiology of SUID.

Investigating cardiac genetic background in sudden infant death syndrome (SIDS)

Sudden infant death syndrome (SIDS) is still the leading cause of death for newborns in developed countries. The pathophysiological mechanisms have not been fully clarified, but in some of SIDS cases variants of genes associated with inherited cardiac conditions are found. In this study, an analysis of SCD-related genes was performed to determine the prevalence of rare pathogenic (P) or likely pathogenic (LP) variants that could provide an unambiguous explanation for the fatal event. A cohort of 76 SIDS cases underwent Next-Generation Sequencing (NGS) analysis with a custom panel of SCD-related genes. Rare variants were classified according to the guidelines provided by the American College of Medical Genetics and Genomics (ACMG) and the specifications of the ClinGen association. Post-mortem genetic testing identified 50 (65.8%) carriers of at least one variant in SCD genes. 104 rare genetic variants were found, 65.4% in genes encoding structural proteins. Only 4 out of 76 cases (5.3%) hosted at least a P or LP variant found in genes with structural or structural/arrhythmogenic functions (SLC22A5, SCN5A, MYL3and TTN). 99 variants were classified as of uncertain significance (VUS). The difference in the distribution of variants between gene groups by function was not statistically significant (chi square, p = 0,219). Despite this, most of the variants concerned structural genes that were supposed to have a close interaction with ion channels, thus providing an explanation for the arrhythmic event. Segregation analysis, reclassification of VUS variants and identification of new associated genes could clarify the implications of the current findings.

Coenzyme Q deficiency may predispose to sudden unexplained death via an increased risk of cardiac arrhythmia

Cardiac arrhythmia is currently considered to be the direct cause of death in a majority of sudden unexplained death (SUD) cases, yet the genetic predisposition and corresponding endophenotypes contributing to SUD remain incompletely understood. In this study, we aimed to investigate the involvement of Coenzyme Q (CoQ) deficiency in SUD. First, we re-analyzed the exome sequencing data of 45 SUD and 151 sudden infant death syndrome (SIDS) cases from our previous studies, focusing on previously overlooked genetic variants in 44 human CoQ deficiency-related genes. A considerable proportion of the SUD (38%) and SIDS (37%) cases were found to harbor rare variants with likely functional effects. Subsequent burden testing, including all rare exonic and untranslated region variants identified in our case cohorts, further confirmed the existence of significant genetic burden. Based on the genetic findings, the influence of CoQ deficiency on electrophysiological and morphological properties was further examined in a mouse model. A significantly prolonged PR interval and an increased occurrence of atrioventricular block were observed in the 4-nitrobenzoate induced CoQ deficiency mouse group, suggesting that CoQ deficiency may predispose individuals to sudden death through an increased risk of cardiac arrhythmia. Overall, our findings suggest that CoQ deficiency-related genes should also be considered in the molecular autopsy of SUD.

Death from Failed Protection? An Evolutionary-Developmental Theory of Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) has been mainly described from a risk perspective, with a focus on endogenous, exogenous, and temporal risk factors that can interact to facilitate lethal outcomes. Here we discuss the limitations that this risk-based paradigm may have, using two of the major risk factors for SIDS, prone sleep position and bed-sharing, as examples. Based on a multipronged theoretical model encompassing evolutionary theory, developmental biology, and cultural mismatch theory, we conceptualize the vulnerability to SIDS as an imbalance between current physiologic-regulatory demands and current protective abilities on the part of the infant. From this understanding, SIDS appears as a developmental condition in which competencies relevant to self-protection fail to develop appropriately in the future victims. Since all of the protective resources in question are bound to emerge during normal infant development, we contend that SIDS may reflect an evolutionary mismatch situation—a constellation in which certain modern developmental influences may overextend the child’s adaptive (evolutionary) repertoire. We thus argue that SIDS may be better understood if the focus on risk factors is complemented by a deeper appreciation of the protective resources that human infants acquire during their normal development. We extensively analyze this evolutionary-developmental theory against the body of epidemiological and experimental evidence in SIDS research and thereby also address the as-of-yet unresolved question of why breastfeeding may be protective against SIDS.

Newborn auditory brainstem response and sudden infant death syndrome.

Sudden infant death syndrome (SIDS)-the sudden and unexplained death of a seemingly healthy infant, <1 year old-may be associated with abnormalities in the brain regions that underlie breathing and arousal during sleep. While post-mortem studies suggest abnormalities in SIDS infants' brainstems, there are no studies of these infants' brainstem function before death. One way to assess the function of the brainstem is with auditory brainstem response (ABR), a routine hearing-screening method that noninvasively measures the brainstem's response to sound. We hypothesize that anomalies in newborns' ABR measures may predict SIDS. Indeed, previous studies identified abnormalities in ABR characteristics in small samples of near-miss SIDS infants hospitalized for infant apnea syndrome. However, there is a need to examine the ABRs of infants who died of SIDS. Therefore, in the current study, we propose integrating two secondary datasets to examine newborns' ABRs (N = 156,972), including those who later died of SIDS (n = ~42; .27 out of every 1000 infants), using existing archived records of neonatal ABR results from a sample of newborns born in Florida. We hypothesize that infants who die from SIDS are more likely than non-SIDS infants to have abnormal ABRs as newborns. Understanding the association between SIDS and ABR may facilitate more accurate identification of an infant's risk for SIDS at birth, enabling increased monitoring, which may facilitate interventions and improve survivorship.

