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Reuben J, Vaithianathan R, Berger R. Identifying infants at risk of sudden unexpected death with an automated predictive risk model. Child Abuse Negl 2024; 151:106716. [PMID: 38531245 DOI: 10.1016/j.chiabu.2024.106716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND/OBJECTIVE Sudden unexpected infant death (SUID) is a common cause of infant death. We evaluated whether a predictive risk model (PRM) - Hello Baby - which was developed to stratify children by risk of entry into foster care could also identify infants at highest risk of SUID and non-fatal unsafe sleep events. PARTICIPANTS AND SETTING Cases: Infants with SUID or an unsafe sleep event over 5½ years in a single county. CONTROLS All births in the same county. METHODS Retrospective case-control study. Demographic and clinical data were collected and a Hello Baby PRM score was assigned. Descriptive statistics and the predictive value of a PRM score of 20 were calculated. RESULTS Infants with SUID (n = 62) or an unsafe sleep event (n = 37) (cases) were compared with 23,366 births (controls). Cases and controls were similar for all demographic and clinical data except that infants with unsafe sleep events were older. Median PRM score for cases was higher than controls (17.5 vs. 10, p < 0.001); 50 % of cases had a PRM score 17-20 vs. 16 % of controls (p < 0.001). CONCLUSIONS The Hello Baby PRM can identify newborns at high risk of SUID and non-fatal unsafe sleep events. The ability to identify high-risk newborns prior to a negative outcome allows for individualized evaluation of high-risk families for modifiable risk factors which are potentially amenable to intervention. This approach is limited by the fact that not all counties can calculate a PRM or similar score automatically.
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Affiliation(s)
- Julia Reuben
- Allegheny County Department of Human Services, United States of America
| | - Rhema Vaithianathan
- Centre for Social Data Analytics, Auckland University of Technology, New Zealand
| | - Rachel Berger
- Child Advocacy Center, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, United States of America.
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Habich M, Zielenkiewicz P, Paczek L, Szczesny P. Correlation of gestational age and age at death in sudden infant death syndrome: another pointer to the role of critical developmental period? BMC Pediatr 2024; 24:259. [PMID: 38641787 PMCID: PMC11027530 DOI: 10.1186/s12887-024-04712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Filiano and Kinney proposed a triple-risk model for the sudden infant death syndrome (SIDS) that involves the intersection of three risks: (1) a vulnerable infant, (2) a critical developmental period in homeostatic control, and (3) an exogenous stressor(s). The primary evidence for the role of a critical developmental period in SIDS etiology is the peak of cases around the third month of life. Independently, several studies pointed to correlation between gestational age and age at death in SIDS, but used that to assess the SIDS risk for preterm infants, ignoring further ramifications. METHODS We did a detailed analysis of CDC data spanning over two decades (1983-2011). We focused not only on the correlation between two age variables (gestational and age at death), but also on the possibility of misdiagnosis. Also, we attempted to account for potential biases in the data induced by the ICD-9/ICD-190 transition or the "Back to Sleep" campaign. RESULTS The peak of deaths in the third month of life, that was the main argument for the role of the critical development period, wasn't unique to SIDS. However, we confirmed an almost linear and negative correlation between gestational age and the week of death due to SIDS. This pattern (slope of correlation < 0 and significance of correlation p < 0.05) is characteristic of SIDS among all diseases analyzed in the study. CONCLUSIONS We interpret the results as the evidence of the role of the critical development period in SIDS etiology. Possibly more attention in the future research should be put to theories that are based on homeostatic control.
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Affiliation(s)
- Malgorzata Habich
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland
| | - Piotr Zielenkiewicz
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland
| | - Leszek Paczek
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Pawel Szczesny
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland.
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Bourneuf AL, Pabic EL, de Visme S, Levieux K, Pladys P. Risk factors for unexpected infant death among very premature infants in France. Arch Pediatr 2024; 31:195-201. [PMID: 38538469 DOI: 10.1016/j.arcped.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/08/2023] [Accepted: 12/10/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Prematurity is one of the risk factors for sudden unexpected infant death (SUID), a phenomenon that remains poorly explained. MATERIALS AND METHODS The analysis of specific factors associated with SUID among very premature infants (VPI) was performed through a retrospective review of data collected in the French SUID registry from May 2015 to December 2018. The factors associated with SUID among VPI were compared with those observed among full-term infants (FTI). Results are expressed as means (standard deviation [SD]) or medians (interquartile range [IQR)]. RESULTS During the study period, 719 cases of SUID were included in the registry, 36 (incidence: 0.60 ‰) of which involved VPI (gestational age: 29.2 [2] weeks, 1157 [364]) g] and 313 (0.18 ‰) involved FTI (gestational age: 40 [0.8] weeks, 3298 [452] g). The infants' postnatal age at the time of death was similar in the two groups: 15.5 (12.2-21.8) vs. 14.5 (7.1-23.4) weeks. We observed low breastfeeding rates and a high proportion of fathers with no occupation or unemployment status among the VPI compared to the FTI group (31% vs. 55 %, p = 0.01 and 32% vs. 13 %, p = 0.05, respectively). Among the VPI, only 52 % were in supine position, and 29 % were lying prone at the time of the SUID (compared to 63 % and 17 %, respectively, in the FTI group). CONCLUSION This study confirms prematurity as a risk factor for SUID with no difference in the SUID-specific risk factors studied except for breastfeeding and socioeconomic status of the fathers. VPI and FTI died at similar chronological ages with a high proportion of infants dying in prone position. These results argue for reinforcement of prevention strategies in cases of prematurity.
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Affiliation(s)
| | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), F-35000 Rennes, France
| | | | - Karine Levieux
- Inserm CIC 1413, Nantes University Hospital, Nantes, France; Pediatric Emergency Care Unit, Nantes University Hospital, Nantes, France
| | - Patrick Pladys
- Department of Child and Adolescent Medicine, CHU de Rennes, Rennes, France; Research and Innovation Department, Paediatric Department, University Hospital of Rennes, Rennes, France
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Ludington-Hoe SM, Addison C. Sudden Unexpected Postnatal Collapse: Review and Management. Neonatal Netw 2024; 43:76-91. [PMID: 38599773 DOI: 10.1891/nn-2023-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.
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Auvray C, Perez-Martin S, Schuffenecker I, Pitoiset C, Tarris G, Ambert-Balay K, Martin L, Dullier-Taillefumier N, Bour JB, Manoha C. Sudden Infant Death Associated with Rhinovirus Infection. Viruses 2024; 16:518. [PMID: 38675861 PMCID: PMC11054477 DOI: 10.3390/v16040518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
A less than one-month-old infant with symptoms of rhinitis died unexpectedly in his sleep. He was not born prematurely and had no known underlying disease. Cerebrospinal fluid, nasopharyngeal and lung samples, and rectal swab were found to be positive for subgroup A rhinovirus, while the blood was negative. This case highlights the important finding that the rhinovirus, a common pathogen associated with upper respiratory tract infections, can sometimes, as the only pathogen, lead to complications such as a cerebrospinal infection and be involved in the sudden infant death syndrome (SIDS). Vigilance is necessary in case of viral infections in the infant's environment, and measures of hygiene and protection must be encouraged in order to reduce the risk of the SIDS.
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Affiliation(s)
- Christelle Auvray
- Department of Microbiology, Virology Laboratory, Dijon University Hospital, 21070 Dijon, France; (C.A.); (C.P.)
| | | | - Isabelle Schuffenecker
- French National Enterovirus/Parechovirus Reference Centre, Hospices Civils de Lyon, 69317 Lyon, France;
| | - Cécile Pitoiset
- Department of Microbiology, Virology Laboratory, Dijon University Hospital, 21070 Dijon, France; (C.A.); (C.P.)
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, 21070 Dijon, France; (G.T.); (L.M.); (N.D.-T.)
| | - Katia Ambert-Balay
- French National Reference Centre for Gastroenteritis Viruses, Virology Laboratory, University Hospital of Dijon, 21070 Dijon, France;
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, 21070 Dijon, France; (G.T.); (L.M.); (N.D.-T.)
| | | | - Jean-Baptiste Bour
- Department of Microbiology, Virology Laboratory, Dijon University Hospital, 21070 Dijon, France; (C.A.); (C.P.)
| | - Catherine Manoha
- Department of Microbiology, Virology Laboratory, Dijon University Hospital, 21070 Dijon, France; (C.A.); (C.P.)
