Can we predict or prevent sudden unexpected deaths during infancy?

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.