Southall D P
Cardiothoracic Institute, Brompton Hospital, London, UK.
Pediatrician. 1988;15(4):183-90.
Mechanisms for sudden unexpected infant deaths remain unproven but the possibilities include cardiac arrhythmias, hypoglycaemia, prolonged apnoea from central respiratory control failure, seizure-induced apnoea, prolonged airway obstruction and alveolar atelectasis. Many of these mechanisms could be treated if the infant at risk could be identified. To date, identification programmes have not been sufficiently sensitive or specific. All the evidence presently available suggests that clinical and socioeconomic factors alone will not be sufficient and that as yet unidentified physiological or biochemical measurements must be included in a scoring system if such an approach is to be effective. Epidemiological studies have shown that a suboptimal intrauterine environment and respiratory tract infections during early infancy are present to excess in future victims. Improvements in antenatal and postnatal care, particularly to mothers from areas of socioeconomic deprivation, will almost certainly reduce the incidence of sudden infant deaths. Certain respiratory tract infections may induce episodes of severe hypoxaemia due to abnormal apnoea and therefore it is not only essential that the infection risk in young infants from pertussis is minimized by immunization of the childhood population but also that methods of preventing other infections, such as respiratory syncytial virus, are developed and applied as soon as possible. Re-organization of mother and baby clinics and mother and baby social groups in order to minimize contact between young infants and pre-school children may reduce cross-infection by respiratory tract pathogens.
婴儿猝死的机制尚未得到证实，但可能的原因包括心律失常、低血糖、中枢呼吸控制衰竭导致的长时间呼吸暂停、癫痫诱发的呼吸暂停、长时间气道阻塞和肺泡肺不张。如果能够识别出有风险的婴儿，其中许多机制是可以治疗的。迄今为止，识别方案的敏感性或特异性都不够高。目前所有可用证据表明，仅靠临床和社会经济因素是不够的，如果要使这种方法有效，评分系统中必须纳入尚未确定的生理或生化测量指标。流行病学研究表明，未来猝死婴儿的子宫内环境欠佳和婴儿早期呼吸道感染情况更为常见。改善产前和产后护理，特别是为社会经济贫困地区的母亲提供护理，几乎肯定会降低婴儿猝死的发生率。某些呼吸道感染可能由于异常呼吸暂停而导致严重低氧血症发作，因此，不仅必须通过儿童群体免疫将幼儿感染百日咳的风险降至最低，而且还必须尽快开发并应用预防其他感染（如呼吸道合胞病毒）的方法。重新组织母婴诊所和母婴社会群体，以尽量减少幼儿与学龄前儿童之间的接触，可能会减少呼吸道病原体的交叉感染。