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Fraile-Martinez O, García-Montero C, Díez SC, Bravo C, Quintana-Coronado MDG, Lopez-Gonzalez L, Barrena-Blázquez S, García-Honduvilla N, De León-Luis JA, Rodriguez-Martín S, Saez MA, Alvarez-Mon M, Diaz-Pedrero R, Ortega MA. Sudden Infant Death Syndrome (SIDS): State of the Art and Future Directions. Int J Med Sci 2024; 21:848-861. [PMID: 38617004 PMCID: PMC11008475 DOI: 10.7150/ijms.89490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/10/2024] [Indexed: 04/16/2024] Open
Abstract
Sudden infant death syndrome (SIDS) is a type of death that occurs suddenly and without any apparent explanation, affecting infants between 28 days of life and up to a year. Recognition of this entity includes performing an autopsy to determine if there is another explanation for the event and performing both an external and internal examination of the different tissues to search for possible histopathological findings. Despite the relative success of awareness campaigns and the implementation of prevention measures, SIDS still represents one of the leading causes of death among infants worldwide. In addition, although the development of different techniques has made it possible to make significant progress in the characterization of the etiopathogenic mechanisms underlying SIDS, there are still many unknowns to be resolved in this regard and the integrative consideration of this syndrome represents an enormous challenge to face both from a point of view scientific and medical view as humanitarian. For all these reasons, this paper aims to summarize the most relevant current knowledge of SIDS, exploring from the base the characterization and recognition of this condition, its forensic findings, its risk factors, and the main prevention measures to be implemented. Likewise, an attempt will be made to analyze the causes and pathological mechanisms associated with SIDS, as well as potential approaches and future paths that must be followed to reduce the impact of this condition.
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Affiliation(s)
- Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Sofía Castellanos Díez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - María de Guadalupe Quintana-Coronado
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Laura Lopez-Gonzalez
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
| | - Silvestra Barrena-Blázquez
- Department of General and Digestive Surgery, University Hospital Príncipe de Asturias, 28805 Madrid, Spain
- Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Sonia Rodriguez-Martín
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Service of Pediatric, Hospital Universitario Principe de Asturias, 28801 Alcalá de Henares, Spain
| | - Miguel A Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, 28801 Alcala de Henares, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, CIBEREHD, 28806 Alcalá de Henares, Spain
| | - Raul Diaz-Pedrero
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
- Department of General and Digestive Surgery, University Hospital Príncipe de Asturias, 28805 Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
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Grimaldi F, Bonasoni MP, Pelletti G, Gabrielli L, Pelotti S. Diagnostic challenges and forensic implications in a case of infantile fatal myocarditis. Forensic Sci Med Pathol 2024; 20:219-225. [PMID: 37335504 PMCID: PMC10944382 DOI: 10.1007/s12024-023-00659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
We present the case of a 23-month-old child who died less than 24 h after the onset of cardiac symptoms, despite being admitted to the hospital 72 h earlier. Autopsy revealed no significant macroscopic changes, and histologic examination revealed focal lymphocytic myocarditis with myocyte disruption, diffuse alveolar damage in the exudative phase, and generalized lymphocytic immune activation in other organs. Ante-mortem and post-mortem microbiological exams did not clearly prove a causative role of infectious agents. The peculiarity of this case was characterized by the contrast between the severe clinical features and the mild cardiac histological findings. This discrepancy, coupled with the suspicion of a viral causative role based on both ante-mortem and post-mortem microbiological examinations, presented significant challenges in reaching an etiological diagnosis. This case also confirms that the diagnosis of myocarditis in children cannot be made solely on the basis of histological cut-offs or microbiological results. Using abductive reasoning, various diagnostic hypotheses were formulated and evaluated to arrive at the final diagnosis of fatal myocarditis of viral or post-viral origin. Data from post-mortem examination are often the only source of information that is available to the experts, especially in cases of sudden infant death syndrome. In such cases, the forensic pathologists should accurately evaluate findings that may appear to indicate a different etiology, and, in the absence of clinical or radiological data, interpret post-mortem data in a logically correct manner. The autopsy is the first essential step to evaluate the cause of death and must be integrated with the results of ante- and post-mortem diagnostic tests in a holistic approach, which is crucial to allow forensic pathologists to provide an appropriate and relevant opinion.
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Affiliation(s)
- Federica Grimaldi
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy
| | - Maria Paola Bonasoni
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, 42122, Italy
| | - Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy.
| | - Liliana Gabrielli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy
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Nath A. Brainstem Encephalitis as a Cause of Sudden Infant Death Syndrome. JAMA Neurol 2024; 81:231-232. [PMID: 38285466 DOI: 10.1001/jamaneurol.2023.5384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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9
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MacFarlane PM. Inflammation in sudden infant death syndrome. Pediatr Res 2024; 95:885-886. [PMID: 38097722 DOI: 10.1038/s41390-023-02966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Peter M MacFarlane
- Department of Pediatrics, Division of Neonatology, Rainbow Babies & Children's Hospital, Case Western Reserve University, 2109 Adelbert Rd, Cleveland, OH, 44106, USA.
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10
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Garstang JJ, Menka M. Infant death from accidental suffocation and strangulation in bed in England and Wales: rare or unrecognised events? BMJ Paediatr Open 2024; 8:e002419. [PMID: 38316470 PMCID: PMC10860092 DOI: 10.1136/bmjpo-2023-002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mandatory joint police and healthcare investigations of sudden unexpected death in infancy (SUDI) have been in place since 2008 in England. These include death scene examination with cause of death determined at multiprofessional case conference. Detailed evidence on sleep arrangements is available for most cases potentially leading to more being identified as due to accidental suffocation. SUDI remaining unexplained following investigation are classified as SIDS (sudden infant death syndrome) or unspecified deaths.Our objective was to determine whether detailed SUDI investigation has led to an increase in deaths classified as accidental suffocation or strangulation in bed (ASSB)? METHODS We obtained official mortality data for England and Wales for infants dying aged 0-364 days for International Statistical Classification of Diseases and Related Health Problems, 10th revision codes R95 (SIDS), R96, R98, R99 (unspecified causes of mortality) and W75 (ASSB) for the years 2000-2019.We calculated the mortality rate for ASSB, SIDS and unspecified causes based on total live births each year. RESULTS Unexplained SUDI decreased from 353 in 2000 to 175 in 2019, with the mortality rate falling from 0.58 to 0.29 per 1000 live births. The total postneonatal mortality rate fell during this time from 1.9 to 0.9 per 1000 live births suggesting this is a genuine fall. SIDS accounted for 70% of unexplained SUDI in 2000 falling to 49% in 2020 with a corresponding increase in R99 unspecified deaths.Few deaths were recorded as ASSB (W75), ranging between 4 in 2010 and 24 in 2001. The rate for ASSB ranged from 0.6 to 4.0 per 100000 live births. CONCLUSIONS There is a shift away from SIDS (R95) towards unspecified causes of death (R96, R98, R99). Improved investigation of deaths has not led to increased numbers of death identified as due to ASSB. There needs to be clear guidelines on accurate classification of deaths from ASSB to facilitate learning from deaths and inform prevention efforts.
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Affiliation(s)
- Joanna Jane Garstang
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Children and Family Services, Birmingham Community Healthcare NHS Trust, Aston, UK
| | - Marivjena Menka
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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11
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Ferrante L, Opdal SH, Byard RW. Understanding the immune profile of sudden infant death syndrome - proteomic perspectives. Acta Paediatr 2024; 113:249-255. [PMID: 37792385 DOI: 10.1111/apa.16988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
AIM The aim of this study was to investigate a panel of immune proteins in cases of sudden infant death syndrome (SIDS). It was hypothesised that, in at least a subset of SIDS, a dysregulated immune response may be a contributing factor leading to death. METHODS The subjects included 46 SIDS cases and 41 controls autopsied at the Department of Forensic Sciences, Norway. The causes of death in the controls were accidents/trauma. Samples of cerebrospinal fluid (CSF) were analysed quantitatively by Proximity Extension Assay (PEA). RESULTS Initial results revealed that normalised protein expression differed in 35 proteins. For the purposes of this report five proteins that are involved in immune system were selected for analysis: IFNLR1 (p = 0.003), IL10 (p = 0.007), IRAK4 (p < 0.001) and IL6 (p = 0.035); all had lower protein concentrations in SIDS cases compared to controls except for CD28 (p = 0.024) which had higher protein concentrations in SIDS cases. CONCLUSION The results confirm previous studies indicating that a dysregulation of the immune system may be a predisposing factor for SIDS. The results may indicate that these aberrant protein concentrations could lead to an inadequate response to immune triggers and uncontrolled defence mechanisms towards the common cold or other non-fatal infections.
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Affiliation(s)
- Linda Ferrante
- Department of Forensic Sciences, Section of Forensic Pathology and Clinical Forensic Medicine, Oslo University Hospital, Oslo, Norway
| | - Siri H Opdal
- Department of Forensic Sciences, Section of Forensic Pathology and Clinical Forensic Medicine, Oslo University Hospital, Oslo, Norway
| | - Roger W Byard
- The University of Adelaide, Adelaide, South Australia, Australia
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Pries AM, Ruskamp JM, Edelenbos E, Fuijkschot J, Semmekrot B, Verbruggen KT, van de Putte E, Puiman PJ. A Systematic Approach to Evaluate Sudden Unexplained Death in Children. J Pediatr 2024; 264:113780. [PMID: 37852434 DOI: 10.1016/j.jpeds.2023.113780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To evaluate in the Netherlands the national outcomes in providing cause of and insights into sudden and unexplained child deaths among children via the Postmortem Evaluation of Sudden Unexplained Death in Youth (PESUDY) procedure. STUDY DESIGN Children aged 0-18 years in the Netherlands who died suddenly were included in the PESUDY procedure if their death was unexplained and their parents gave consent. The PESUDY procedure consists of pediatric and forensic examination, biochemical, and microbiological tests; radiologic imaging; autopsy; and multidisciplinary discussion. Data on history, modifiable factors, previous symptoms, performed diagnostics, and cause of death were collected between October 2016 and December 2021. RESULTS In total, 212 cases (median age 11 months, 56% boys, 33% comorbidity) were included. Microbiological, toxicological, and metabolic testing was performed in 93%, 34%, and 32% of cases. In 95% a computed tomography scan or magnetic resonance imaging was done and in 62% an autopsy was performed. The cause of death was explained in 58% of cases and a plausible cause was identified in an additional 13%. Most children died from infectious diseases. Noninfectious cardiac causes were the second leading cause of death found. Modifiable factors were identified in 24% of non-sudden infant death syndrome/unclassified sudden infant death cases and mostly involved overlooked alarming symptoms. CONCLUSIONS The PESUDY procedure is valuable and effective for determining the cause of death in children with sudden unexplained deaths and for providing answers to grieving parents and involved health care professionals.
