Squier Waney, Mack Julie, Jansen Anna C
Formerly Department of Neuropathology, Oxford University John Radcliffe Hospital, Oxford, UK.
Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
Dev Med Child Neurol. 2016 Dec;58(12):1223-1234. doi: 10.1111/dmcn.13202. Epub 2016 Jul 20.
The cause of death in infants who die suddenly and unexpectedly (sudden unexpected death in infancy [SUDI]) remains a diagnostic challenge. Some infants have identified diseases (explained SUDI); those without explanation are called sudden infant death syndrome (SIDS). Demographic data indicate subgroups among SUDI and SIDS cases, such as unsafe sleeping and apparent life-threatening events. Infants dying suddenly with retinal and dural bleeding are often classified as abused, but in many there is no evidence of trauma. Demographic features suggest that they may represent a further subgroup of SUDI. This review examines the neuropathological hypotheses to explain SIDS and highlights the interaction of infant oxygen-conserving reflexes with the brainstem networks considered responsible for SIDS. We consider sex- and age-specific vulnerabilities related to dural bleeding and how sensitization of the dural innervation by bleeding may influence these reflexes, potentially leading to collapse or even death after otherwise trivial insults.
突然意外死亡的婴儿（婴儿猝死综合征[SUDI]）的死因仍然是一个诊断难题。一些婴儿患有已确诊的疾病（可解释的SUDI）；那些无法解释的则被称为婴儿猝死综合征（SIDS）。人口统计学数据显示了SUDI和SIDS病例中的亚组情况，比如不安全睡眠和明显危及生命的事件。视网膜和硬脑膜出血的突然死亡婴儿常被归类为受虐，但许多病例并无创伤证据。人口统计学特征表明，它们可能代表了SUDI的另一个亚组。本综述探讨了解释SIDS的神经病理学假说，并强调了婴儿氧保存反射与被认为与SIDS有关的脑干网络之间的相互作用。我们考虑了与硬脑膜出血相关的性别和年龄特异性易感性，以及出血引起的硬脑膜神经支配致敏如何可能影响这些反射，从而可能在受到其他轻微刺激后导致虚脱甚至死亡。
