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Shock and SIDS

My major concern here is that Dr. Harper said that monitors haven't reduced the incidence of SIDS because first responders are using CPR instead of treating for shock. What should I do if I get a true alarm? Should I cover both bases and elevate the feet while doing CPR?

I wasn't sure what exactly you were referring to so I asked Dr. Harper. He was referring to a theory or hypothesis that he is investigating. As I've mentioned, there is evidence suggesting the *possibility* of a shock-like state occurring around the time of death in infants dying of SIDS. Dr. Harper has been looking into this. At this point it is a subject under study -- they've reached no firm conclusions yet on this particular subject. So, if I understood him correctly, the idea you mention above about why monitoring has not been effective is, at present, a hypothesis, but not known or proven.

Concerning what to do in response to a true alarm, it would seem prudent to follow the current recommended procedures for checking the infant, instituting CPR if indicated, and calling 911 if indicated. I don't know of any new recommendations. Perhaps Dr. Harper's and other's research will lead to new recommendations but, so far, the recommendations haven't changed.

There is no evidence that I'm aware of that sudden brainstem malfunction leads to suddenly stopping breathing and dying.

This is not to say that something else doesn't lead to relatively sudden onset of shock or other system failure that is fatal. I want to be careful not to mislead anyone. That brainstem comment was meant to be very specific. I have heard stories of babies that died without making a sound while a parent was in the same, or infants that looked apparently fine and then a few minutes or hours later were found dead, or infants in which even expert-quality CPR couldn't revive the baby. Perhaps some on this list have had similar experiences. There is suggestive evidence consistent with a shock-like state occurring in infants who die of SIDS. As I said in a recent post, my interest in this concept has increased recently in light of some new information and re-examination of some old studies.

It might be worthwhile to reconsider an infant's appearance in the hours before SIDS struck. There were some studies a while back asking parents about this and several things came out: 1) some parents felt that the baby was just 'not right' or not acting right but couldn't put their finger on exactly what was different, 2) there was an increased number of visits to pediatricians in the few days before the SIDS death occurred. The reasons for the increased number of visits to the doctor weren't clear but perhaps reflected this feeling that something wasn't quite right. Also, in the NICHD epidemiological study there was a significantly higher incidence of infants being described as "listless" or "droopy" before SIDS occurred compared to control infants. Again, this could be taken as another sign that something wasn't quite right. Finally, Andre Kahn reported a finding that has intrigued me for years... the frequent report (from parents of babies that died of SIDS) of the infant sweating copiously. Others have described babies, who later died of SIDS, as soaking the pajamas or bedding material with sweat. Dr. Harper has communicated to me that he too finds this finding of excessive sweating to be a possible indicator of a shock-like state. So, the point is that there are subtle signs that something was going on in many of these infants that is consistent with some of the known causes of shock. If anyone is willing to talk about their own experience in this regard it might reveal important clues.

The 'shock' theory was sort of dismissed by some because of one study. However, that study may have missed it.

Thanks,

John L. Carroll, M.D.
The Johns Hopkins Children's Center
Baltimore, MD

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