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Affiliation(s)
- Annelotte Maretta Pries
- Department of General Paediatrics, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jopje Marlies Ruskamp
- Department of Paediatrics, University Medical Center Utrecht Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Esther Edelenbos
- Department of Paediatrics, Amsterdam University Medical Center Emma Children's Hospital, Amsterdam, The Netherlands
| | - Joris Fuijkschot
- Department of Paediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Ben Semmekrot
- Department of Paediatrics, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Krijn Teunis Verbruggen
- Department of Paediatrics, University Medical Center Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Elise van de Putte
- Department of Paediatrics, University Medical Center Utrecht Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Patrycja Jolanta Puiman
- Department of General Paediatrics, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands.
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13
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Grad E, Rossato NE, Taire DL. [Update on safe sleep recommendatios]. ARCH ARGENT PEDIATR 2023; 121:e202310113. [PMID: 37883066 DOI: 10.5546/aap.2023-10113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Sudden unexpected infant death may be explained, cause by an etiology, unexplained but insufficiently investigated, or unexplained when a full investigation fails to determine the cause. Unexplained sudden death in infancy or sudden infant death syndrome particularly affects the most vulnerable populations. The death of these children who are born with alterations in their neurodevelopment is the visible part of a problem that originates in pregnancy. Reducing the number of vulnerable children depends on health policies and, above all, on improving the living conditions of the population. These are long-term actions. Knowing in depth the risk factors that can trigger unexpected death is what can be done now. The update of the recommendations on safe sleep reflects new knowledge based on scientific evidence and a comprehensive approach to the sociocultural aspects related to this problem.
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Affiliation(s)
- Estela Grad
- Grupo de Trabajo Trastornos del Sueño y Muerte Súbita e Inesperada del Lactante, Sociedad Argentina de Pediatría
| | - Norma E Rossato
- Grupo de Trabajo Trastornos del Sueño y Muerte Súbita e Inesperada del Lactante, Sociedad Argentina de Pediatría
| | - Damián L Taire
- Grupo de Trabajo Trastornos del Sueño y Muerte Súbita e Inesperada del Lactante, Sociedad Argentina de Pediatría
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14
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Wojcik MH, Krous HF, Goldstein RD. Sudden Unexplained Death in Childhood: Current Understanding. Pediatr Emerg Care 2023; 39:984-5. [PMID: 38019719 DOI: 10.1097/01.pec.0000997588.40847.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Sudden, Unexplained Death in Childhood (SUDC) is a term that encompasses apparently natural deaths in children over one year of age with no discernible cause despite a thorough assessment. Definitive underlying causes vary but most cases remain largely unexplained. Research has furthered the view that SUDC is not an accident, but rather a sentinel medical event for which a thorough postmortem investigation is indicated. Emerging evidence in genetics, neurology, and neuropathology point to heterogeneous causes that in some cases share features of recognized diseases.
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15
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Pease A, Turner N, Ingram J, Fleming P, Patrick K, Williams T, Sleap V, Pitts K, Luyt K, Ali B, Blair P. Changes in background characteristics and risk factors among SIDS infants in England: cohort comparisons from 1993 to 2020. BMJ Open 2023; 13:e076751. [PMID: 37832988 PMCID: PMC10582842 DOI: 10.1136/bmjopen-2023-076751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES Using the National Child Mortality Database, this work aims to investigate background characteristics and risk factors in the sleeping environment associated with sudden infant death syndrome (SIDS) and compare the prevalence with previous English SIDS case-control studies. DESIGN Cohort of SIDS in 2020 compared with a combined analysis of two case-control studies conducted in 1993-1996 and 2003-2006. SETTING England, UK PARTICIPANTS: 138 SIDS deaths in 2020 compared with 402 SIDS deaths and 1387 age-equivalent surviving controls, combined from previous studies. RESULTS The increased vulnerability of SIDS infants identified in previous studies has become more marked. The infants who died in 2020 were younger (median=66 days (IQR: 34-118) vs 86 days (IQR: 52-148), p=0.003) with an increased prevalence of low birth weight (30.5% vs 21.6%, p=0.04) and preterm births (29.6% vs 19.3%, p=0.012). The excess of socioeconomically deprived families, male infants and high levels of maternal smoking during pregnancy were still evident. Among recent deaths, fewer infants were put down or found on their side; however, there was no significant change in the proportion of infants who were put down (15.6% vs 14.6%, p=0.81) and found prone (40.4% vs 35.3%, p=0.37), despite population wide risk reduction advice over three decades. The proportional increase observed in 2003-2006 of half the deaths occurring while sleeping next to an adult was maintained in 2020, and for the vast majority (90%), this was in hazardous circumstances (adult had consumed alcohol, smoked, slept on a sofa, or the infant was premature or low birth weight and less than 3 months old). More deaths also occurred when there was a disruption in infant care routine compared with previous observations (52.6% vs 20.7%, p<0.001). CONCLUSIONS A more targeted approach is needed with vulnerable families emphasising the importance of sleeping infants on their back and proactive planning infant sleep when there are disruptions to the normal routine, in particular to avoid hazardous co-sleeping.
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Affiliation(s)
- Anna Pease
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jenny Ingram
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Peter Fleming
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Karen Patrick
- Research and Development, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Tom Williams
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Vicky Sleap
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Karen Luyt
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Becky Ali
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Peter Blair
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
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16
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Goldwater PN. Current SIDS research: time to resolve conflicting research hypotheses and collaborate. Pediatr Res 2023; 94:1273-1277. [PMID: 37173404 PMCID: PMC10175898 DOI: 10.1038/s41390-023-02611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/01/2023] [Indexed: 05/15/2023]
Abstract
From the earliest publications on cot death or sudden infant death syndrome (SIDS) through to this day, clinical pathology and epidemiology have strongly featured infection as a constant association. Despite mounting evidence of the role of viruses and common toxigenic bacteria in the pathogenesis of SIDS, a growing school of thought featuring a paradigm based on the triple risk hypothesis that encompasses vulnerability through deranged homoeostatic control of arousal and/or cardiorespiratory function has become the mainstream view and now dominates SIDS research. The mainstream hypothesis rarely acknowledges the role of infection despite its notional potential role as a cofactor in the triple hit idea. Decades of mainstream research that has focussed on central nervous system homoeostatic mechanisms of arousal, cardiorespiratory control and abnormal neurotransmission has not been able to provide consistent answers to the SIDS enigma. This paper examines the disparity between these two schools of thought and calls for a collaborative approach. IMPACT: The popular research hypothesis explaining sudden infant death syndrome features the triple risk hypothesis with central nervous system homoeostatic mechanisms controlling arousal and cardiorespiratory function. Intense investigation has not yielded convincing results. There is a necessity to consider other plausible hypotheses (e.g., common bacterial toxin hypothesis). The review scrutinises the triple risk hypothesis and CNS control of cardiorespiratory function and arousal and reveals its flaws. Infection-based hypotheses with their strong SIDS risk factor associations are reviewed in a new context.
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Affiliation(s)
- Paul N Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, Australia.
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17
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Collette M, Hauet M, de Visme S, Borsa A, Schweitzer C, Marchand E, Martrille L, Wiedemann A. Procalcitonin is associated with sudden unexpected death in infancy due to infection. Eur J Pediatr 2023; 182:3929-3937. [PMID: 37353601 DOI: 10.1007/s00431-023-05064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
Infection is an important cause of death during infancy worldwide and is a frequent etiology of sudden unexpected death in infancy (SUDI). Procalcitonin (PCT) is a useful marker to diagnose infection in patients, and several studies report the stability of PCT after death. The added value of a biological marker, such as the PCT level in the blood, remains controversial in investigating SUDI. The aim of this study was to determine if PCT can help clinicians determine whether infection caused SUDI. We conducted a retrospective, multicenter study with the French SUDI registry (Observatoire National des Morts Inattendues du Nourrisson; OMIN). We collected data from this registry on children who died between May 2015 and June 2021. The levels of PCT in the blood of 540 SUDI patients were measured. We compared PCT and other biological tests performed in terms of infection status, autopsy results, and cause of death using clinical and biological data compiled by pediatricians at the SUDI referral center. PCT levels were significantly higher in the children who died from infection than in those who did not (0.12 µg/L vs. 0.08 µg/L, p < 0.001). A PCT blood level exceeding 0.2 µg/L was more frequently observed when infection was present than in the absence of infection (44.3% vs. 15.4%, p < 0.001). The same data were obtained with a 0.5 µg/L cut-off (36.1% with infection vs. 9.2% without, p < 0.001). Conclusions: PCT is a sensitive biomarker for detecting infections postmortem; thus, additional samples may be necessary during autopsy. What is known: • PCT is a stable marker postmortem and increases earlier than CRP, i.e., 2-4 h after the beginning of an infection vs. 6 h. • PCT can be measured up to 140 h after death. What is new: • PCT is a sensitive marker for detecting infection in SUDI patients postmortem. • This test can reveal an infection from non-standardized samples obtained during autopsy if such an infection was not determined before death.
