Sudden infant death syndrome: overview of recent research developments from a pediatric pathologist's perspective

Interesting new information concerning SIDS infants has appeared in the medical literature in recent years. It seems that the unique curve for their ages at death is independent of all other risk factors suggesting that, in most cases, there is probably an important mechanism involving growth and development. Furthermore, some SIDS deaths occur among newborns and comprise as much as 10% of all neonatal mortality, an issue heretofore systematically excluded from consideration. Until now, racial differences in SIDS rates were usually attributed to differences in socioeconomic status. Recent data concerning impoverished Hispanics in this country appear to indicate that cultural factors must play some role as well. Pediatric pathologists have demonstrated a higher incidence of dysmorphic, dysplastic, and minor anomalous lesions as well as cytomegaloviral infection among SIDS babies than among autopsied control infants. These observations suggest that the former have experienced adverse influences prenatally which may make them peculiarly vulnerable to postnatal challenges. One study indicates that virtually all SIDS victims have higher than normal levels of fetal hemoglobin which fact, if confirmed, may permit identification of the potential victim before the fact. Finally, the multicenter NICHD study has shown that only 39.8% of 757 crib death babies had received DTP inoculation as compared to 53.2 and 55% of two control groups of living infants. In fact, one conclusion of the study might be that DTP immunization is likely to protect an infant against crib death.