Gingras J L, O'Donnell K J, Hume R F
Department of Pediatrics, Duke University Medical Center, Durham, NC 27707.
Med Hypotheses. 1990 Dec;33(4):227-30. doi: 10.1016/0306-9877(90)90131-w.
Abnormalities of respiratory regulation, such as apnea and abnormal hypoxic arousal during sleep, are mechanistic in the pathophysiology of SIDS. In utero cocaine exposure is associated with poor head growth, abnormal neurodevelopment, and an increased incidence of sudden, unexplained death, suggesting that in utero cocaine exposure disrupts the central regulation of breathing. It is likely that this disruption is due to altered CNS maturation. Indeed, cocaine alters norepinephrine metabolism within the locus coeruleus, important in arousal from sleep, suggesting that the increased incidence of SIDS in cocaine exposed infants may be secondary to sleep-related deficits in arousal. Since components of fetal behavioural state organization reflect the successful integration of the Central Nervous System, have a specific developmental timetable, and can be studied by fetal ultrasound techniques, we developed a strategy for assessing the state organization of the fetus by ultrasound techniques. We hypothesize that fetal evaluation of state will be a marker of abnormal CNS maturation and a predictor of risk, i.e. abnormal neurodevelopment and/or state related arousal deficits predisposing the cocaine exposed neonate to SIDS. We propose that the study of in utero cocaine exposed fetuses will provide a human model for examining the pathophysiology of SIDS.
呼吸调节异常，如睡眠期间的呼吸暂停和异常的低氧唤醒，是婴儿猝死综合征病理生理学的机制。子宫内可卡因暴露与头部生长不良、神经发育异常以及不明原因的猝死发生率增加有关，这表明子宫内可卡因暴露会破坏呼吸的中枢调节。这种破坏很可能是由于中枢神经系统成熟改变所致。事实上，可卡因会改变蓝斑核内的去甲肾上腺素代谢，而蓝斑核在从睡眠中唤醒方面很重要，这表明暴露于可卡因的婴儿中婴儿猝死综合征发生率增加可能继发于与睡眠相关的唤醒缺陷。由于胎儿行为状态组织的组成部分反映了中枢神经系统的成功整合，有特定的发育时间表，并且可以通过胎儿超声技术进行研究，我们开发了一种通过超声技术评估胎儿状态组织的策略。我们假设对胎儿状态的评估将是中枢神经系统成熟异常的标志和风险预测指标，即异常的神经发育和/或与状态相关的唤醒缺陷使暴露于可卡因的新生儿易患婴儿猝死综合征。我们提出，对子宫内暴露于可卡因的胎儿的研究将为研究婴儿猝死综合征的病理生理学提供一个人类模型。
