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与神经学上的早产相比,生理性贫血婴儿的急性呼吸道感染更有可能是婴儿猝死综合征的病因。

An Acute Respiratory Infection of a Physiologically Anemic Infant is a More Likely Cause of SIDS than Neurological Prematurity.

作者信息

Mage David T, Latorre Maria Luisa, Jenik Alejandro G, Donner E Maria

机构信息

Retired , Newark, DE , USA (formerly affiliated to WHO, Geneva, Switzerland).

Corporacion Infancia Colombia , Bogotá , Colombia.

出版信息

Front Neurol. 2016 Aug 23;7:129. doi: 10.3389/fneur.2016.00129. eCollection 2016.

Abstract

INTRODUCTION

The cause of the sudden infant death syndrome (SIDS) is perhaps the oldest of unsolved mysteries of medicine, possibly dating back to Exodus in Biblical times when Egyptian children died in their sleep as if from a plague. It occurs when infants die unexpectedly with no sufficient cause of death found in a forensic autopsy, including death scene investigation and review of medical history. That SIDS is an X-linked recessive death from infectious respiratory disease of a physiologically anemic infant and not a simple anomalous cardiac or neurological condition is an extraordinary claim that requires extraordinary evidence. If it were by a simple cause, it would have already been solved, with over 11,000 papers on SIDS listed now in PubMed. Our aim is to use mathematical models of SIDS to explain: (1) its 50% excess male death rate; (2) its 4-parameter lognormal distribution of ages at death; (3) its winter maxima and summer minima; and (4) its increasing rate with live-birth order.

METHODS

From extensive SIDS vital statistics data and published epidemiologic studies, we developed probability models to explain the mathematical behavior of SIDS meeting the four constraints mentioned above. We, then, compare these SIDS properties to infant death from acute respiratory infection (ARI), and infant death from encephalopathy, unspecified (EU).

RESULTS

Comparisons show that SIDS are congruent with ARI and are not consistent with EU and that these probability models not only fit the SIDS data but they also predict and fit the male fraction of all infant and child mortality from birth through the first 5 years of their life.

CONCLUSION

SIDS are not rejected as an X-linked disease involving ARI and are not explained by a triple risk model that has been commonly accepted by the SIDS medical community, as implicating a neurological causation process in a subset of SIDS.

摘要

引言

婴儿猝死综合征(SIDS)的病因可能是医学上最古老的未解之谜,其历史可能追溯到圣经时代的出埃及记,当时埃及儿童在睡眠中死亡,仿佛死于一场瘟疫。当婴儿意外死亡,且法医尸检(包括死亡现场调查和病史回顾)未发现足够的死亡原因时,即发生SIDS。认为SIDS是生理性贫血婴儿因传染性呼吸道疾病导致的X连锁隐性死亡,而非简单的心脏或神经系统异常状况,这一说法非同寻常,需要非凡的证据。如果是由简单原因导致,那它早就应该被解决了,目前在PubMed上列出的关于SIDS的论文已超过11,000篇。我们的目的是使用SIDS的数学模型来解释:(1)其男性死亡率高出50%;(2)其死亡年龄的四参数对数正态分布;(3)其冬季高发和夏季低发;以及(4)其随出生顺序的上升率。

方法

从广泛的SIDS生命统计数据和已发表的流行病学研究中,我们开发了概率模型来解释符合上述四个约束条件的SIDS的数学行为。然后,我们将这些SIDS特性与急性呼吸道感染(ARI)导致的婴儿死亡以及未明确病因的脑病(EU)导致的婴儿死亡进行比较。

结果

比较表明,SIDS与ARI相符,与EU不一致,并且这些概率模型不仅符合SIDS数据,还能预测并拟合从出生到生命最初5年所有婴儿和儿童死亡中的男性比例。

结论

SIDS作为一种涉及ARI的X连锁疾病并未被否定,也不能用SIDS医学界普遍接受的三重风险模型来解释,该模型认为在一部分SIDS中存在神经病因过程。

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