Neck Extension and Rotation in Sudden Infant Death Syndrome and Other Natural Infant Deaths

Abstract

It has been hypothesized that some cases of sudden infant death syndrome (SIDS) are a result of neck extension and/or rotation that causes vertebral artery (VA) compression and brain stem ischemia. There is a paucity of relevant literature on this topic. Therefore, our aim was to compare neck rotation and extension in SIDS and other natural infant deaths. Cases of SIDS and other natural infant deaths within the San Diego SIDS Research Project database were analyzed retrospectively with respect to neck and body position as reported by the trained, experienced scene investigators and/or the caretakers who discovered the infants. Information was used from 246 SIDS cases and 56 cases of other natural deaths. Simultaneous neck extension and rotation was not reported in either group. When data regarding neutral/flexed/extended position and rotation of the neck were combined, no significant differences were found between the two groups (P = 0.94); 40% of the SIDS cases and 41% of the other natural death cases were found with the neck either extended or rotated (odds ratio [OR] 0.97, [reference group = neck either neutral or flexed, and not rotated], 95% confidence interval [CI] 0.45, 2.11). There were also no significant differences between the groups when neck rotation and neck extension were analyzed independent of one another. Neck rotation among cases found in the prone position was common and was not significantly different between the two groups (49% of 146 SIDS cases, 58% of 24 other natural death cases, P = 0.38, OR 0.68, 95% CI 0.28, 1.62). Neck rotation among infants found in the supine position occurred one-third as often in the SIDS group (9% of 33 cases) as in the other natural death group (29% of 14 cases); however, the difference was not significant (P = 0.17; OR 0.25, 95% CI 0.05, 1.31). Although our analysis does not exclude VA compression and brain stem ischemia in some cases of SIDS, we found no evidence to affirm its importance. This study demonstrates the importance of meticulous scene descriptions, including neck position.

Keywords

sudden infant death syndrome other natural infant death vertebral artery compression neck position brain stem ischemia

Get full access to this article

View all access options for this article.

References

Filiano

, Kinney

. A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model. Biol Neonate 1994;65:194–197.

Filiano

. Arcuate nucleus hypoplasia in sudden infant death syndrome: a review. Biol Neonate 1994;65:156–159.

Kinney

, Filiano

. Brainstem research in sudden infant death syndrome. Pediatrician 1988;15:240–250.

Kinney

, Burger

, Harrell

Jr. , Hudson

Jr. ‘Reactive gliosis’ in the medulla oblongata of victims of the sudden infant death syndrome. Pediatrics 1983;72:181–187.

Kinney

, Filiano

, Sleeper

, Mandell

, Valdes-Dapena

, White

. Decreased muscarinic receptor binding in the arcuate nucleus in sudden infant death syndrome. Science 1995;269:1446–1450.

Kinney

, O'Donnell

, Kriger

, White

. Early developmental changes in [³H]nicotine binding in the human brainstem. Neuroscience 1993;55:1127–1138.

Kinney

, Filiano

, Assmann

, Tritiated-naloxone binding to brainstem opioid receptors in the sudden infant death syndrome. J Auton Nerv Syst 1998;69:156–163.

Panigrahy

, Filiano

, Sleeper

, Decreased kainate receptor binding in the arcuate nucleus of the sudden infant death syndrome. J Neuropathol Exp Neurol 1997; 56:1253–1261.

Giles

, Bina

, Sotrel

Infantile atlantooccipital instability. The potential danger of extreme extension. Am J Dis Child 1979;133:30–37.

10.

Pamphlett

, Murray

Vulnerability of the infant brain stem to ischemia: a possible cause of sudden infant death syndrome. J Child Neurol 1996;11:181–184.

11.

Pamphlett

, Raisanen

, Kum-Jew

Vertebral artery compression resulting from head movement: a possible cause of the sudden infant death syndrome. Pediatrics 1999;103:460–468.

12.

Saternus

, Adam

Sudden infant death. Postmortem flow measurements in the large vessels of the neck for the demonstration of posture-dependent cerebral hypoxemia (in German). Dtsch Med Wochenschr 1985;110:297–303.

13.

Krous

Instruction and Reference Manual for the International Standardized Autopsy Protocol for Sudden Unexpected Infant Death. J SIDS Infant Mortality 1996;1:203–246.

14.

Iyasu

, Rowley

, Hanzlick

Guidelines for Death Scene Investigation of Sudden, Unexplained Infant Deaths: Recommendations of the Interagency Panel on Sudden Infant Death Syndrome. J SIDS Infant Mortality 1996;1:183–202.

15.

Willinger

, James

, Catz

Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol 1991; 11:677–684.

16.

Dwyer

, Ponsonby

. The decline of SIDS: a success story for epidemiology. Epidemiology 1996;7:323–325.

17.

Fleming

, Gilbert

, Azaz

, Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case–control study. BMJ 1990;301:85–89.

18.

Fleming

, Blair

, Bacon

, Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993–5 case–control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths regional coordinators and researchers. BMJ 1996;313:191–195.

19.

Adams

, Chavez

, Steen

, Shah

, Iyasu

, Krous

. Changes in the epidemiologic profile of sudden infant death syndrome as rates decline among California infants: 1990–1995. Pediatrics 1998;102:1445–1451.

20.

Willinger

, Hoffman

, Wu

, Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA 1998;280:329–335.

21.

Dwyer

, Ponsonby

, Newman

, Gibbons

. Prospective cohort study of prone sleeping position and sudden infant death syndrome. Lancet 1991;337:1244–1247.