SIDS: facts and controversies

Scientific consensus forum to review the evidence underpinning the recommendations of the Australian SIDS and Kids Safe Sleeping Health Promotion Programme--October 2010

This paper summarises a 1-day scientific consensus forum that reviewed the evidence underpinning the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. The focus was on each of the potentially modifiable risk factors for sudden unexpected deaths in infancy, including sudden infant death syndrome (SIDS) and fatal sleeping accidents. In particular infant sleeping position, covering of the face, exposure to cigarette smoke, room sharing, unsafe sleeping environments, bed sharing, immunisation, breastfeeding, pacifier use and Indigenous issues were discussed in depth. The participants recommended that future 'Reducing the Risk' campaign messages should focus on back to sleep, face uncovered, avoidance of cigarette smoke before and after birth, safe sleeping environment, room sharing and sleeping baby in own cot.

SIDS pathogenesis: pathological findings indicate infection and inflammatory responses are involved

This article explores the pathological evidence that supports the hypothesis that infection and inflammation are underlying mechanisms in SIDS. It reviews the pathological findings in relation to the risk factors reported for SIDS and compares these findings with other hypotheses suggested as causes of these unexplained deaths in infants. The roles of environmental factors and bacterial products such as soluble curlin detectable in SIDS sera in triggering cytokine cascades and aberrant inflammatory responses resulting in a toxic shock-like event are also explored. Areas for future research are outlined.

Sudden infant death syndrome: a critical review of approaches to research

This review explores the various research approaches taken attempting to solve the problem of SIDS. It would appear that major clues provided by pathological findings have been largely overlooked and as a consequence much effort, time, and money has been wasted on projects that satisfy only sub-specialty and political needs. Close examination of the pathological clues would provide better insights into the mechanisms underlying this enigmatic and heartbreaking problem.

Sustaining dietary changes for preventing obesity and diabetes: lessons learned from the successes of other epidemic control programs

A degree of success has been achieved in controlling several epidemics of infectious and non-infectious causes of death in countries, such as, Australia and New Zealand. Using the epidemiological triad (host, vector, environment) as a model, the key components of the control of these epidemics have been identified and compared to the current status of interventions to prevent obesity and its main disease consequence, type 2 diabetes. Reductions in mortality from tobacco, cardiovascular diseases, road crashes, cervical cancer and sudden infant death syndrome have been achieved by addressing all corners of the triad. Similarly, prevention programs have minimized the mortality from HIV AIDS and melanoma mortality rates are no longer rising. The main lessons learned from these prevention programs that could be applied to the obesity/diabetes epidemic are: taking a more comprehensive approach by increasing the environmental (mainly policy-based) initiatives; increasing the 'dose' of interventions through greater investment in programs; exploring opportunities to further influence the energy density of manufactured foods (one of the main vectors for increased energy intake); developing and communicating specific, action messages; and developing a stronger advocacy voice so that there is greater professional, public and political support for action. Successes in the other epidemics have been achieved in the face of substantial barriers within individuals, society, the private sector and government. The barriers for preventing obesity/diabetes are no less formidable, but the strategies for surmounting them have been well tested in other epidemics.

SIDS: more facts and controversies

A more robust theory of the causation of sudden infant death syndrome (SIDS) is needed. The asphyxial theory of SIDS, which encompasses the prone sleeping position, relies on contradictory pathological evidence and fails to explain infants with SIDS who are found in the supine or lateral position. Many of the risk factors for SIDS point to an infective cause. The relative risks of these infection-related factors differ from study to study, as does the relative risk of prone sleeping position. I present the case for an infection model for SIDS causation, which has largely been neglected by mainstream SIDS researchers.