Abstract
While many aspects related to the etiology and pathogenesis of sudden infant death
remain unclear, the ultimate trigger event appears to be an acute regulatory disturbance
of the cardiorespiratory neurons of the reticular formation of the brain stem. Retrospective
studies have demonstrated that SIDS often occurs after infection of the upper respiratory
tract. We present the case history of a 10-week old infant, where the respiratory
pattern demonstrated highly pathological alterations induced by a mild infection of
the upper airways, as confirmed by oxycardiorespirography. Oxycardiorespirography
provides continous recording of the respiration (transthoracic impedance) extending
over several hours during sleep and during the critical phase just before going to
sleep and waking up in relation to heart rate, partial oxygen pressure (measured transcutaneously)
and nasal flow. The presented infant is a premature infant delivered in the 34th week
of gestation according to Dubowitz (artificial respiration for 7 days due to hyalin
membrane syndrome stage II). During infection periodic breathing was found to be 19,3%
with partly severe hypoxemia. The longest single episode of apnea was 30 seconds.
On the average, 5 episodes of bradycardia occurred (< 100/min/measuring hour). An
OCRG investigation performed at the age of 5 weeks and after disappearance of the
infection at the age of 12 weeks yielded normal findings. This permits the conclusion
that in out patient an infection of the upper airways may have induced a pathologic
respiratory pattern, which could be a major trigger mechanism for sudden infant death.
Zusammenfassung
Obwohl vieles über Ätiologie und Pathogenese des plötzlichen Kindestodes nach wie
vor ungeklärt ist, scheint das den sudden infant death letztlich katalysierende Ereignis
in einer akuten Regulationsstörung der kardiorespiratorischen Neurone der Formatio
reticularis des Hirnstammes zu liegen. Retrospektive Studien zeigen, daß dem SIDS-Ereignis
oft ein banaler Infekt des oberen Respirationstraktes vorausgeht. Bei dem von uns
präsentierten Fall änderte sich, induziert durch einen Infekt der oberen Atemwege
das Atemmuster eines 10 Wochen alten Säuglings akut und zeigte hochpathologische Werte,
wie dies anhand der Oxycardiorespirographie, der polygraphischen Aufzeichnung von
Atmungsparametern, registriert werden konnte.