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Affiliation(s)
- Maritie Collette
- Pediatric Emergency Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
| | - Mathilde Hauet
- Pediatric Emergency Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
| | - Sophie de Visme
- Inserm, Clinical Investigation Centre 1413, University Hospital of Nantes, Nantes, France
| | - Anne Borsa
- Pediatric Emergency Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
| | - Cyril Schweitzer
- Pediatric Department, Children's Hospital, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
- DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, 3450, Vandœuvre-Les-Nancy, EA, France
| | - Elodie Marchand
- Université de Lorraine, CHU Nancy, Service de Médecine Légale, 54000, Nancy, France
| | - Laurent Martrille
- EDPFM, Univ Montpellier, CHU Montpellier, Service de Médecine Légale, Montpellier, France
| | - Arnaud Wiedemann
- Pediatric Intensive Care Unit, Children's Hospital, University Hospital of Nancy, C.H.R.U. Nancy, 54500, Vandoeuvre-Les-Nancy, France.
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France.
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18
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Galambos C, Bush D, Abman SH, Caplan M. Prominent Intrapulmonary Shunt Vessels and Altered Lung Development in Infants With Sudden Unexplained Infant Death. J Pediatr 2023; 255:214-219.e1. [PMID: 36336004 DOI: 10.1016/j.jpeds.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to evaluate intrapulmonary arteriovenous shunts in patients with and without sudden unexplained infant death. We identified open intrapulmonary bronchopulmonary anastomoses as potential pathways for right-to-left shunt in a subset of infants with sudden unexplained infant death.
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Affiliation(s)
- Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Douglas Bush
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven H Abman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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19
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Shapiro-Mendoza CK, Woodworth KR, Cottengim CR, Lambert ABE, Harvey EM, Monsour M, Parks SE, Barfield WD. Sudden Unexpected Infant Deaths: 2015-2020. Pediatrics 2023; 151:e2022058820. [PMID: 36911916 PMCID: PMC10091458 DOI: 10.1542/peds.2022-058820] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE Although the US infant mortality rate reached a record low in 2020, the sudden infant death syndrome (SIDS) rate increased from 2019. To understand if the increase was related to changing death certification practices or the coronavirus disease 2019 (COVID-19) pandemic, we examined sudden unexpected infant death (SUID) rates as a group, by cause, and by race and ethnicity. METHODS We estimated SUID rates during 2015 to 2020 using US period-linked birth and death data. SUID included SIDS, unknown cause, and accidental suffocation and strangulation in bed. We examined changes in rates from 2019 to 2020 and assessed linear trends during prepandemic (2015-2019) using weighted least squares regression. We also assessed race and ethnicity trends and quantified COVID-19-related SUID. RESULTS Although the SIDS rate increased significantly from 2019 to 2020 (P < .001), the overall SUID rate did not (P = .24). The increased SIDS rate followed a declining linear trend in SIDS during 2015 to 2019 (P < .001). Other SUID causes did not change significantly. Our race and ethnicity analysis showed SUID rates increased significantly for non-Hispanic Black infants from 2019 to 2020, widening the disparities between these two groups during 2017 to 2019. In 2020, <10 of the 3328 SUID had a COVID-19 code. CONCLUSIONS Diagnositic shifting likely explained the increased SIDS rate in 2020. Why the SUID rate increased for non-Hispanic Black infants is unknown, but warrants continued monitoring. Interventions are needed to address persistent racial and ethnic disparities in SUID.
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Affiliation(s)
| | - Kate R. Woodworth
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carri R. Cottengim
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Elizabeth M. Harvey
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Monsour
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharyn E. Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanda D. Barfield
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Blair PS, Ball HL, Pease A, Fleming PJ. Bed-sharing and SIDS: an evidence-based approach. Arch Dis Child 2023; 108:e6. [PMID: 35256354 DOI: 10.1136/archdischild-2021-323469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | - Anna Pease
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Peter J Fleming
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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21
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Affiliation(s)
- David Tappin
- Child Health, University of Glasgow, Glasgow, UK
| | | | - James Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Fern Hauck
- Family Medicine and Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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22
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Glinge C, Rossetti S, Oestergaard LB, Stampe NK, Lynge TH, Skals R, Winkel BG, Lodder EM, Bezzina CR, Gislason G, Banner J, Behr ER, Torp-Pedersen C, Jabbari R, Tfelt-Hansen J. Risk of Sudden Infant Death Syndrome Among Siblings of Children Who Died of Sudden Infant Death Syndrome in Denmark. JAMA Netw Open 2023; 6:e2252724. [PMID: 36696110 DOI: 10.1001/jamanetworkopen.2022.52724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Sudden infant death syndrome (SIDS) remains a leading cause of death during the first year of life. The etiology of SIDS is complex and remains largely unknown. OBJECTIVE To evaluate whether siblings of children who died of SIDS have a higher risk of SIDS compared with the general pediatric population. DESIGN, SETTING, AND PARTICIPANTS This register-based cohort study used Danish nationwide registers. Participants were all infants (<1 year) in Denmark between January 1, 1978, and December 31, 2016, including siblings of children who died of SIDS. Siblings were followed up from the index cases' date of SIDS, date of birth, or immigration, whichever came first, and until age 1 year, emigration, developing SIDS, death, or study end. The median (IQR) follow-up was 1 (1-1) year. Data analysis was conducted from January 2017 to October 2022. MAIN OUTCOMES AND MEASURES Standardized incidence ratios (SIRs) of SIDS were calculated with Poisson regression models relative to the general population. RESULTS In a population of 2 666 834 consecutive births (1 395 199 [52%] male), 1540 infants died of SIDS (median [IQR] age at SIDS, 3 [2-4] months) during a 39-year study period. A total of 2384 younger siblings (cases) to index cases (first sibling with SIDS) were identified. A higher rate of SIDS was observed among siblings compared with the general population, with SIRs of 4.27 (95% CI, 2.13-8.53) after adjustment for sex, age, and calendar year and of 3.50 (95% CI, 1.75-7.01) after further adjustment for mother's age (<29 years vs ≥29 years) and education (high school vs after high school). CONCLUSIONS AND RELEVANCE In this nationwide study, having a sibling who died of SIDS was associated with a 4-fold higher risk of SIDS compared with the general population. Shared genetic and/or environmental factors may contribute to the observed clustering of SIDS. The family history of SIDS should be considered when assessing SIDS risk in clinical settings. A multidisciplinary genetic evaluation of families with SIDS could provide additional evidence.
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Affiliation(s)
- Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sára Rossetti
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise Bruun Oestergaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Regitze Skals
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth M Lodder
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Cardiology Section, St George's, University of London, London, United Kingdom
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
- Mayo Clinic Healthcare, London, United Kingdom
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, North Zealand University Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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23
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Parks SE, DeSisto CL, Kortsmit K, Bombard JM, Shapiro-Mendoza CK. Risk Factors for Suffocation and Unexplained Causes of Infant Deaths. Pediatrics 2023; 151:e2022057771. [PMID: 36464994 PMCID: PMC9942004 DOI: 10.1542/peds.2022-057771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). METHODS We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. RESULTS We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. COCLUSIONS We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.
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24
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Beltrán-Castillo S, Bravo K, Eugenín J. Impact of Prenatal Nicotine Exposure on Placental Function and Respiratory Neural Network Development. Adv Exp Med Biol 2023; 1428:233-244. [PMID: 37466776 DOI: 10.1007/978-3-031-32554-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Smoking during pregnancy is associated with multiple undesirable outcomes in infants, such as low birth weight, increased neonatal morbidity and mortality, and catastrophic conditions like sudden infant death syndrome (SIDS). Nicotine, the most addictive and teratogenic substance in tobacco smoke, reaches and crosses the placenta and can be accumulated in the amniotic fluid and distributed by fetal circulation, altering the cholinergic transmission by acting on the nicotinic acetylcholine receptors (nAChRs) expressed from very early gestational stages in the placenta and fetal tissue. Because nAChRs influence the establishment of feto-maternal circulation and the emergence of neuronal networks, prenatal nicotine exposure can lead to multiple alterations in newborns. In this mini-review, we discuss the undeniable effects of nicotine in the placenta and the respiratory neural network as examples of how prenatal nicotine and smoking exposition can affect brain development because dysfunction in this network is involved in SIDS etiology.
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Affiliation(s)
- Sebastián Beltrán-Castillo
- Centro integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O'Higgins, Santiago, Chile.
| | - Karina Bravo
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile
- Facultad de Ingeniería, Universidad Autónoma de Chile, Santiago, Chile
| | - Jaime Eugenín
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile.
