Japanese national SIDS project: 1998-2000 research for the improvement of infant mortality

The aim of the present study is to see if by conducting research on sudden infant death syndrome (SIDS), one of major contributing factors to infant mortality in Japan, infant mortality can be reduced. Concrete approaches taken in this study took four different directions: elucidation of SIDS etiology, prevention, elucidation of its social aspects (education) and the investigation of administrative aspects. At the same time, an attempt was made to get better grasp on the epidemiological trends in infant mortality, including that of SIDS. The idea behind this etiological approach was to unify hitherto separate approaches taken by those in epidemiological, physiological and pathological fields. A molecular-biological approach was also added. Physiologically hypothesized causes of SIDS--apnea and arousal disorder--together with the epidemiologically presumed risk factor of sleeping position, were examined jointly from a pathological viewpoint. Research in the first 2 years of the grant found that hypoxia reflected by gliosis in the brain stem arousal pathway was related to the duration of sleep apnea. Research in the final year of the grant found the possibility of organic fragility in the brain stem arousal pathway, particularly in periaqueducal gray matter and pedunculopontine nucleus reflected by apoptosis and neuronal plasticity. These findings gave support to the arousal disorder hypothesis in SIDS. Application of the restriction landmark genomic scanning (RLGS) method supported the possibility of locating a site for a SIDS-specific gene. The US collaborative home infant monitoring evaluation (CHIME) currently in use was evaluated. In addition, three new monitoring methods were developed: a non-invasive multi-channel pressure-sensing bed, microwave radar, and a pacifier that functions as a suckometer which can be used to evaluate a neonate's autonomic nervous functions. Social (educational) activities included: surveys of the current state of educational campaigns on SIDS in other countries, epidemiological evaluation of campaigns run by the Japan SIDS families' Association to evaluate the effectiveness of the SIDS campaign, and creation of a home page, mostly to inform the public about the output from this research group. "Guidelines for Death Scene Investigation of Sudden, Unexplained Infant Deaths: Recommendations of Interagency Panel on Sudden Infant Death Syndrome" was translated into japanese. Activities that concerned administrative measures included clarification of the unique nature of SIDS-related trials in Japan when compared to those in the United States. Other concrete administrative proposals were: a pressing need to increase the rate of SIDS-related autopsies to facilitate a better etiological understanding and, for this purpose, establishing regulations in local jurisdictions and amending Article 8 of the Postmortem Examination and Corpse Preservation Act, keeping in perspective the medico-economic evaluation of the japanese medical examiner system. For these proposals to be realized, establishment of a new office in charge of administrative and approved autopsies at the national level of government is desirable. Also pointed out were the different opinions held among specialists concerning the diagnosis of SIDS and their need to hold multiple conferences to unify their views. Basic data for these conferences were provided from epidemiological examinations of infant mortality.