Researchers in Australia have found that some babies at risk of Sudden Infant Death Syndrome, or SIDS, have low levels of an enzyme called butyrylcholinesterase (BChE) in their blood. Their study, published May 6 in the journal eBioMedicine, could pave the way for screening and interventions in newborns if the results are confirmed by additional research.
“This is the first time we have a potential biomarker for SIDS,” said Dr. Carmel Harrington, who led the study at Westmead Children’s Hospital in Sydney, Australia.
Researchers have been trying to dispel the biological underpinnings of the puzzling syndrome for decades. And while public health campaigns have drastically reduced the incidence of SIDS, it remains the leading cause of sudden and unexpected death in infants under 1 year of age in Western countries. In the United States, some 3,400 babies die suddenly and unexpectedly each year, according to the Centers for Disease Control and Prevention. This includes babies who die suddenly for some reason, such as suffocation, and those who die for no apparent reason, such as SIDS. Nearly half of all sudden and sudden infant deaths (SUIDs) in the United States are due to SIDS.
What the new study found
One of the reasons why SIDS remains so tragic and mysterious is because it is probably not caused by a single biological mechanism, but by a combination of factors that come together in a perfect storm, said Dr. Thomas Kins, a pediatric pulmonologist at Los Angeles Children’s Hospital. Previous studies have shown low activity or damage in parts of the baby’s brain that control heart rate, respiration and sleep arousal, for example, as well as environmental stressors such as soft bedding or secondhand smoke.
“Researchers think that some babies die of SIDS because they don’t wake up in response to a dangerous situation when they’re sleeping,” said Dr. Kins.
To see if there was anything different about babies with SIDS, Dr. Harrington and her colleagues compared dried blood samples from a newborn heel prick test to 655 healthy babies, 26 babies who died of SIDS and 41 babies who died from another cause. . They found that about nine out of ten babies who died of SIDS had significantly lower BChE levels than babies in the other two groups.
“I was just stunned,” said Dr. Harrington, who has been searching for evidence and raising funds for her research for nearly 30 years since losing one of her own children to SIDS. “Parents of babies with SVDS are very guilty because, in fact, their child died in an hour. But what we found with this study is that these babies are different from birth, the difference is hidden, and no one knew about it before. So it’s not the parents’ fault. “
The new findings add support to researchers’ hypothesis that babies dying of SIDS have arousal problems, said Dr. Richard Goldstein, a pediatric palliative care specialist at Boston Children’s Hospital. BChE plays a role in the presence of important neurotransmitters in the excitation pathway of the brain. Low levels of the enzyme may indicate that the brain is unable to send signals that tell the baby to wake up and turn his head or take a breath. “But we need a lot more research before we understand its true significance,” said Dr. Goldstein.
What parents need to know
Although the study identifies an important chemical marker in a small group of babies, it is too early to say whether widespread testing for BChE will be helpful.
On the one hand, scientists and doctors do not know what the “normal” level of the enzyme looks like. And because Australian researchers did not have access to fresh blood samples for BChE, they did not measure absolute levels of the enzyme. There was also an overlap between infants. Some babies who died of SIDS had BChE levels in the same range as babies who did not die.
“If you’re going to test every newborn baby, you want the results to stand out as unusual only for babies who are at very high risk,” Dr. Kins said. Even if further research helped refine the BChE test to make a clear distinction between babies who may die from SIDS and those who could continue to live healthy lives, doctors and parents would still be facing a dilemma: What to do next? There is currently no intervention or treatment for low BChE levels.
Much of the advice on preventing SIDS remains the same, Dr Kins said. Make sure you follow the recommendations for safe sleep, such as lying on your baby’s back – both during a nap and at night. Remove loose sheets, blankets, pillows, bumper pads and soft toys from your baby’s sleeping area. And consider keeping your baby in the same room with you at night for at least six months, or ideally until your baby is one year old.
The American Academy of Pediatrics also recommends avoiding exposure to smoke, alcohol, and illicit drugs during pregnancy; breastfeeding; routine immunization; and using a pacifier to reduce the risk of SIDS.
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