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Isbey SC, Howard MB, Abdulrahman E, Giese K, Cuchara B, Gourishankar A. Characteristics and Geographic Variation in Sudden Unexpected Infant Deaths in the District of Columbia. Am J Forensic Med Pathol 2022; 43:328-333. [PMID: 36103406 DOI: 10.1097/paf.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sleep-related infant death is a major cause of infant mortality in the United States. In the District of Columbia, infant mortality varies widely among regions (2 to 14 per 1000 live births). The study objectives were to analyze the patient characteristics and related variables to sudden unexpected infant deaths at 2 pediatric emergency department (ED) sites and the geographic patterns of infant deaths and their relationship to social vulnerability. This retrospective cohort study examined infants under 1 year of age presenting with cardiac arrest at 2 ED sites from 2010 to 2020. Analysis showed 81 deaths with a median population age of 75 days (SD, 46 days). The most frequent demographics of deceased patients were African American Black (89%) with Medicaid insurance (63%), born at term gestation (66%), and without comorbidity (60%). The cause of death was most frequently undetermined (32%) and asphyxia (31%). Most cases involved bed-sharing (63%), despite more than half of those cases having a known safe sleep surface available. Infant death location showed that most deaths occurred in areas with the highest social vulnerability index, including near a community ED location. Understanding the etiologies of this geographic variability may enhance sleep-related infant death prevention strategies.
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Affiliation(s)
| | - Mary Beth Howard
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Bandoli G, Baer RJ, Owen M, Kiernan E, Jelliffe-Pawlowski L, Kingsmore S, Chambers CD. Maternal, infant, and environmental risk factors for sudden unexpected infant deaths: results from a large, administrative cohort. J Matern Fetal Neonatal Med 2022; 35:8998-9005. [PMID: 34852708 PMCID: PMC9310558 DOI: 10.1080/14767058.2021.2008899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/07/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Many studies of sudden unexpected infant death (SUID) have focused on individual domains of risk factors (maternal, infant, and environmental), resulting in limited capture of this multifactorial outcome. The objective of this study was to examine the geographic distribution of SUID in San Diego County, and assess maternal, infant, and environmental risk factors from a large, administrative research platform. STUDY DESIGN Births in California between 2005 and 2017 were linked to hospital discharge summaries and death files. From this retrospective birth cohort, cases of SUID were identified from infant death files in San Diego County. We estimated adjusted hazard ratios (aHRs) for infant, maternal, and environmental factors and SUID in multivariable Cox regression analysis. Models were adjusted for maternal sociodemographic characteristics and prenatal nicotine exposure. RESULTS There were 211 (44/100,000 live births; absolute risk 0.04%) infants with a SUID among 484,905 live births. There was heterogeneity in geographic distribution of cases. Multiparity (0.05%; aHR 1.4, 95% confidence interval (CI) 1.1, 1.9), maternal depression (0.11%; aHR 1.8, 95% CI 1.0, 3.4), substance-related diagnoses (0.27%; aHR 2.3, 95% CI 1.3, 3.8), cannabis-related diagnosis (0.35%; aHR 2.7, 95% CI 1.5, 5.0), prenatal nicotine use (0.23%; aHR 2.5, 95% CI 1.5, 4.2), preexisting hypertension (0.11%; aHR 2.3, 95% CI 1.2, 4.3), preterm delivery (0.09%; aHR 2.1, 95% CI 1.5, 3.0), infant with a major malformation (0.09%; aHR 2.0, 95% CI 1.1, 3.6), respiratory distress syndrome (0.12%; aHR 2.6, 95% CI 1.5, 4.6), and select environmental factors were all associated with SUID. CONCLUSIONS Multiple risk factors were confirmed and expanded upon, and the geographic distribution for SUID in San Diego County was identified. Through this approach, prevention efforts can be targeted to geographies that would benefit the most.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California San Francisco, La Jolla, CA, USA
| | - Mallory Owen
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Elizabeth Kiernan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | | | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Macdonald M, Thompson D, Perry R, Brooks R. Comparing asphyxia and unexplained causes of death: a retrospective cohort analysis of sleep-related infant death cases from a state child fatality review programme. BMJ Open 2022; 12:e059745. [PMID: 36104144 PMCID: PMC9476159 DOI: 10.1136/bmjopen-2021-059745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the characteristics and circumstances of infants who died while sleeping or in a sleep environment and compare deaths classified as either unintentional asphyxia or an unexplained cause. DESIGN A retrospective cohort study. SETTING Data were extracted from the National Fatality Review Case Reporting System and Florida Vital Statistics databases. PARTICIPANTS Data on 778 sleep-related infant deaths occurring from 2014 to 2018 in Florida were analysed. PRIMARY OUTCOME MEASURE Cause of death classification as unintentional asphyxia or unexplained. RESULTS Overall, 36% (n=276) of sleep-related infant deaths in this study sample were classified as resulting from an unexplained cause compared with unintentional asphyxia. Most infants were reported to be in an adult bed (60%; n=464) and sharing a sleep surface with a person or animal (60%; n=468); less than half (44%; n=343) were reportedly placed to sleep on their back. After controlling for the influence of other independent variables, female sex (adjusted risk ratio: 1.36; 95% CI 1.06 to 1.74) and fully obstructed airway condition (adjusted risk ratio: 0.30; 95% CI 0.18 to 0.50) were associated with an unexplained cause of death. CONCLUSIONS The results of this analysis indicate that sleep environment hazards remain prevalent among infants who die suddenly and unexpectedly, regardless of the cause of death determination. While significant differences were observed for some factors, in many others the distributions of both demographic and incident characteristics were similar between unexplained deaths and those resulting from asphyxia. The results of this study support growing evidence that unsafe sleep environments contribute to all forms of sudden unexpected infant death, underscoring the need for standardising cause of death determination practices and promoting consistent, high-quality forensic investigations to accurately explain, monitor and prevent these deaths.
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Affiliation(s)
- Megan Macdonald
- Division of Children's Medical Services, Florida Department of Health, Tallahassee, Florida, USA
| | - Daniel Thompson
- Independent Statistical Consultant, Tallahassee, Florida, USA
| | - Robin Perry
- Social Work, Florida Agricultural and Mechanical University, Tallahassee, Florida, USA
| | - Robert Brooks
- Division of Children's Medical Services, Florida Department of Health, Tallahassee, Florida, USA
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Polavarapu M, Klonoff-Cohen H, Joshi D, Kumar P, An R, Rosenblatt K. Development of a Risk Score to Predict Sudden Infant Death Syndrome. Int J Environ Res Public Health 2022; 19:ijerph191610270. [PMID: 36011906 PMCID: PMC9407916 DOI: 10.3390/ijerph191610270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 06/12/2023]
Abstract
Sudden Infant Death Syndrome (SIDS) is the third leading cause of death among infants younger than one year of age. Effective SIDS prediction models have yet to be developed. Hence, we developed a risk score for SIDS, testing contemporary factors including infant exposure to passive smoke, circumcision, and sleep position along with known risk factors based on 291 SIDS and 242 healthy control infants. The data were retrieved from death certificates, parent interviews, and medical records collected between 1989−1992, prior to the Back to Sleep Campaign. Multivariable logistic regression models were performed to develop a risk score model. Our finalized risk score model included: (i) breastfeeding duration (OR = 13.85, p < 0.001); (ii) family history of SIDS (OR = 4.31, p < 0.001); (iii) low birth weight (OR = 2.74, p = 0.003); (iv) exposure to passive smoking (OR = 2.64, p < 0.001); (v) maternal anemia during pregnancy (OR = 2.07, p = 0.03); and (vi) maternal age <25 years (OR = 1.77, p = 0.01). The area under the curve for the overall model was 0.79, and the sensitivity and specificity were 79% and 63%, respectively. Once this risk score is further validated it could ultimately help physicians identify the high risk infants and counsel parents about modifiable risk factors that are most predictive of SIDS.
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Affiliation(s)
- Mounika Polavarapu
- School of Population Health, The University of Toledo, HH 1010, Mail Stop 119, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Hillary Klonoff-Cohen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Divya Joshi
- Department of Pediatrics, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA
| | - Praveen Kumar
- Department of Pediatrics, Children’s Hospital of Illinois, Peoria, IL 61603, USA
| | - Ruopeng An
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Karin Rosenblatt
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Maruyama N, Hageman JR. An Update on Infant Safe Sleep Recomendations. Pediatr Ann 2022; 51:e297-e298. [PMID: 35938896 DOI: 10.3928/19382359-20220712-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Harrington CT, Hafid NA, Waters KA. Letter Re: Butyrylcholinesterase is a potential biomarker for sudden infant death syndrome. EBioMedicine 2022; 82:104171. [PMID: 35841874 PMCID: PMC9297105 DOI: 10.1016/j.ebiom.2022.104171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carmel Therese Harrington
- SIDS and Sleep Apnoea Research Group, The Sydney Children's Hospital Network, Westmead, NSW 2145, Australia.
