Elhaik Eran
Department of Animal and Plant Sciences, University of Sheffield, UK.
J Clin Transl Res. 2019 Jan 9;4(2):136-151. eCollection 2019 Jan 10.
Sudden infant death syndrome (SIDS) is the most common cause of postneonatal unexplained infant death. The allostatic load hypothesis posits that SIDS is the result of cumulative perinatal painful, stressful, or traumatic exposures that tax neonatal regulatory systems.
To test the predictions of the allostatic load hypothesis we explored the relationships between SIDS and two common phenotypes, male neonatal circumcision (MNC) and prematurity.
We collated latitudinal data from 15 countries and 40 US states sampled during 2009 and 2013. We used linear regression analyses and likelihood ratio tests to calculate the association between SIDS and the phenotypes.
SIDS mortality rate was significantly and positively correlated with MNC. Globally (weighted): Increase of 0.06 (95% CI: 0.01-0.1, = 2.86, = 0.01) per 1000 SIDS mortality per 10% increase in circumcision rate. US (weighted): Increase of 0.1 (95% CI: 0.03-0.16, = 2.81, = 0.01) per 1000 unexplained mortality per 10% increase in circumcision rate. US states in which Medicaid covers MNC had significantly higher MNC rates ( = 0.72 vs 0.49, = 0.007) and male/female ratio of SIDS deaths ( = 1.48 vs 1.125, = 0.015) than other US states. Prematurity was also significantly and positively correlated with MNC. Globally: Increase of 0.5 (weighted: 95% CI: 0.02-0.086, = 3.37, = 0.004) per 1000 SIDS mortality per 10% increase in the prematurity rates. US: Increase of 1.9 (weighted: 95% CI: 0.06-0.32, = 3.13, = 0.004) per 1000 unexplained mortalities per 10% increase in the prematurity rates. Combined, the phenotypes increased the likelihood of SIDS.
Epidemiological analyses are useful to generate hypotheses but cannot provide strong evidence of causality. Biological plausibility is provided by a growing body of experimental and clinical evidence linking aversive preterm and early-life SIDS events. Together with historical and anthropological evidence, our findings emphasize the necessity of cohort studies that consider these phenotypes with the aim of improving the identification of at-risk infants and reducing infant mortality.
Preterm birth and neonatal circumcision are associated with a greater risk of SIDS, and efforts should be focused on reducing their rates.
婴儿猝死综合征（SIDS）是新生儿期后不明原因婴儿死亡的最常见原因。应激负荷假说认为，SIDS是围产期累积的疼痛、压力或创伤性暴露导致新生儿调节系统负担过重的结果。
为了检验应激负荷假说的预测，我们探讨了SIDS与两种常见表型，即男性新生儿包皮环切术（MNC）和早产之间的关系。
我们整理了2009年至2013年期间从15个国家和美国40个州采集的纬度数据。我们使用线性回归分析和似然比检验来计算SIDS与这些表型之间的关联。
SIDS死亡率与MNC显著正相关。全球范围（加权）：包皮环切率每增加10%，每1000例SIDS死亡率增加0.06（95%置信区间：0.01 - 0.1，z = 2.86，p = 0.01）。美国（加权）：包皮环切率每增加10%，每1000例不明原因死亡率增加0.1（95%置信区间：0.03 - 0.16，z = 2.81，p = 0.01）。医疗补助涵盖MNC的美国州，其MNC率（z = 0.72对0.49，p = 0.007）和SIDS死亡的男/女比例（z = 1.48对1.125，p = 0.015）显著高于其他美国州。早产也与MNC显著正相关。全球范围：早产率每增加10%，每1000例SIDS死亡率增加0.5（加权：95%置信区间：0.02 - 0.086，z = 3.37，p = 0.004）。美国：早产率每增加10%，每1000例不明原因死亡率增加1.9（加权：95%置信区间：0.06 - 0.32，z = 3.13，p = 0.004）。综合来看，这些表型增加了SIDS的可能性。
流行病学分析有助于提出假设，但不能提供因果关系的确凿证据。越来越多的实验和临床证据将厌恶的早产和生命早期SIDS事件联系起来，提供了生物学合理性。结合历史和人类学证据，我们的研究结果强调了队列研究的必要性，这些研究应考虑这些表型，以改善对高危婴儿的识别并降低婴儿死亡率。
早产和新生儿包皮环切术与SIDS风险增加相关，应致力于降低其发生率。
