Thymic dysplasia, persistence of measles virus, and unexpected infant death

A case of sudden infant death in an 18-month female infant is described which occurred 3 weeks after clinical recovery from a typical attack of measles. At post-mortem examination no obvious cause of death could be found apart from some terminal aspiration of vomit. Histologically, the thymus showed selective absence of Hassall's corpuscles with a normal number of cortical lymphocytes. There were many atypical lymphocytoid cells in the lymph nodes, spleen, and portal tracts, and measles virus was subsequently isolated from the lung and tonsil. There was a raised titre of complement fixing measles antibody (1/256).

The sudden infant death syndrome and epidemic viral disease

A study was done to investigate the relationship between the sudden infant death syndrome (SIDS) and epidemic respiratory viral disease among hospitalized children under 18 months of age. During the 42 month-period of this study, there were 778 sudden infant deaths in Chicago and 3244 hospital admissions of children under 18 months for respiratory disease. Four outbreaks of respiratory syncytial (RS) virus infections, three outbreaks of influenza A virus infections, and several small clusters of parainfluenza virus infections occurred during the course of this study. Influenza A was the only virus infection found to have a statistically significant association with SIDS. Although environmental temperature was also significantly correlated with SIDS, the association with influenza A virus infection was independent of this temperature effect and neither association was strong.

Sudden infant death syndrome: hypothesis of causation

The airway of the young infant is anatomically vulnerable at the oropharyngeal level between the soft palate and the base of the skull. Airway occlusion at this level might occur during the muscle relaxation which occurs during REM sleep, facilitated by a hypermobile mandible, by the hypotonia of infection, perhaps by an enlarged tongue with a strong backwards sucking action which might be the result of the artificial feeding of the infant. It is possible that "cot deaths" (SIDS) may be precipitated by such oropharyngeal airway occlusion, cardiac arrest following variable periods of partial or complete oxygen deprivation.

Unexpected postneonatal deaths (cot deaths) due to recognizable disease

At least a quarter of the babies dying as unexpected home 'cot deaths' do so from recognizable diseases. A study of the background of such children, compared with age and admission controls, suggests that the disease symptomatology in this group of children differs in no way from children who are successfully treated. The factors leading to the death of these children appear to lie in the general lack of ability of some parents to recognize the importance of symptoms, their negative attitude and inability to avail themselves of health services, and the amount of drive and persistence required to obtain general medical practice services in some areas. There is also the failure of some practitioners to recognize severely ill children.

Ulceration and necrosis of vocal cords in hospital and unexpected child deaths

Lesions are described in the vocal cords of an unselected group of 91 infants dying as "cot deaths", 11 stillbirths and 107 infants and children dying from conventional diseases. The lesions have been classified into six types. After allowances for the effects of intubation, the same incidence and type of change was present in all but the stillbirths. This argues against them being a specific pathogenic mechanism confined to the cot death situation. The aetiology and pathogenesis are unexplained but indicate the existence of an unsuspected laryngeal disorder that merits further study in mechanism leading to child death.