| | - Naz Al Hafid
- SIDS and Sleep Apnoea Research Group, The Sydney Children's Hospital Network, Westmead, NSW 2145, Australia
| | - Karen Ann Waters
- SIDS and Sleep Apnoea Research Group, The Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; Child and Adolescent Health, The University of Sydney, Camperdown, NSW 2006, Australia
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Affiliation(s)
- Emma Matthews
- Atkinson Morley Neuromuscular Centre, St George's University Hospitals NHS Foundation Trust, and Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
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Bryan MA, Florence A, Gower AD, Evans YN, Moreno MA. Safe Sleep Behaviors and Factors Associated With Infant Second Sleep Practices. Pediatrics 2022; 149:e2021053935. [PMID: 35634879 DOI: 10.1542/peds.2021-053935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the prevalence and safety of infant second-sleep practices. METHODS A cross-sectional online survey of parents with infants ≤12 months assessed parent-reported sleep practices: position, use of a separate sleep surface, and sleep location at 2 time points (sleep onset and after nighttime waking). A composite score examined if all 3 safe sleep practices were used at each time point. Safe sleep was defined as: supine position, sleeping in a separate space, and in a crib, bassinet, cradle, or playard. Wilcoxon sign rank test was used to examine changes between the time points. Poisson regression models compared parents who reported a second-sleep location with those who did not. RESULTS Of participants (n = 1500), 74% were female, 65% were White, 12% were Black, and 17% were of Hispanic ethnicity. Thirty-nine percent (n = 581) reported a second-sleep practice. Of parents who reported a second-sleep practice, 28% (n = 137) met all 3 safe sleep criteria at sleep onset; 9% (n = 42) met all 3 safe sleep criteria at both time points. A higher proportion of changes in sleep practices were to less-safe practices (P <.001). Factors associated with a second-sleep practice were parental age <25 years, parental race and ethnicity, first-time parents, homes with smoke exposure, and infants born at <37 weeks. CONCLUSIONS Less than 10% of infants met all 3 safe sleep criteria at sleep onset and after nighttime waking. Interventions focused on safe sleep should highlight the importance of safe sleep practices after nighttime waking.
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Affiliation(s)
- Mersine A Bryan
- University of Washington, Seattle, Washington
- Seattle Children's Research Institute, Seattle, Washington
| | | | | | - Yolanda N Evans
- University of Washington, Seattle, Washington
- Seattle Children's Research Institute, Seattle, Washington
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
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33
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Dobson CP. Cardiac Causes of Sudden Unexpected Infant Death and the Role of the Primary Pediatrician. Pediatr Ann 2022; 51:e228-e233. [PMID: 35667100 DOI: 10.3928/19382359-20220407-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sudden death of an infant can be from numerous causes. The leading cardiac causes include major congenital heart disease, myocarditis, cardiomyopathies, and channelopathies. There are new approaches to evaluating these patients and surviving family members. Pediatricians are a key component in support of the family, investigation of other at-risk family members, and coordination of subspecialty consultation. [Ped Ann. 2022;51(6):e228-e233.].
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Affiliation(s)
- Richard D Goldstein
- From Robert's Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics (R.D.G., H.C.K.), and the Department of Pathology (H.C.K.), Boston Children's Hospital, and Harvard Medical School (R.D.G., H.C.K.) - both in Boston; and East Thetford, VT (A.E.G.)
| | - Hannah C Kinney
- From Robert's Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics (R.D.G., H.C.K.), and the Department of Pathology (H.C.K.), Boston Children's Hospital, and Harvard Medical School (R.D.G., H.C.K.) - both in Boston; and East Thetford, VT (A.E.G.)
| | - Alan E Guttmacher
- From Robert's Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics (R.D.G., H.C.K.), and the Department of Pathology (H.C.K.), Boston Children's Hospital, and Harvard Medical School (R.D.G., H.C.K.) - both in Boston; and East Thetford, VT (A.E.G.)
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35
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Lavezzi AM, Pusiol T, Paradiso B. Harmful Effect of Intrauterine Smoke Exposure on Neuronal Control of "Fetal Breathing System" in Stillbirths. Int J Environ Res Public Health 2022; 19:ijerph19074164. [PMID: 35409845 PMCID: PMC8999022 DOI: 10.3390/ijerph19074164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
This article is aimed to contribute to the current knowledge on the role of toxic substances such as nicotine on sudden intrauterine unexplained deaths’ (SIUDS’) pathogenetic mechanisms. The in-depth histopathological examination of the autonomic nervous system in wide groups of victims of SIUDS (47 cases) and controls (20 cases), with both smoking and no-smoking mothers, highlighted the frequent presence of the hypodevelopment of brainstem structures checking the vital functions. In particular, the hypoplasia of the pontine parafacial nucleus together with hypoplastic lungs for gestational age were observed in SIUDS cases with mothers who smoked cigarettes, including electronic ones. The results allow us to assume that the products of cigarette smoke during pregnancy can easily cross the placental barrier, thus entering the fetal circulation and damaging the most sensitive organs, such as lungs and brain. In a non-negligible percentage of SIUDS, the mothers did not smoke. Furthermore, based on previous and ongoing studies conducted through analytical procedures and the use of scanning electron microscopy, the authors envisage the involvement of toxic nanoparticles (such as agricultural pesticides and nanomaterials increasingly used in biomedicine, bioscience and biotechnology) in the death pathogenesis, with similar mechanisms to those of nicotine.
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Affiliation(s)
- Anna M. Lavezzi
- “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20121 Milan, Italy;
- Correspondence:
| | - Teresa Pusiol
- Institute of Anatomic Pathology, APSS, 38122 Trento, Italy;
| | - Beatrice Paradiso
- “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20121 Milan, Italy;
- General Pathology Unit, Dolo Hospital, 30031 Dolo, Italy
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36
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Servick K. Geneticists find clues to unexplained child deaths. Science 2022; 375:597-598. [PMID: 35143313 DOI: 10.1126/science.ada1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sequencing mysterious cases yields mutations linked to seizures and arrhythmias.
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Dahl K, Andersen M, Henriksen TB. Association between auditory system pathology and sudden infant death syndrome (SIDS): a systematic review. BMJ Open 2021; 11:e055318. [PMID: 34911724 PMCID: PMC8679124 DOI: 10.1136/bmjopen-2021-055318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A theory has emerged, suggesting that abnormalities in the auditory system may be associated with sudden infant death syndrome (SIDS). However, current clinical evidence has never been systematically reviewed. DESIGN A systematic review was conducted according to the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES PubMed, Embase and Web of Science were systematically searched through 7 September 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Only human studies with a reference group were included. Studies were eligible for inclusion if they examined infants exposed to otoacoustic emissions (OAEs), auditory brainstem response (ABR) or had autopsies with brainstem histology of the auditory system. SIDS was the primary outcome, while the secondary outcome was near-miss sudden infant death syndrome episodes. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias, and the quality of evidence. Due to high heterogeneity, a narrative synthesis was conducted. Risk of bias and quality of evidence was assessed using the Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development and Evaluation. RESULTS Twelve case-control studies were included. Seven studies on OAEs or ABR had a high degree of inconsistency. Contrarily, four out of five studies reporting on brainstem histology found that auditory brainstem abnormalities were more prevalent in SIDS cases than in controls. However, the quality of evidence across all studies was very low. CONCLUSION This systematic review found no clear association between auditory system pathology and SIDS. The higher prevalence of histological abnormalities in the auditory system of SIDS may indicate an association. However, further studies of higher quality and larger study populations are needed to determine whether these findings are valid. PROSPERO REGISTRATION NUMBER CRD42020208045.
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Affiliation(s)
- Katrine Dahl
- Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Mads Andersen
- Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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Abstract
BACKGROUND Fatal child abuse can be mistaken for sudden unexpected infant death (SUID) in the emergency department setting. It is unknown if there are characteristics that distinguish abusive from nonabusive causes of SUIDs in the emergency department. METHODS Using a matched case-control design, we reviewed the medical examiner records of deaths of infants younger than 12 months who were found unresponsive at a residence, required cardiopulmonary resuscitation, and had a complete forensic autopsy between 2009 and 2015. Infants with a manner of death as homicide were cases; controls were those with the manner of death as accident, natural, or undetermined. Each case was matched with 5 controls based on age (months). Differences between cases and controls were evaluated with respect to demographic, parental, and household characteristics and clinical outcomes. RESULTS We identified 12 cases (homicides) and 169 controls (nonhomicides), of which 60 were selected for the matched analysis. We found no significant differences between cases and controls with respect to age, race, sex, maternal substance use, Child Protective Services involvement prior to death, presence of male head of household, surviving siblings, or emergency medical services transport. Cases were more likely to have Child Protective Services involvement at the time of death (83% vs 38%; P = 0.01), sentinel injuries (odds ratio, 9.67; 95% confidence interval, 1.30-122.43), and return of spontaneous circulation (odds ratio, 29.99; 95% confidence interval, 3.70-241.30). CONCLUSIONS Child Protective Services agency involvement at time of death, sentinel injury, and return of spontaneous circulation were more often associated with abusive causes of SUID. Further study is needed to confirm these findings.
