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The American SIDS Institute is committed to comprehensive multidisciplinary
research directed at all major SIDS-related problems. The objective is accomplished by encouraging collaborative
research efforts between members of the Institute staff and investigators from other institutions throughout the
country. Furthermore, the Institute aims to serve as a "catalyst" in promoting and conducting clinical
and epidemiologic research in order to elucidate potential risk factors associated with sudden infant death.
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Current research projects in which the Institute is involved
include the following:
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Prolonged Apnea and Prolonged Bradycardia Following
DTaP Immunization in Preterm Infants: A Multicenter Study
The American SIDS Institute is coordinating a multicenter
research study on 200 premature infants (younger than 37 weeks gestation) in which several Neonatal Centers around
the country are participating. This study is a randomized controlled clinical trial that will examine the relationship
between diphtheria-tetanus-acellular pertussis immunization and the occurrence of prolonged apnea and bradycardia
in preterm infants.
The following investigators and corresponding Neonatal Centers are participating in this project:
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Tracy Carbone, MD
Director
Center for Pediatric Sleep Disorders
The Valley Hospital
Ridgewood, New Jersey
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Kimon Violaris, MD
Co-Director of Neonatology
The Brooklyn Hospital Center
Apnea Center
Brooklyn, New York
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Eric Gibson, MD
Director of Infant Apnea Program
Thomas Jefferson University
Philadelphia, Pennsylvania
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Brenda Marino, MD
Director of Neonatology
Kennestone Hospital
Marietta, Georgia
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Nilima Karamchandani, MD
Chief of Neonatology Infant Apnea Center
Western Pennsylvania Hospital and TIC
The Children’s Home of Pittsburgh
Pittsburgh, Pennsylvania
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David Hufford, MD
Associate Director
Pediatric Pulmonary Medicine
Toledo Children’s Hospital
Toledo, Ohio
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Michael Metcalf, MD
Director of NICU
Wellstar Cobb Hospital
Austell, Georgia
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Jerry Ferlauto, MD
NICU Medical Director
The Children’s Hospital
Greenville, South Carolina
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Nicotine Exposure and Cardiorespiratory Events: A Multicenter
Prospective Cohort Study
Exposure to the environmental tobacco smoke (ETS)
has known negative effects on fetal, neonatal and perinatal morbidity and mortality. Besides higher rates of spontaneous
abortions, complications of pregnancy and labor, nicotine exposure increases the rate of low birthweight, as well
as pulmonary and cardiovascular pathology and sudden infant death syndrome. Of clinical importance is the potential
effect of passive smoke on the prevalence and frequency of prolonged apnea and bradycardia in infancy.
Relatively few studies have been conducted which bear directly on the potential relationship between episodes of
prolonged apnea or prolonged bradycardia in infancy and exposure to cigarette smoke. The purpose of the current
study is to examine the relationship between environmental tobacco smoke exposure and prolonged episodes of apnea
and bradycardia in infants. The American SIDS Institute and the American Association of SIDS Prevention Physicians
(AASPP) are proposing to do a multi-center prospective cohort study, where infants
prescribed to be on cardiorespiratory monitors will be followed for 28 days. We will use exposure of an infant
to nicotine as reported by parent(s) and objectively measured (from hair samples) as the independent variables.
The dependent variables will include prevalence and frequency of episodes of prolonged apnea and bradycardia, detected
by cardiorespiratory event recording monitors.
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Maternal Cigarette Smoking And Prolonged Episodes Of
Apnea And Bradycardia In High-Risk For Sudden Death Infants: A Retrospective Exploratory Analysis
Although maternal smoking is a known risk factor
for sudden infant death syndrome (SIDS), the mechanisms of its effect on infants are unknown. The purpose of this
exploratory study was to examine the relationship between maternal smoking and prolonged episodes of apnea and
bradycardia in high-risk for sudden death infants.
The study population consisted of high risk for SIDS infants less or equal to 6 months old referred to the American
SIDS Institute between 1987 and 1997, including those who had one or more severe apparent life threatening events
(n=405), were siblings of SIDS victims (n=272), were premature with recurrent apnea episodes in the nursery (n=383),
or had other reason for referral (n=245). The demographic and clinical information including self-reported data
on cigarette smoking during pregnancy were obtained through interviews with mothers and self-administered questionnaires.
The data on prolonged apnea and bradycardia were collected during home monitoring with event recording capability.
In our sample, maternal reports of smoking during pregnancy were associated with an increased risk of prolonged
apnea or prolonged bradycardia in certain groups of infants. In general, though not exclusively, smoking interacted
with different risk factors for the two types of prolonged episodes. Additional studies (preferably using objective
measurements of nicotine exposure) will be necessary to confirm the relationships observed in the current analysis.
The results of this study were published in the proceedings of the VII
SIDS International Conference in Florence, Italy,
2002.
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The Prevalence and Determinants of Central Apnea in High Risk for
SIDS Infants
Data were collected retrospectively on 733 infants identified to be at high risk, epidemiologically, for SIDS:
siblings of SIDS victims (SibSIDS, n=215), infants who experienced an apparent life threatening event (ALTE) at
home (ALTE n=237), and premature infants with histories of apnea or bradycardia in the newborn nursery (Premie
Apnea, n=281). The objectives of this study were to determine the prevalence of at least one episode of prolonged
central apnea in each group, to assess whether the prevalence of central apnea differed by group and other risk
factors, and to evaluate the temporal interval of monitoring before an infant's initial episode of central apnea.
The following data on central apnea prevalence were presented at the V
SIDS International Conference in Rouen, France, 1998:
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Duration(s)
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ALTE
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SibSIDS
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Premie Apnea
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15
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25.3%
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21.4%
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29.7%*
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18
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4.1%
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6.1%
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14.5%*
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20
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3.0%
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3.1%
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8.5%*
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PA-15**
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6.4%
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5.3%
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16.4%*
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PA-18**
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3.0%
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3.1%
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12.1%*
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* p < 0.05
** Defined as apnea at least 15 seconds (PA-15) in duration
or 18 seconds (PA-18) in duration when associated with bradycardia at least 5 seconds in duration.
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The Prevalence and Determinants of Prolonged Bradycardia
in High Risk for SIDS Infants
The objective of this retrospective descriptive study was
to estimate the prevalence of bradycardia of varying durations among three groups of infants known to be at increased
epidemiologic risk for SIDS: siblings of SIDS victims (SibSIDS, n=215), infants who experienced an apparent life
threatening event (ALTE) at home (ALTE n=237), and premature infants with histories of apnea or bradycardia in
the newborn nursery (Premie Apnea, n=281).
The following data on bradycardia prevalence were presented
at the 8th European Society for the Study and Prevention
of Infant Death Conference in Jerusalem, Israel,
1999:
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Duration(s)
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ALTE
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SibSIDS
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Premie Apnea
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5
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35.0%
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30.3%
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73.0%*
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10
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20.5%
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11.9%
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54.9%*
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15
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4.6%
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4.2%
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29.8%*
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* p < 0.05
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Identification of Infants at Risk: Clinical, Epidemiologic,
and Chemical Factors
We are examining a variety of factors for their
potential associations with SIDS and related risks. Programs are in place to examine various data including physiological
characteristics and plasma catecholamine levels in order to identify subtle chronic abnormalities that may place
infants at increased risk for sudden death.
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