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http://www3.interscience.wiley.com/cgi-bin/abstract/104540989/START
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Online ISSN: 1099-0496 Print
ISSN: 8755-6863 Copyright © 2003 Wiley-Liss, Inc. |
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Original Article
| Characterization of successful and failed autoresuscitation in human infants, including those dying of SIDS |
| Raghunathan Sridhar, MD 1, Bradley T. Thach, MD 1 *, Dorothy H. Kelly, MD 2, Judith A. Henslee, LMSW 2 |
| 1Division of Newborn Medicine,
Department of Pediatrics, Washington University, St. Louis, Missouri 2Southwest SIDS Research Institute, Lake Jackson, Texas |
| email: Bradley T. Thach (thach@kids.wustl.edu) |
*Correspondence to Bradley T. Thach, Division of Newborn Medicine, Department of Pediatrics, Washington University, One Children's Place, St. Louis, MO 63110.
Funded by:
NIH; Grant Number: NICH HD
10993
| Keywords |
| autoresuscitation • home monitor • bradycardia • hypoxic gasping • sudden infant deaths |
| Abstract |
Our purpose was to identify and further characterize physiologic
mechanisms relevant to autoresuscitation from hypoxic apnea in
infants dying suddenly and unexpectedly. We studied
cardiorespiratory recordings of 24 infants (age range, 0.8-21
months) who died suddenly while being monitored at home. These
recordings were analyzed for features indicated by studies in animal
models to be characteristic of hypoxic gasping, and of recovery from
bradycardia and apnea associated with gasping (e.g.,
autoresuscitation). Findings in 5 infants diagnosed as having sudden
infant death syndrome were compared with 6 non-SIDS infants whose
deaths resulted from other conditions. Additionally, we studied 15
healthy infants during sleep, using home monitor and other
respiratory recording techniques, in order to obtain comparison
data. We found in recordings from 23 of 24 subjects that hypoxic
gasps with characteristic features occurred immediately preceding
death. A unique pattern of complex, closely spaced gasps ( double or
triple gasps) was present
in many subjects. Evidence of partially successful autoresuscitation
closely following one or more gasps occurred in 11 subjects, while
another 4 had evidence of complete autoresuscitation with return of
normal heart rate and resolution of apnea on one or more occasions.
Significant differences between SIDS infants and those dying from
other causes included increased occurrence of complex gasps and
decreased occurrence of partial or complete autoresuscitation in the
SIDS infants. The non-SIDS cases were different from the SIDS cases
in that only one had double gasps (n = 7), while none had triple gasps, as compared with 4 out of 5
SIDS cases with these patterns (P < 0.05, chi-square). Also,
in contrast with the SIDS cases, more of the cases with specific
postmortem diagnoses had evidence of partial (5 out of 6 cases) or
complete (1 out of 6 cases) autoresuscitation (P < 0.05,
chi-square). We conclude that partial or complete autoresuscitation
by gasping is not uncommon in moribund infants during the first year
of life. Failure of autoresuscitation mechanisms other than failure
to initiate gasping may be characteristic of infants dying of SIDS.
Some SIDS infants appear to be different from infants dying with
other diagnoses with respect to efficacy and characteristics of
hypoxic gasping. Pediatr Pulmonol. 2003; 36:113-122. © 2003
Wiley-Liss, Inc. |
Received: 11 April 2002; Accepted: 23 January 2003
| Digital Object Identifier (DOI) |
10.1002/ppul.10287 About DOI
| References are available in the Enhanced Abstract |
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