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Affiliation(s)
- Kirsten Bechtel
- From the Department of Pediatrics, Yale School of Medicine, New Haven
| | | | - Julie R Gaither
- From the Department of Pediatrics, Yale School of Medicine, New Haven
| | - John M Leventhal
- From the Department of Pediatrics, Yale School of Medicine, New Haven
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Ahn YM, Yang KM, Ha HI, Cho JA. Cultural variation in factors associated with sudden infant death during sleep. BMC Pediatr 2021; 21:443. [PMID: 34627192 PMCID: PMC8501689 DOI: 10.1186/s12887-021-02894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the significant reduction decades ago in sudden unexpected death in infancy (SUDI), decline of rates has slowed and stalled in some countries, including the USA. This led to an appreciation of ethnic variations in SUDI rates and the need to increase cultural sensitivity regarding sleep practices and circumstantial factors of SUDI. The study explored SUDI-related factors, in journal articles from two geo-cultural regions (Asian and Western countries), particularly for factors related to infant sleep practices. METHODS A systematic review was conducted to identify SUDI-related factors in articles from PubMed, Scopus, and the Korean Citation Index from January 1992 to April 2019. From each article, SUDI-related factors were retrieved and categorized through the identification, aggregation, and categorization of factors into the areas of the triple risk model (TRM) of SUDI by their meanings and commonality. Significant trends in the frequency of factors were analyzed across time and between the two geo-cultural regions (Asian and Western countries) of article. RESULTS From a review of 218 articles (38 Asian and 180 Western articles), 84 SUDI-related factors were identified: 39 factors for TRM 1, 44 factors for TRM 2, and one factor for TRM 3. Four of the top-ranked 10 factors were found in both cultural zones: sleep position, male sex, bed-sharing, and genetics. Both cultural zones identified sleep position (44.0%), bed-sharing (22.0%), and rooming-in (16.5%) as the three most important sleep-related factors for SUDI. Variations between the cultural zones were observed in the place of SUDI occurrence, overheating, swaddling or bedding standards, and smoking. CONCLUSIONS Regardless of the urgent need to identify SUDI-related factors in low-SUDI societies, Asian cultures showed a significant lack of articles on SUDI. Several sociocultural issues were recognized such as the meaning of bed-sharing and rooming-in, along with residential styles and traditional health beliefs on sleep-related SUDI factors. Particularly little attention towards smoking was found in Asian articles in terms of frequency, suggesting the need to enhance SUDI reduction strategies by incorporating gender-sensitive smoking cessation interventions. This review of SUDI factors requests child health professionals to be alert to sociocultural variations in sleep practices and SUDI factors.
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Affiliation(s)
- Young Mee Ahn
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea.
| | - Kyung-Moo Yang
- Division of Forensic Medicine, National Forensic Service, 10, Ipchun-ro, Wonju-si, Gangwon-do, Republic of Korea, 26460
| | - Hong Il Ha
- Division of Forensic Medicine, National Forensic Service Seoul Institute, 139, Jiyang-ro, Yangcheon-gu, Seoul, Republic of Korea, 08036
| | - Jung Ae Cho
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea
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D'Hondt D, Van Hoyweghen A, Broeckx G, Pauwels P. An Incidental Finding of Congenital Pulmonary Airway Malformation Type 3 During a Forensic Autopsy for a Sudden Infant Death: A Case Report With a Brief Literature Review. Am J Forensic Med Pathol 2021; 42:301-306. [PMID: 33833194 DOI: 10.1097/paf.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Congenital pulmonary airway malformation (CPAM), previously known as congenital cystic airway malformation, is a developmental disorder of the lower respiratory tract. It is subdivided into 5 types based on clinical and pathologic features. Type 3, an adenomatoid type of CPAM, is the second rarest form of CPAM, occurring in approximately 5% of all CPAM cases. This article reports an autopsy of a nearly 11-week-old male infant, found unresponsive in bed with his mother. She had fallen asleep after breastfeeding a few hours prior. Although the autopsy and additional technical examinations did not uncover the exact cause of death, CPAM type 3 was eventually identified on histological examination. Taking into account the context of this case, in which accidental asphyxia/neglect could not be ruled out, it is thought that the presence of CPAM might have contributed to the demise of the infant. As CPAM is a rare congenital disorder, the diagnosis could easily be missed. Therefore, this article aims to raise awareness of this diagnosis and points out the clinical and pathologic features of this disorder.
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41
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Chen YT, Liu CL, Chen CJ, Chen MH, Chen CY, Tsao PN, Chou HC, Chen PC. Association between short-term exposure to air pollution and sudden infant death syndrome. Chemosphere 2021; 271:129515. [PMID: 33450422 DOI: 10.1016/j.chemosphere.2020.129515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
The association between air pollution and infant mortality has been inconsistently reported. A few studies have estimated short-term effects of air pollution on infants' health. This population-based case-control study aimed to examine the potential effects of air pollution on sudden infant death syndrome (SIDS) in the post-neonatal period in Taiwan during 1997-2002. Each case of infant death was matched with 20 randomly selected sex-matched controls who were born on the same day and were still alive. We obtained 24-h measurements of air pollutants and meteorological factors in each case and control with 1- to 14-day lags from 55 air-quality monitoring stations. After controlling for potential confounders, conditional logistic regression analysis was performed to estimate effects of air pollutants on SIDS (n = 398) and respiratory death (n = 121) among neonates. In single- and multi-pollutant models, we found that 100-ppb increment in carbon monoxide (Odds Ratio = 1.04-1.07) and 10-ppb increment in nitrogen dioxide (Odds Ratio = 1.20-1.35) with 1- to 14-day lags were associated with significant increase in SIDS, although a significant relationship between air pollution and respiratory death was not determined in 1- to 14-day lags. Short-term carbon monoxide and nitrogen dioxide exposure were associated with significant increase in SIDS in the post-neonatal period, with latency estimated within days before death.
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Affiliation(s)
- Yin-Ting Chen
- Division of Neonatology, Department of Pediatric, China Medical University Children's Hospital, Taiwan
| | - Chia-Lin Liu
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Chi-Jen Chen
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Mei-Huei Chen
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; The Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Pau-Chung Chen
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
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42
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Abstract
BACKGROUND Sudden unexpected infant death (SUID) represents a broad group of explained and unexplained infant deaths (<1 year old). Explaining why SUID occurs is critical to understanding etiology and prevention. Death certificate data cannot differentiate explained from unexplained SUID cases nor describe the surrounding circumstances. We report SUID rates by explained and unexplained categories and describe demographics and history of recent injury or illness using the Centers for Disease Control and Prevention SUID Case Registry. METHODS The registry is a population-based surveillance system built on Child Death Review programs. Data are derived from multiple sources, including death certificates, scene investigations, and autopsy reports. Cases included SUIDs reported by states or jurisdictions participating in the registry during 2011-2017. Cases were classified into explained and unexplained categories by using the registry's classification system. Frequencies, percentages, and mortality rates per 100 000 live births were calculated. RESULTS Of the 4929 SUID cases, 82% were categorized as unexplained. Among all cases, 73% had complete case information. Most SUIDs (72%) occurred in an unsafe sleep environment. The SUID mortality rate was 97.3 per 100 000 live births. Among explained and possible suffocation deaths, ∼75% resulted from airway obstruction attributed to soft bedding. CONCLUSIONS Unsafe sleep factors were common in explained and unexplained SUID cases, but deaths could only be classified as explained suffocation for ∼20% of cases. Further analysis of unexplained deaths, including continued improvements to death scene investigation and documentation, may generate hypotheses for physiologic and genetic research, advance our understanding of gaps in SUID investigation, and enhance our understanding of infants at highest risk.
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Affiliation(s)
- Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | - Fern R Hauck
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia; and
| | - Carri R Cottengim
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meghan Faulkner
- Center for National Prevention Initiatives, Michigan Public Health Institute, Okemos, Michigan
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43
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Price S. Talk to Patients About: Vaccines and SIDS. Tex Med 2021; 117:43. [PMID: 33641121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Over the years, several vaccines have been blamed for SIDS, including those for pertussis, tetanus, diphtheria, Hemophilus influenzae type B, polio, and hepatitis B. This misconception has triggered a lot of scientific study to find out if vaccines could, in fact, cause SIDS. However, multiple studies and safety reviews have concluded that the answer is no, according to the Centers for Disease Control and Prevention (CDC).
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44
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Sánchez T, Peirano D, Pipino C, Brockmann PE. [Bad sleeping habits in infants: Risk factor for sudden infant death syndrome. Pilot study]. Rev Chil Pediatr 2020; 91:529-535. [PMID: 33399729 DOI: 10.32641/rchped.vi91i4.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 05/11/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The American Academy of Pediatrics recommends, through the implementation of the "Back to Sleep (BTS)" campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS). OBJECTIVE To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS). SUBJECTS AND METHOD Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center. EXCLUSION CRITERIA Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old. RESULTS We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents' room and 31% slept in parents' bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). Conclu sion: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.
