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Abnormal regulation of ventilation in infants at risk for sudden-infant-death syndrome

D C Shannon, D H Kelly, K O'Connell

    The New England Journal of Medicine
    |October 6, 1977
    PubMed

    Insights

    Infants experiencing apparent sudden infant death syndrome (SIDS) episodes show abnormal breathing control. These infants exhibit hypoventilation and a reduced response to inhaled carbon dioxide, indicating a ventilation regulation defect.

    Area of Science:

    • Pediatric Medicine
    • Respiratory Physiology
    • Neonatology

    Background:

    • Sudden Infant Death Syndrome (SIDS) remains a leading cause of post-neonatal mortality.
    • The underlying pathophysiology of SIDS is not fully understood.
    • Aborted SIDS cases, characterized by prolonged apnea, offer insights into potential SIDS mechanisms.

    Purpose of the Study:

    • To investigate if alveolar hypoventilation and impaired ventilatory response to carbon dioxide contribute to SIDS.
    • To compare ventilatory control during quiet sleep in normal infants versus infants with aborted SIDS.

    Main Methods:

    • Assessed ventilatory control during quiet sleep in two groups: normal infants and infants with a history of prolonged apnea (aborted SIDS).
    • Measured alveolar partial pressure of carbon dioxide (PaCO2) and ventilatory response to inhaled carbon dioxide.
    • Compared physiological parameters between the two infant groups.

    Main Results:

    • Infants with aborted SIDS demonstrated significantly higher resting alveolar PaCO2 (hypoventilation) compared to normal infants (38.9 vs. 35.1 mm Hg, P < 0.01).
    • The ventilatory response to inhaled carbon dioxide was markedly impaired in infants with aborted SIDS (22.1 vs. 63.1 ml/kg/min/mm Hg, P < 0.001).
    • Three infants with aborted SIDS later died during sleep; autopsies revealed no clear cause.

    Conclusions:

    • Infants with a history suggestive of SIDS exhibit a defect in the regulation of alveolar ventilation.
    • Hypoventilation and an abnormal ventilatory response to carbon dioxide are significant findings in these infants.
    • These respiratory control abnormalities may play a crucial role in the pathogenesis of SIDS.

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