Atopy in parents of children dying with sudden infant death syndrome

The value of serum IgE assay in milk aspiration and the sudden infant death syndrome

Global serum levels of IgE (PRIST, Phadebas) and specific anti-cow's milk IgE (RAST) were measured in populations of infants with a history of one or more episodes of milk aspiration (n = 12), victims of the sudden infant death syndrome (SIDS) (n = 18), "near miss" SIDS infants (n = 23), siblings of a SIDS victim ((n = 21) and control infants (n = 38). Only the infants with a past history of milk aspiration had significantly raised global and specific IgE. The absence of raised specific IgE in the subjects who died from SIDS argues against the hypothesis of sensitisation to cow's milk proteins during a previous episode of aspiration. Nasopharyngeal reflux is frequently seen in near-miss infants. This reflux is more often responsible for reflex apnoea due to stimulation of the laryngeal chemo-receptors than to a fatal aspiration.

Selective denervation of the S-A node in the treatment of progressive central vagal bradycardia

The condition of central hypervagism and central vagal bradycardia, up to now, have been largely overlooked. Selective surgical vagal denervation of the SA node for progressive central and local episodic reflex arc bradycardia, via right thoracotomy, is a well-tolerated procedure even in the debilitated child. The bradycardia must, of course, be atropine-responsive. It appears to be a valuable alternative to pacemakers, especially because of the necessity of using the sequential type in this form of heart block. Our follow-ups are from 8 months to 13 years in seven children (five central and two peripheral). Up to now, in an admittedly small series, there has been only one recurrence of bradycardia. This was from crossover left vagal innervation of the SA node. The incidence of this is 10% to 15%. It responded to right cervical vagotomy, following a preliminary diagnostic novocain block. We hope that these findings may lead to more awareness and investigations of conditions due to autonomic dysfunction--both central and peripheral--which may help among other conditions in the elucidation and prevention of sudden infant death syndrome (SIDS) and other related problems, and that this surgical approach will be a definitive means for the control of refractory, persistent, or recurrent vagal bradycardia.