False Alarm: The failed promise of Apnea Monitors ...
Part 4 (Final Part)

This is a lengthy article published electronically on the Syracuse Online electronic newspaper. It is very interesting to read. The fourth and final part starts below.

Please honor the copyright of the article. Thank you to Timothy D. Bunn, Deputy Executive Editor, The Post-Standard, tbunn@Syracuse.com, for allowing this reprint.

Syracuse Herald American
Sunday, May 5, 1996
BYLINE: Charles B. Hickey, John O'Brien and Todd Lighty Staff Writers

SIDS: A SILENT KILLER THROUGHOUT HISTORY
EVEN THOUGH IT HAS BEEN DESCRIBED SINCE BIBLICAL DAYS,
THE CAUSE OF CRIB DEATH REMAINS ELUSIVE.

The sudden, unexpected death of infants has been a source of mystery and
conflict since biblical times.

The Old Testament tells how King Solomon threatened to cut a baby in two
to settle a dispute between two women who each claimed to be the child's
mother.

The wise king's ploy worked: The real mother pleaded with Solomon to
spare the baby; the impostor, who had stolen the other woman's baby to
replace a dead infant, cried, "Divide it!"

According to 1 Kings (3:16-27), the impostor's baby "died in the night
because she overlaid it." For centuries afterward, sudden infant deaths
were blamed on overlaying, or mothers rolling over on their sleeping
babies and smothering them.

Scientific research into the cause of unexplained infant deaths
proceeded haphazardly until about 20 years ago, when parents of victims
started putting pressure on doctors to find a cure. Even with increased
attention and funding, however, the cause of crib death remains elusive.

Doctors first began to look for the biological cause for the sudden,
unexplained deaths of apparently healthy infants in the 19th century.
Two studies published in Britain shaped the course of modern research on
sudden infant death.

One study found that babies tended to die at night, during the winter
and before the age of three months. Children from poor families were
more likely to die.

The other study analyzed autopsy findings from two cases of sudden
infant death, one in which the victim had slept with its mother, the
other involving a child who slept alone. Although the doctor could not
pinpoint a cause of death in either case, the nearly identical autopsy
results led him to conclude that the first child had not been suffocated
by overlaying, still a common explanation for sudden infant death.

These parallel approaches - trying to define the characteristics of
high-risk children through epidemiological studies, and comparing
evidence from autopsies - defined the scope of research in Britain and
the United States into the 20th century.

During the 1940s and 1950s, sudden infant death emerged as a medical
conundrum in the morgues of large cities across the United States.

"Nobody in the realm of pediatrics was interested in it at the time
because it completely bypassed them," said Dr. Marie Valdes-Dapena, a
pediatric pathologist at the University of Miami who has studied sudden
infant death since the 1950s.

"The babies would be born, go home and end up dead in an emergency room
before they had ever seen ... a pediatrician."

Unable to find any evidence of fatal disease or injury, medical
examiners might attribute these deaths to undetermined causes, or
pneumonia, or suffocation in bedclothes.

By the late 1950s, the accumulated observations of medical examiners in
several U.S. cities produced a fuzzy picture of the typical victim. They
found more males died than females. Premature babies were more likely to
die than those born full term. A disproportionate number of victims were
black children from poor families. Several studies also showed victims
tended to have colds around the time they died.

Medical examiners began to suspect they were looking at a distinct
lethal entity with many causes. They started referring to such cases as
crib deaths, because that's where grieving parents often found their
lifeless babies.

Haphazard research during the early 1960s produced more than a
half-dozen competing theories for the cause of crib death. The notion
that an allergic reaction to cows' milk caused sudden infant death held
sway for years until follow-up studies debunked the idea.

Research remained unfocused and uncoordinated until parents who had lost
children forced researchers and politicians to pay attention to the
issue. In the early 1960s, crib death parents formed support groups that
fused into a powerful special interest lobby.

Lobbying by a Seattle parents group led to the first international
conference on sudden infant death in 1963. The conference ended with
researchers split on a key point: Some believed sudden infant death was
caused by a specific disorder, while others thought the babies were
dying coincidentally from a variety of hard-to-detect diseases.

Researchers reached a consensus in 1969. They coined the term "sudden
infant death syndrome," or SIDS, to describe a lethal disorder that
seemed to arise from a common, underlying problem, rather than an
assemblage of unrelated causes.

"Our conviction was that this really was an entity worthy of a name and
that it deserved a lot more attention than it was getting at that time,"
said Dr. J. Bruce Beckwith, the pediatric pathologist who defined SIDS.

By the 1970s, the pressure to find a cause had reached another level.
Congress passed the federal Sudden Infant Death Syndrome Act in 1974,
broadening the government's commitment to the prevention of SIDS and
dramatically increasing money available to researchers.

In 1972, Dr. Alfred Steinschneider, a pediatric researcher at Upstate
Medical Center in Syracuse, published a study that suggested SIDS
victims were afflicted by a subtle abnormality that showed up as apnea,
the periodic, involuntary pauses of breathing.

Steinschneider believed that infants who experienced prolonged apnea
spells were at risk for SIDS, and that their deaths could be prevented
if they were wired to apnea monitors. The machines were designed to
sound an alarm if the baby stopped breathing.

Although subsequent studies failed to support Steinschneider's findings
and the federal government concluded there was no proof apnea monitors
could prevent SIDS, parents and pediatricians relied on the machines.

"No research has yet demonstrated that you could predict SIDS - zero,"
Valdes-Dapena said.

In the 1980s, attention shifted to the central nervous system. Many
researchers suspect that SIDS babies must have subtle defects that
result in a loss of control over breathing and heart rate during sleep.

The number of deaths attributed to SIDS in the United States each year
has fallen from 10,000 in the early 1970s to about 6,000 today.

The drop could have many causes, including the use by medical examiners
of a more restrictive definition of SIDS. And despite the drop, the face
of SIDS hasn't changed much over the years. It still strikes poor black
families about twice as often as wealthy white families.

"What we always like to say is, it can happen to anybody," Valdes-Dapena
said. "It can, but the truth is that it doesn't happen to everybody.
Very few well-to-do families are affected."

Dr. Abraham Bergman, the physician-activist credited with securing
passage of the 1974 SIDS Act, sees a parallel between the drop in SIDS
and the overall decline in infant mortality, which remains
disproportionately high among blacks.

"I think the reason it's gone down is that there's better prenatal care
- all the factors that have reduced infant mortality." said Bergman, a
pediatrician in Seattle. "Some people feel that infant sleeping position
has had a big impact."

In other countries, public campaigns urging parents to put their babies
to sleep on their backs rather than their stomachs have cut the number
of SIDS deaths in half.

In the United States, a federal "back to sleep" campaign began in June
1994. The early results seem promising: The state of Maryland already
has reported a 31 percent drop in its SIDS rate.

Some researchers believe that when babies sleep on their stomachs, with
their noses embedded in soft surfaces, they rebreathe the air they
exhale. The trapped air contains lethal levels of carbon dioxide.

But Bergman and others who have watched medicine's approach to SIDS
evolve over the last three decades remain cautious.

"The thing I always use to teach humility to us is that in the 1930s in
the United States the avant garde practice of pediatrics was to take an
X-ray of a baby, and if they had a large thymus gland, to irradiate them
to prevent crib death. And that caused a whole hell of a lot of thyroid
cancer," Bergman said.

"And that was done by very smart doctors of the time ... They were the
best doctors. Well, it turned out to be wrong."