Sudden Unexpected Infant Death and Sleep Surface Sharing

Sudden Unexpected Infant Death and Sleep Surface Sharing

Early Screening for Long QT Syndrome and Cardiac Anomalies in Infants: A Comprehensive Study.

(1) Background: Sudden Infant Death Syndrome (SIDS) represents sudden and unexplained deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for a prolonged QTc interval, a marker for Long QT Syndrome (LQTS), should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiograms (ECGs) could identify congenital heart defects (CHDs) early, especially those not detected at birth. Infants with prolonged QTc intervals typically undergo genetic analysis for Long QT Syndrome. (2) Methods: The study involved infants aged 20-40 days, born with no apparent clinical signs of heart disease, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHDs identified immediately after birth, as well as infants who had previously had an ECG or echocardiogram for other medical reasons, were excluded from the study. We used statistical software (SPSS version 22.0) to analyze the data. (3) Results: Of the 42,200 infants involved, 2245 were enrolled, with 39.9% being males. Following this initial screening, 164 children (37.8% males) with prolonged QTc intervals underwent further evaluation. Out of these 164 children, 27 children were confirmed to have LQTS. However, only 18 children were finally investigated for genetic mutations, and mutations were identified in 11 tests. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Treatment options included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%. (4) Conclusions: This screening approach has demonstrated effectiveness in the early identification of LQTS and other cardiac rhythm anomalies, with additional identification of mutations and/or prolonged QTc intervals in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.

Kenntnisse und tatsächliche Umsetzung der Empfehlungen zur Prävention des plötzlichen Säuglingstods innerhalb des ersten Lebensjahres – eine Analyse longitudinaler Daten der KUNO Kids Gesundheitsstudie

Kenntnisse und tatsächliche Umsetzung der Empfehlungen zur Prävention des plötzlichen Säuglingstods innerhalb des ersten Lebensjahres – eine Analyse longitudinaler Daten der KUNO Kids Gesundheitsstudie

A New Normal: A Pilot Examination of the Modern Cephalic Index

ABSTRACT Introduction The cephalic index (CI) is the width-to-length ratio of the head. Brachycephalic head shapes are wider than the norm and have a higher CI. In 1994, the American Academy of Pediatrics recommended babies sleep on their backs to combat rates of sudden infant death syndrome, which correlated to a sudden increase in the incidence of brachycephaly in the American population. The commonly accepted “normal” CI comes from a table that was published in the 1970s and should be updated for the modern population. The purpose of this study is to examine the modern average CI, compare measurements from today’s population to the highly referenced 1970s table, and examine what genealogical factors may impact a person’s CI measurement. Methods Fifty-nine subjects were measured for cephalic width and length. CI was calculated for all subjects, and statistical analysis was performed. Results There was a clinically significant increase in CI in every age group since the 1970s. The only statistically significant differences were between ethnicity and ethnicity-sex subgroups (not between age or sex groups). Conclusions The CI has changed in recent years, and based on these pilot data, the modern CI may be impacted more by ethnicity than age and sex. Clinical Relevance The typical CI in the modern generation is higher from the previously used 1970s standard tables. Updated measurements would aid clinicians when determining the need for cranial remolding orthoses and provide insight into the outcomes of treatment for deformational head shapes (whether via orthoses or other methods).

Dysregulation of platelet serotonin, 14–3–3, and GPIX in sudden infant death syndrome

Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant mortality, but the underlying cause(s) are unclear. A subset of SIDS infants has abnormalities in the neurotransmitter, serotonin (5-hydroxytryptamine [5-HT]) and the adaptor molecule, 14–3–3 pathways in regions of the brain involved in gasping, response to hypoxia, and arousal. To evaluate our hypothesis that SIDS is, at least in part, a multi-organ dysregulation of 5-HT, we examined whether blood platelets, which have 5-HT and 14–3–3 signaling pathways similar to brain neurons, are abnormal in SIDS. We also studied platelet surface glycoprotein IX (GPIX), a cell adhesion receptor which is physically linked to 14–3–3. In infants dying of SIDS compared to infants dying of known causes, we found significantly higher intra-platelet 5-HT and 14–3–3 and lower platelet surface GPIX. Serum and plasma 5-HT were also elevated in SIDS compared to controls. The presence in SIDS of both platelet and brainstem 5-HT and 14–3–3 abnormalities suggests a global dysregulation of these pathways and the potential for platelets to be used as a model system to study 5-HT and 14–3–3 interactions in SIDS. Platelet and serum biomarkers may aid in the forensic determination of SIDS and have the potential to be predictive of SIDS risk in living infants.

Educational Boost Slashes SIDS Risk Awareness Gap Among Nurses in Iraq

This study evaluates the impact of an educational program on nurses' knowledge of Sudden Infant Death Syndrome (SIDS) risk factors at pediatric teaching hospitals in Baghdad City. Using a quasi-experimental design with fifty nurses divided into a control and a research group, we assessed knowledge levels through pre-tests and two post-tests. Results indicated that the educational intervention significantly improved nurses' knowledge from 60% to 76%, although this effect diminished slightly over time. The study underscores the importance of continuous education in enhancing nurse awareness and the implementation of safe sleep practices to reduce SIDS occurrences. Highlights: Educational Impact: The study demonstrates a significant increase in nurses' knowledge about SIDS risk factors following an educational intervention. Sustained Learning: Knowledge gains were observed to diminish slightly over time, highlighting the need for ongoing educational programs. Practical Implications: Enhanced nurse training supports safer sleep practices, potentially reducing the incidence of SIDS. Keywords: Nurse Education, Knowledge, Risk Factors, Sudden Infant Death Syndrome, Safe Sleep Practices