New research provides clues as to why some children die of SIDS

Scientists in Australia have found that some children at risk of sudden infant death syndrome, or SIDS, have low levels of an enzyme called butyrlcholinesterase (BChE) in their blood. Their study, published May 6 in the journal Ibiomedicine, could pave the way for newborn screening and intervention if the results are confirmed by further research.

“This is the first time we have had a potential biomarker of SIDS,” said Dr Carmel Harrington, who led the research at Westmead Children’s Hospital in Sydney, Australia.

Researchers have been trying for decades to chip in the biological underpinnings of Puzzling Syndrome. And although public health campaigns have greatly reduced the incidence of SIDS, it remains a major cause of sudden and unexpected deaths of children under 1 year of age in Western countries. In the United States, approximately 3,400 children die suddenly and unexpectedly each year, according to the Centers for Disease Control and Prevention. This includes children who die suddenly due to known causes like suffocation, as well as those who die without any obvious cause like SIDS. About half of all sudden and unexpected infant deaths (SUIDs) in the United States are caused by SIDS.

One of the reasons SIDS is so tragic and mysterious is because it is probably not caused by a single biological process, but rather a combination of factors that combine with a perfect storm, says Dr. Thomas Keynes says previous research by Engels has pointed to reduced activity or damage to certain parts of children’s brains that control heartbeat, breathing and arousal from sleep, as well as environmental stressors such as soft bed or secondhand smoke.

“The concern among researchers is that some children die from SIDS because they do not wake up in response to a dangerous situation while they are asleep,” said Dr. Keynes.

To test whether SIDS was inherently different in children, Dr. Harrington and colleagues compared dried blood samples from the heel prick test of 655 healthy newborns, 26 children who died of SIDS and 41 children who died of other causes. They found that nine out of ten children who died of SIDS had significantly lower BChE levels than children in the other two groups.

“I was just shocked,” said Dr. Harrington, who has been looking for clues and crowdfunding for his research for almost 30 years since he lost one of his own children to SIDS. “Parents of children with SIDS carry a lot of guilt because their child died within hours. But what we found in this study is that these children are born different, the difference is hidden and no one knew before. So it’s not the parents’ fault. “

Dr Richard Goldstein, a pediatric palliative care specialist at Boston Children’s Hospital, said the new findings support researchers’ hypothesis that children who die from SIDS have arousal problems. BChE plays a role in the availability of important neurotransmitters in the excitatory pathways of the brain. Low levels of the enzyme may indicate that the brain is unable to send signals to a child to wake up, turn his head, or breathe. “But we need more research before we can understand its true meaning,” said Dr. Goldstein.

Although the study identifies an important chemical marker in a small group of children, it is too early to say whether a comprehensive test would be helpful for BChE.

For one, scientists and doctors do not know what a “normal” level of enzyme looks like. And Australian researchers did not have access to fresh blood samples for BChE, so they did not measure absolute levels of the enzyme. There was overlap between the children. Some children who died of SIDS had BCHE levels within the same range as those who did not die.

“If you’re going to test every baby that is born, you want the results to stand out as abnormal only for babies who are at very high risk,” said Dr. Keynes. Even if further studies subtly help the BChE test to accurately differentiate between children who may die of SIDS and those who can lead healthy lives, doctors and parents will still be faced with a dilemma: what to do next? Currently, there is no intervention or treatment for low BChE levels.

Many suggestions for SIDS prevention remain the same, Dr. Keynes said. Make sure you follow safe sleep recommendations, such as putting your baby on his or her back – both at bedtime and at night. Remove loose sheets, blankets, pillows, bumper pads and soft toys from your baby’s sleeping area. And consider keeping your baby in the same room as you at night for at least six months, or ideally, until your baby is one year old.

The American Academy of Pediatrics also recommends avoiding smoking, alcohol and exposure to illicit drugs during pregnancy; Breastfeeding; Regular vaccinations; And using a pacifier to reduce the risk of SIDS.

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