Decreased muscarinic receptor binding in the arcuate nucleus in sudden infant death syndrome

Effects of unilateral lesions of retrotrapezoid nucleus on breathing in awake rats

In anesthetized rats, unilateral retrotrapezoid nucleus (RTN) lesions markedly decreased baseline phrenic activity and the response to CO2 (E. E. Nattie and A. Li. Respir. Physiol. 97:63-77, 1994). Here we evaluate the effects of such lesions on resting breathing and on the response to hypercapnia and hypoxia in unanesthetized awake rats. We made unilateral injections [24 +/- 7 (SE) nl] of ibotenic acid (IA; 50 mM), an excitatory amino acid neurotoxin, in the RTN region (n = 7) located by stereotaxic coordinates and by field potentials induced by facial nerve stimulation. Controls (n = 6) received RTN injections (80 +/- 30 nl) of mock cerebrospinal fluid. A second control consisted of four animals with IA injections (24 +/- 12 nl) outside the RTN region. Injected fluorescent beads allowed anatomic identification of lesion location. Using whole body plethysmography, we measured ventilation in the awake state during room air, 7% CO2 in air, and 10% O2 breathing before and for 3 wk after the RTN injections. There was no statistically significant effect of the IA injections on resting room air breathing in the lesion group compared with the control groups. We observed no apnea. The response to 7% CO2 in the lesion group compared with the control groups was significantly decreased, by 39% on average, for the final portion of the 3-wk study period. There was no lesion effect on the ventilatory response to 10% O2. In this unanesthetized model, other areas suppressed by anesthesia, e.g., the reticular activating system, hypothalamus, and perhaps the contralateral RTN, may provide tonic input to the respiratory centers that counters the loss of RTN activity.

Sudden Infant Death Syndrome: The Role of Central Chemosensitivity

Clinical and basic research on Sudden Infant Death Syndrome (SIDS) has focused on sleep-disordered cardiorespiratory control during a critical period of brainstem maturation. Recently, some SIDS cases have been reported to have abnormalities of the arcuate nucleus of the medulla. The human arcuate nucleus is thought to be homologous to the medullary raphe in rats and cats, a widely projecting serotonergic system that is functionally linked to both respiration and sleep. Neurons of the medullary raphe are now known to be highly sensitive to respiratory acidosis in vitro and are candidates for central chemoreceptors. The relevance of changes in the arcuate nucleus to the mechanisms of death in SIDS remains controversial. However, based on this new data, a specific hypothesis is proposed here. In combination with Immaturity of respiratory control mechanisms, dysfunction of arcuate neurons may lead to a fatal exaggeration of a normal physiologic inhibition of central chemoreception during sleep. The major elements of this working hypothesis are testable in animal experiments and clinical studies.

Are bedding and rebreathing suffocation a cause of SIDS?

Suffocation by bedclothes became a popular diagnosis in the 1940s but gradually became replaced with the diagnostic label of Sudden Infant Death Syndrome (SIDS). In 1991 a paper purported that, instead of SIDS, pillows filled with polystyrene beads had caused death by rebreathing suffocation; this conclusion was reached on the basis of experiments with anesthetized rabbits breathing through a doll's head that was placed face down on the pillow. Because of the anesthesia, rabbits could not change their face down position. The doll's nares could not collapse, which would have resulted in rapid death due to conventional suffocation. The rabbits required up to 3 hours or more to die of hypercarbia and hypoxia. Studies in normal infants revealed that they turned from the face-down position after only 2 minutes. (The only infant who retained CO2 soon died of a fatal neurologic disorder, with central hypoventilation). Using the rabbit/doll's head and mechanical models, a wide range of bedding was indicted, including cushions, sheepskins, pillows, comforters, foam mattresses, and even simple blankets and sheets as potentially causing fatal rebreathing. Except for the use of pillows in general, as well as mattresses filled with kapok and bark, there has been no epidemiologic support for these indictments. Although normal infants are unlikely to succumb to rebreathing suffocation, infants with blunted ventilatory responsiveness and delayed arousal due to prior hypoxia were hypothesized to be at increased risk. Support for this concept was found in the pathology of the brain stem in victims of SIDS that was attributed to prior hypoxic injury. In infants who survived prolonged apnea, less than 20% have demonstrated a diminished ventilatory responsiveness to hypercarbia, but, more significantly, none had an absent response. Arousal to hypercarbia, an abnormality which is crucial to the hypothesis of rebreathing suffocation, is regularly present in normal subjects, but the threshold is higher in near-SIDS infants; however, no instances of failure to arouse have been reported in near-SIDS. If the infant is placed on his or her back or side, the issue of bedding could become moot; unfortunately, a sizable percentage of infants are still being placed prone for sleep. Instead of confusing parents with an ever-expanding list of "dangerous bedding," the message "Back to Sleep" should be emphasized.

