SIDS: A perspective on SIDS pathogenesis. The hypotheses: plausibility and evidence

Paul N Goldwater BMC Medicine 2011, 9:64doi:10.1186/1741-7015-9-64

Published:	27 May 2011

Abstract (provisional)

Several theories of the underlying mechanisms of Sudden Infant Death Syndrome (SIDS) have been proposed. These theories have born relatively narrow beach-head research programs attracting generous research funding sustained for many years at expense to the public purse. This perspective endeavors to critically examine the evidence and bases of these theories and determine their plausibility; and questions whether or not a safe and reasoned hypothesis lies at their foundation. The Opinion sets specific criteria by asking the following questions: 1. Does the hypothesis take into account the key pathological findings in SIDS? 2. Is the hypothesis congruent with the key epidemiological risk factors? 3. Does it link 1 and 2? Falling short of any one of these answers, by inference, would imply insufficient grounds for a sustainable hypothesis. Some of the hypotheses overlap, for instance, notional respiratory failure may encompass apnea, prone sleep position, and asphyxia which may be seen to be linked to co-sleeping. For the purposes of this paper, each element will be assessed on the above criteria.
http://www.biomedcentral.com/1741-7015/9/64/abstract

SIDS: Sudden Unexpected Death in Infancy and the Dilemma of Defining the Sudden Infant Death Syndrome

Henry F. Krous

Departments of Pathology and Pediatrics, UCSD School of Medicine and Rady Children’s Hospital-San Diego, La Jolla

CA, USA

Abstract:

Sudden unexpected death in infancy (SUDI) is an umbrella label that some employ to encompass all sudden unexpected infant deaths, whether or not explained, while others restrict its use to cases in which the cause of death is uncertain, but possibly due to asphyxia as may occur, for example, with sleeping prone, face down on a soft sleep surface, and/or being found with the head covered. Since sudden infant death syndrome (SIDS) is a diagnosis of exclusion, there is an inevitable interface between it and those cases whose deaths are potentially caused by unsafe sleep environments. This
interface is especially blurred given the lack of definitive, easily identifiable postmortem marker(s) for SIDS. Therefore, present SIDS definitions are imprecise and its diagnosis remains one of exclusion. Improved death scene investigation has resulted in a diagnostic shift away from SIDS towards other causes of death such as positional asphyxia or undetermined.

Unfortunately incomplete death scene investigation has hampered evaluation of the real circumstances of death in too many of the cases further contributing to confusion. In this report, the purposes for and primary definitions of SIDS are delineated. Subsequent discussion focuses on the increasing challenge to incorporate risk factors and the underlying

pathology germane to the pathophysiology of SIDS into future definitions. This challenge is matched by the need to develop affordable and widely available testing that will identify pathology relevant to medical examiners and others

charged with certifying the cause and manner of death.
Current Pediatric Reviews,
<http://www.californiasids.com/UploadedFiles/Forms/SIDSDiagnosticDilemmasKrous.pdf>
Blogger's Comment:
An important article that analyses some of the abuse and misuse of the unsatisfactory nature of SIDS as a diagnosis.