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Affiliation(s)
- Trinidad Sánchez
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dominga Peirano
- Escuela de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Camila Pipino
- Escuela de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Pablo E Brockmann
- Departamento de Cardiología y Enfermedades Respiratorias del Niño, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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45
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Goldwater PN. SIDS, prone sleep position and infection: An overlooked epidemiological link in current SIDS research? Key evidence for the "Infection Hypothesis". Med Hypotheses 2020; 144:110114. [PMID: 32758900 PMCID: PMC7366103 DOI: 10.1016/j.mehy.2020.110114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
Mainstream researchers explain the etiology of SIDS with the cardiorespiratory paradigm. This has been the focus of intense study for many decades without providing consistent supporting data to link CNS findings to epidemiological risk factors or to the usual clinicopathological findings. Despite this, and the apparent oversight of the link between prone sleep position and respiratory infection, papers citing CNS, cardiac and sleep arousal findings continue to be published. Discovery of the prone sleep position risk factor provided tangential support for the cardiorespiratory control hypothesis which defines the mainstream approach. Despite many decades of research and huge expenditure, no aetiological answer has been forthcoming. In asking why?This paper exposes some of the shortcomings regarding this apparent oversight by mainstream SIDS researchers and examines the role of respiratory infection and puts the case for the “Infection Hypothesis.” In addition, the paper provides encouragement to neuropathologists to examine the potential link between CNS findings and cardiac function (as opposed to respiratory function) in relation to infection and to examine possible correlates between CNS findings and established risk factors such as recent infection, contaminated sleeping surfaces, maternal/obstetric/higher birth, ethnicity, non-breast-feeding, male gender, etc. or with the usual gross pathological findings of SIDS (intrathoracic petechial hemorrhages, liquid blood, congested lungs). The shortcomings exposed through this review invite questions over current research directions and hopefully encourage research into other more plausible hypotheses, such as the infection paradigm.Mainstream SIDS researchers appear to have overlooked the key relationship between prone sleep position and infection. This omission has major implications for current and future SIDS research.
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Affiliation(s)
- Paul N Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
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46
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Levieux K, Hubert G, Vrignaud B. [Severe malaise and unexpected death of the infant]. Rev Prat 2020; 70:e95-e96. [PMID: 32877079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Karine Levieux
- Service des urgences pédiatriques, hôpital Femme-Enfant-Adolescent, CHU de Nantes,44093 Nantes, France
| | - Gaëlle Hubert
- Service des urgences pédiatriques, hôpital Femme-Enfant-Adolescent, CHU de Nantes,44093 Nantes, France
| | - Bénédicte Vrignaud
- Service des urgences pédiatriques, hôpital Femme-Enfant-Adolescent, CHU de Nantes,44093 Nantes, France
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47
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McGuone D, Leitner D, William C, Faustin A, Leelatian N, Reichard R, Shepherd TM, Snuderl M, Crandall L, Wisniewski T, Devinsky O. Neuropathologic Changes in Sudden Unexplained Death in Childhood. J Neuropathol Exp Neurol 2020; 79:336-346. [PMID: 31995186 PMCID: PMC7036658 DOI: 10.1093/jnen/nlz136] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/14/2019] [Accepted: 12/10/2019] [Indexed: 12/21/2022] Open
Abstract
Sudden unexplained death in childhood (SUDC) affects children >1-year-old whose cause of death remains unexplained following comprehensive case investigation and is often associated with hippocampal abnormalities. We prospectively performed systematic neuropathologic investigation in 20 SUDC cases, including (i) autopsy data and comprehensive ancillary testing, including molecular studies, (ii) ex vivo 3T MRI and extensive histologic brain samples, and (iii) blinded neuropathology review by 2 board-certified neuropathologists. There were 12 girls and 8 boys; median age at death was 33.3 months. Twelve had a history of febrile seizures, 85% died during apparent sleep and 80% in prone position. Molecular testing possibly explained 3 deaths and identified genetic mutations in TNNI3, RYR2, and multiple chromosomal aberrations. Hippocampal abnormalities most often affected the dentate gyrus (altered thickness, irregular configuration, and focal lack of granule cells), and had highest concordance between reviewers. Findings were identified with similar frequencies in cases with and without molecular findings. Number of seizures did not correlate with hippocampal findings. Hippocampal alterations were the most common finding on histological review but were also found in possibly explained deaths. The significance and specificity of hippocampal findings is unclear as they may result from seizures, contribute to seizure pathogenesis, or be an unrelated phenomenon.
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Affiliation(s)
- Declan McGuone
- From the Department of Pathology, Yale School of Medicine, New haven, Connecticut
| | - Dominique Leitner
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, New York
| | - Christopher William
- Department of Neurology
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York
| | | | - Nalin Leelatian
- From the Department of Pathology, Yale School of Medicine, New haven, Connecticut
| | - Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York
| | - Laura Crandall
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, New York
- Sudden Unexplained Death in Childhood Foundation, Cedar Grove, New Jersey
| | - Thomas Wisniewski
- Department of Neurology
- Center for Cognitive Neurology, and Psychiatry, NYU Langone Health and School of Medicine, New York, New York
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, New York
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48
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Levieux K, Hubert G, Vrignaud B. [Severe malaise of the infant and sudden death]. Rev Prat 2020; 70:e89-e94. [PMID: 32877078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Karine Levieux
- Service des urgences pédiatriques, hôpital Femme-Enfant-Adolescent, CHU de Nantes,44093 Nantes, France
| | - Gaëlle Hubert
- Service des urgences pédiatriques, hôpital Femme-Enfant-Adolescent, CHU de Nantes,44093 Nantes, France
| | - Bénédicte Vrignaud
- Service des urgences pédiatriques, hôpital Femme-Enfant-Adolescent, CHU de Nantes,44093 Nantes, France
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49
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Yazdanfard PD, Christensen AH, Tfelt-Hansen J, Bundgaard H, Winkel BG. Non-diagnostic autopsy findings in sudden unexplained death victims. BMC Cardiovasc Disord 2020; 20:58. [PMID: 32019512 PMCID: PMC7001247 DOI: 10.1186/s12872-020-01361-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several inherited cardiac diseases may lead to sudden cardiac death (SCD) a devastating event in the families. It is crucial to establish a post mortem diagnosis to facilitate relevant work-up and treatment of family members. Sudden unexplained death (SUD) victims constitute roughly one third of all SCD cases in Denmark. METHODS This was a single center, retrospective study investigating SUD cases. Victims who died unexplained due to suspected or confirmed cardiac disease were consecutively referred to a third line referral center established in 2005. All autopsy reports were investigated. Victims were divided into two groups: non-diagnostic cardiac findings and normal cardiac findings. None of the included victims had findings consistent with a diagnosis based on existing criteria. RESULTS In total, 99 SUD cases were referred. The mean age of the victims was 37 years (range 0-62 years, 75% males). A total of 14 (14%) victims had a cardiovascular diagnosis pre-mortem. Thirty-seven cases had normal cardiac findings and non-diagnostic cardiac findings were found in 62 cases (63%). The five most common findings included ventricular hypertrophy and/or enlarged heart (n = 35, 35%), coronary atheromatosis (n = 31, 31%), myocardial fibrosis (n = 19, 19%), dilated chambers (n = 7, 7%) and myocardial inflammation (n = 5, 5%). CONCLUSION One third of SUD victims had normal cardiac findings and non-diagnostic cardiac findings were seen in almost two thirds of the SUD victims. These non-diagnostic findings may be precursors or early markers for underlying structural cardiac disorders or may be innocent bystanders in some cases. Further studies and improved post-mortem examination methods are needed for optimization of diagnostics in SUD.
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Affiliation(s)
- Puriya Daniel Yazdanfard
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
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50
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Rizzo S, De Gaspari M, Carturan E, Paradiso B, Favretto D, Thiene G, Basso C. A standardized postmortem protocol to assess the real burden of sudden infant death syndrome. Virchows Arch 2020; 477:177-183. [PMID: 31975036 PMCID: PMC7371652 DOI: 10.1007/s00428-020-02747-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
Abstract
Sudden unexpected infant death (SUID) is a major cause of death in infants < 1 year of age. Sudden infant death syndrome (SIDS) is a SUID still unexplained after post-mortem examination. In 2014, a protocol of post-mortem investigation was introduced to assess both the prevalence and the etiopathogenesis of SUID. Our aim was to compare SUID data before and after the application of a standardized autopsy protocol of investigation. In the time interval 2004-2018, SUID cases occurring in the Veneto Region, North-East Italy, were referred to our Core Lab. Since 2014, a complete autopsy was performed, including gross and histological study with toxicologic and molecular analysis carried out at the referral center. A total of 36 SUIDs (22 M, mean age 95.5 ± 80 days), 17 before (group A) and 19 after (group B) 2014, were collected. In group A, only 1 (6%) resulted as explained SUID, due to lymphocytic myocarditis and 16 (94%) were SIDS. In group B, 8 were SIDS (42%) and 11 (58%) explained SUID cases (p < 0.01), consisting of interstitial pneumonia and bronchiolitis in 9 and lymphocytic myocarditis in 2 cases. Molecular analysis was positive for viruses in 8 of them (73%). In conclusion, since the application of a standardized protocol of post-mortem investigation, inflammatory, mostly infective, cardio-pulmonary diseases have been identified as the most common cause of SUID, with SIDS falling from 94 to 42% of SUID. Efforts must be made to implement a uniform autopsy protocol to provide reliable epidemiological data on SIDS.
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Affiliation(s)
- Stefania Rizzo
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via A. Gabelli, 61 35121, Padova, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via A. Gabelli, 61 35121, Padova, Italy
| | - Elisa Carturan
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via A. Gabelli, 61 35121, Padova, Italy
| | - Beatrice Paradiso
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via A. Gabelli, 61 35121, Padova, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via A. Gabelli, 61 35121, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via A. Gabelli, 61 35121, Padova, Italy.
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