Dynamics of respiratory patterning in normal infants and infants who subsequently died of the sudden infant death syndrome

Despite evidence that respiratory control mechanisms may be altered in infants who succumb to the sudden infant death syndrome (SIDS), overall respiratory variability in SIDS victims is comparable to that of control infants. We assessed dynamic characteristics of breathing in 16 recordings of apparently healthy infants who subsequently died of SIDS, and 35 recordings of age-matched control infants. Each breath-to-breath interval in 10-min epochs of quiet sleep and rapid eye movement sleep was plotted against the previous interval. Dispersion of next-intervals was determined after short, intermediate, and long interbreath intervals. In SIDS victims, dispersion after long intervals (slow respiratory rates) was significantly restricted relative to control infants. Moreover, after long breath-to-breath intervals, SIDS victims showed smaller mean breath-to-breath changes in respiratory rate than did controls. The findings indicate that breath-to-breath respiratory patterns differ in infants who succumb to SIDS, and the differences occur preferentially at low respiratory rates.

SUDDEN INFANT DEATH SYNDROME IN CROSS-CULTURAL PERSPECTIVE: Is Infant-Parent Cosleeping Protective?

▪ Abstract  This chapter reviews what is presently known about the sudden infant death syndrome (SIDS) and examines the role that infant sleeping arrangements may play in reducing SIDS risks. Alongside sleep laboratory-based experimental evidence comparing bedsharing and solitary sleeping mother-infant pairs, an evolutionary and cross-cultural framework is used to argue that infant-parent cosleeping is biologically, psychologically, and socially the most appropriate context for the development of healthy infant sleep physiology. It is also the context within which potentially more optimal breastfeeding activities for both the mother and infant are most likely to emerge. A survey of cross-cultural data and laboratory findings suggest that where infant-parent cosleeping and breastfeeding are practiced in tandem in nonsmoking households, and are practiced by parents specifically to promote infant health, the chances of an infant dying from SIDS should be reduced.

Reorganization of pontine rhythmogenic neuronal networks in Krox-20 knockout mice

We have shown previously that the inactivation of the zinc finger gene Krox-20 affects hindbrain segmentation, resulting in the elimination of rhombomeres 3 and 5. We demonstrate here that Krox-20 homozygous mutant mice exhibit abnormally slow respiratory and jaw opening rhythms, indicating that a modification of hindbrain segmentation influences the function of neuronal networks after birth. Central neuronal networks that control respiratory frequency are made predominantly depressant by the elimination of a previously undescribed rhythm-promoting system. Recordings of rhythmic activity from the isolated hindbrain following progressive tissue transections indicate that the reorganization takes place in the caudal pontine reticular formation. The newborn (PO) Krox-20-/- mice, in which apneas are ten times longer than in wild-type animals, may be a valuable model for the study of life-threatening apneas during early infancy.

Respiratory responses to rapid-onset, repetitive vs. continuous hypoxia in piglets

Repeated, frequent hypoxic exposures may precede Sudden Infant Death. This study assessed whether such hypoxic modality, vs. continuous hypoxia, compromised compensatory cardiorespiratory responses. Following aseptic, chronic instrumentation, 10 to 20 day-old, unsedated piglets underwent measurements of arterial O2 saturation, pH and gas tensions, respiration, heart rate, physical activity, O2 consumption and rectal temperature on several experimental days. The piglets were exposed to 21 min of either 10% or 6% O2 in N2, each comprising either seven, 3-min exposures alternating with 3-min intervals in 21% O2 balance N2, or 7 consecutive hypoxic exposures. Responses to 6% hypoxia were greater than those to 10% hypoxia. In 10% hypoxia, responses to repetitive vs. continuous exposure differed only in PaCO2. In 6% hypoxia, repetitive vs. continuous exposure resulted in lower respiratory frequency (p < 0.05) and in lower ventilation equivalent (p = 0.07) despite higher activity levels. Thus, the mode of hypoxic exposure determines the extent of the respiratory response: Severe, repetitive hypoxia mitigates protective respiratory responses when compared to equivalent, but sustained hypoxia.

The cerebral regulation of cardiovascular and respiratory functions

Respiratory and cardiovascular control systems require the integrity of brain structures at many levels of the neuraxis, extending from neocortical sites to the spinal cord. The widespread distribution of neural sites reflects the multiple roles served by respiratory musculature and the close integration of breathing and cardiovascular reflexes. Descending influences to brainstem regions controlling respiration include projections from limbic and other structures that mediate affective and other nonmetabolic drives, as well as activity of classic motor systems. Disturbances in breathing and cardiac control, particularly disorders associated with sleep or emotional behavior, may result from dysfunction of either nonmetabolic pathways or traditional respiratory structures.

Pulmonary Neuroendocrine Cells and Lung Development

Pulmonary neuroendocrine cells produce bioactive peptides such as gastrin-releasing peptide (GRP) at high levels in developing fetal lung. The role of GRP and other peptides in promoting branching morphogenesis, cell proliferation, and cell differentiation during lung organogenesis is reviewed. Possible roles for bioactive peptides derived from these cells in the pathophysiology of perinatal lung disorders are discussed.