Kerbl Reinhold, Zotter Heinz, Einspieler Christa, Roll Peter, Ratschek Manfred, Köstl Gerhard, Strenger Volker, Hoffmann Erna, Perrogon Anni, Zötsch Waltraud, Schober Peter, Gränz Alfred, Sauseng Werner, Bachler Isolde, Kenner Thomas, Ipsiroglu Osman, Kurz Ronald
Universitätsklinik für Kinder- und Jugendheilkunde Graz, Graz, Austria.
Wien Klin Wochenschr. 2003 Dec 30;115(24):887-93. doi: 10.1007/BF03040411.
Sudden infant death syndrome (SIDS) remains a challenge for health professionals despite decreasing rates in recent years. The figures for different areas and time periods are hardly comparable, because of differences in postmortem investigations and classification criteria. In 1992, the European Society for the Study and Prevention of Infant Deaths (ESPID) proposed a classification for any sudden and unexpected death in infancy. This proposal has been used in our study since 1993 to better classify sudden infant death (SID) cases.
56 consecutive SID cases observed between 1993 and 2002 in Styria, the south-eastern province of Austria, were analysed by a multidisciplinary team of health professionals. The study group consisted of pediatricians, forensic pathologists, pathologists, psychologists, nurses, members of the parents' association and health authorities. SID cases were analysed with regard to potential risk factors during pregnancy and early life, the circumstances of death (death scene) and post-mortem findings. From the latter, every SID was classified as either 1) classic SIDS, 2) borderline SIDS, 3) non-autopsied SID or 4) explained death.
Of the 56 SID cases, 22 were assigned to category 1, 19 to category 2, four to category 3, and in 11 cases death could be explained by major post-mortem findings. For 17/22 cases in category 1 and 11/19 cases in category 2, the death scene investigation showed the typical risk profile of manner of bedding and/or environmental conditions. In three cases, child abuse or infanticide was considered possible but could not be proven despite careful autopsy. In recent years, SIDS incidence in Styria has decreased to approximately 0.18/1,000 live-born infants, and the few deaths still occurring mainly present with the typical risk profile.
An extensive analysis of SID events is a prerequisite for reliable and comparable SIDS statistics. Our data show that in several SID cases careful post-mortem examinations led to an explanation of death. In other cases, minor alterations may have contributed to the lethal event. These findings should therefore be considered in the classification of SIDs. The ESPID classification of 1992 appears to be very useful for this purpose and its use may therefore be recommended.
尽管近年来婴儿猝死综合征（SIDS）的发生率有所下降，但它仍然是健康专业人员面临的一项挑战。由于尸检调查和分类标准的差异，不同地区和时间段的数据很难进行比较。1992年，欧洲婴儿死亡研究与预防协会（ESPID）提出了一种针对婴儿期任何突然和意外死亡的分类方法。自1993年以来，该提议已在我们的研究中用于更好地对婴儿猝死（SID）病例进行分类。
1993年至2002年期间在奥地利东南部的施蒂利亚州连续观察到的56例SID病例，由一个多学科的健康专业人员团队进行分析。研究小组由儿科医生、法医病理学家、病理学家、心理学家、护士、家长协会成员和卫生当局组成。对SID病例进行了关于孕期和生命早期潜在风险因素、死亡情况（死亡现场）和尸检结果的分析。根据后者，每例SID被分类为1）经典SIDS、2）边缘性SIDS、3）未尸检的SID或4）死因明确的死亡。
在56例SID病例中，22例被归类为第1类，19例被归类为第2类，4例被归类为第3类，11例死亡可通过主要尸检结果解释。对于第1类中的17/22例病例和第2类中的11/19例病例，死亡现场调查显示了典型的睡眠姿势和/或环境条件风险特征。在3例病例中，尽管进行了仔细的尸检，但怀疑可能存在虐待儿童或杀婴行为，但无法得到证实。近年来，施蒂利亚州的SIDS发病率已降至约0.18/1000活产婴儿，仍发生的少数死亡主要呈现典型的风险特征。
对SID事件进行广泛分析是获得可靠且可比的SIDS统计数据的前提。我们的数据表明，在一些SID病例中，仔细的尸检导致了死因明确。在其他病例中，轻微改变可能促成了致命事件。因此，在SIDS分类中应考虑这些发现。1992年的ESPID分类在此方面似乎非常有用，因此可能推荐使用。
