Diphtheria-tetanus-pertussis immunization and sudden infant death syndrome.

We compared the recency of diphtheria-tetanus-pertussis (DTP) immunization in healthy children with birthweights greater than 2500 gms who died of sudden infant death syndrome (SIDS) to that of age-matched reference children, using a modified case-control analysis. Focusing on very narrow time intervals following immunization, we found the SIDS mortality rate in the period zero to three days following DTP to be 7.3 times that in the period beginning 30 days after immunization (95 per cent confidence interval, 1.7 to 31). The mortality rate of non-immunized infants was 6.5 times that of immunized infants of the same age (95 per cent CI, 2.2 to 19). The latter result and to some extent the former appear to be ascribable to known risk factors for SIDS. Although the mortality ratios for SIDS following DTP, as estimated from this study, are high the period of apparently elevated risk was very short, so that only a small proportion of SIDS cases in infants with birthweights greater than 2500 gms could be associated with DTP.

[Toxic environmental factors in sudden infant death (SIDS)]. / Zur Problematik schädigender Umwelteinflüsse beim plötzlichen Kindstod (SIDS).

The increasing number of discussions on the influence of toxic environmental factors, including SIDS, prompted systematic postmortem chemical-toxicological investigations to be carried out on 54 SIDS cases and 2 control cases of the same age group. Tissue levels of arsenic, lead, cadmium, mercury, and pentachlorphenol, as well as other organic noxious agents, were measured in several organs. In addition, the COHb concentrations were determined. In spite of the widely scattered values, the extreme levels measured and the arithmetic means and median averages of As, Pb, Cd, Hg, PCP, and COHb had no more range in concentrations than can be expected for toxic effects - according to present knowledge anyway. It was observed that infants from an urban environment showed no greater concentration of noxious agents than did infants from rural regions. There were also no differences between SIDS cases and the controls, nor was there a correlation between infections of the respiratory system that are often morphologically detected - including laryngitis - and higher concentrations of these agents in the organs of SIDS cases.

Possible role of lysolecithins and nonesterified fatty acids in the pathogenesis of Reye's syndrome, sudden infant death syndrome, acute pancreatitis, and diabetic ketoacidosis.

In vitro denaturation and (or) alteration of protein function by detergents have been extensively documented. I suggest that similar biochemical and clinical features of Reye's syndrome, sudden infant death syndrome, acute pancreatitis, and diabetic ketoacidosis may be explained as sequelae of the toxic detergent effects of nonesterified fatty acids and lysolecithins. These diseases may be provoked by a drug-induced diminution of the detergent-buffering capacity of blood or tissue proteins; by excess detergents produced in vivo, consequent to lipase activity induced by viral infection or metabolic disease; or by some combination of these factors.

Phenothiazine-induced sleep apneas in normal infants.

A relationship between sudden infant death syndrome and the use of phenothiazine-containing medications is suspected. In order to investigate the influence of phenothiazines upon cardiorespiratory and sleep characteristics, four normal infants (mean age 15.8 weeks) had polygraphic recordings made for one night. The recordings were repeated three nights later, after the daily administration of a usual therapeutic dose of a standard phenothiazine syrup (promethazine, 1 mg/kg of body weight per day). The infants were monitored for six days after the first treatment. Findings from the first polygraphic recordings were normal for each infant. The second recordings disclosed an increase in sleep time, a reduction in the number and duration of awakenings, an increase in non-rapid eye movement (NREM) III sleep state, and a reduction in body movements. During the second night, each infant showed an increase in the number of central apneas, and each infant also had several episodes of obstructive apneas (median duration four seconds). It is concluded that promethazine depresses the arousal and respiratory mechanisms in normal infants during sleep. This observation reinforces the opinion that CNS depressants should be avoided in infants less than 1 year of age; CNS depressants could result in sudden death in apnea-prone infants.

Bordetella pertussis whole cell vaccines--efficacy and toxicity.

The literature concerning efficacy and side effects of pertussis vaccines is reviewed. With few exceptions, most vaccines induce a protective immunity lasting for 2 to 5 years. The large-scale use of pertussis vaccines has markedly contributed to the decrease in pertussis morbidity in small children but in some countries the incidence has increased in older children. Not even countries with immunisation rates of 90-95% have managed to eradicate pertussis or prevent disease in infants below the age of immunisation. The pertussis-associated mortality is currently very low in the industrialised countries and no differences can be discerned when countries with high, low and zero immunisation rates are compared. Local and benign systemic reactions are commonly seen after immunisation. The vaccines also sometimes cause convulsions, a shock-like state and, rarely, serious neurological reactions.

An overview: maternal nicotine and caffeine consumption and offspring outcome.

Smoking and caffeine ingestion are the most commonly abused physiologically addictive licit drugs [32]. They have similar neurally facilitative properties and individuals monitor their intake so as to maintain a constant level in blood. As is true of other addictive drugs, tolerance to their effects develops over time resulting in increased consumption. This pattern is fairly small with nicotine and caffeine however. THe effects on offspring outcome of smoking and caffeine use and abuse in gravid women and animal models is the subject of this overview.

Cot deaths and water-sodium.

Over a thirty-year period in Scunthorpe, during which there were two changes in the sodium content of the water supply, there were significantly more sudden deaths in infancy during the decade when sodium levels were highest. This is compatible with the hypothesis that hypernatraemia is a factor leading to cot death. Changes in the incidence of breastfeeding over the same period may have contributed to, but are unlikely to account for, the result because the pattern was different in a neighbouring district where there was no change in water quality.