Citation

Goldstein RD. Pediatrics 2019; ePub(ePub): ePub.

Affiliation

Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts richard.goldstein@childrens.harvard.edu.

Copyright

(Copyright © 2019, American Academy of Pediatrics)

DOI

10.1542/peds.2019-3212

PMID

31818864

Abstract

Fifty years ago, an extraordinary group of pathologists, pediatricians, and epidemiologists met to address the limited research and numerous diagnoses applied to unexplained, largely sleep-related pediatric deaths. Their efforts led to the identification of a new category of disease, sudden infant death syndrome (SIDS). Among the observations fueling the creation of the category was the relative sparing of neonates despite what should be increased vulnerability in the early days of life. When Dr Bruce Beckwith, the conference’s leader, asked whether anyone doubted this age-related sparing, not a single objection was raised. Yet, humility about what was not yet known led to broader diagnostic criteria of “any infant or young child.” Years later, SIDS was redefined as pertaining to infants <1 year of age. Still later, when classification practices scattered because of objections about the concept of SIDS and the varied use of alternative terminologies, the composite of sudden unexplained infant death (SUID) came to stand in.

In this issue of Pediatrics, big data concur with the pioneering thinkers and draw the demarcation at 1 week. In “Distinct Populations of Sudden Unexpected Infant Death Based on Age,” Lavista Ferres et al used elegant, unbiased computational modeling without predetermined age boundaries to determine distinct age-related subgroups in SUID. Using profiles that included birth order, birth weight, marital status, maternal age, and smoking, they showed that associated features of SUID during the first week of life were statistically divergent from SUID during the remainder of the first year. Their efforts join other recent contributions arguing that this earliest unexplained neonatal mortality may represent something different from SIDS and its analogs. At first glance, this accumulated research is reminiscent of findings that led to the demise of what was once called “near SIDS,” when differences in risk factors and incidence over time led to the conclusion that apparent life-threatening events, now called brief resolved unexplained events, were unrelated to SIDS.

This analysis centers on birth and death statistics in early life and is especially reliant on day 0 data. But accounting for mortality near the time of birth is notorious for its challenges. The definition of ...

Language: en