4 ms·

Fascinating. SIDS is... so strange. Can someone comment whether this is a significant result, vs minor contributing factor? I can’t really interpret the result

Fascinating. SIDS is... so strange. Can someone comment whether this is a significant result, vs minor contributing factor? I can’t really interpret the results... there is a significant coef on (quantity of something in blood) in a logistic regression... how big is the residual?

flatiron 4y ago
I am not a doctor. SIDS seems to be a catch all for a lot of things. Putting babies on their back, removing objects and bumpers from the crib, etc did reduce SIDS but didn’t eliminate it. This may be a major chunk of what is still considered SIDS but is not 100% of what is considered SIDS
- petercooper 4y ago
  I'm also very much not a doctor, but I read a lot of medical texts for fun and I have a naive interpretation to float out there (that hopefully someone in the know can correct or refute!) The paper talks about "cholinergic deficit" (a situation that is also common in dementia sufferers). The parasympathetic nervous system is heavily reliant on cholinergic agents which is why if you take medication that's anticholinergic (including many antihistamines like promethazine) it tends to dull the senses, send people to sleep, make it harder to wake up, etc. (This is what a lot of those "sleep aids" you find in US airports are doing at a low level.) My layman's attempt at jumping to a conclusion, then, is that death is not caused merely by cholinergic deficit, but that if someone has such a deficit and is harder to self-rouse, asphyxiation during sleep becomes somewhat more likely?
abcc8 4y ago
Not a physician either. This is an interesting result and is deserving of being followed up. That being said, there are many acknowledged causes of SIDS so this biomarker is unlikely to end up being predictive (or correlated) with all causes of SIDS. As has been mentioned elsewhere in the tread, suffocation on objects within the crib was responsible for at least some cases. What is interesting to me is that this is a biochemical marker and biochemical disorders are known causes of SIDS. Newborn screening, which varies from state to state, can catch many of these disorders. This result is interesting because it may lead to other studies that identify other pathways/enzymes that represent markers or causes of less common causes of SIDS. MCAD deficiency, the most common inborn error in fatty acid oxidation, is a biochemical disorder that is one of the more common causes of SIDS. The infants simply run out of easily available fuel for their metabolism if untreated and can die during fasting (i.e. in their cot in the middle of the night). Giving starch or other complex carbs before bedtime is one of several treatments for this disease, with the overall goal of treatment to prevent the individual from entering a fasting state, as that is when they metabolically decompensate.
roguecoder 4y ago
This didn't establish a causal mechanism or even whether this particular enzyme is a contributing factor. It looked at an enzyme also associated with disfunction of the autonomic nervous system & finding that it is associated with SIDs deaths, but not other deaths. This is additional evidence supporting a hypothesis advanced in the last decade associating SIDs deaths with a reflex that causes infants to stop breathing instead of try to breath faster when they aren't getting enough oxygen. It doesn't establish much on its own, but it could enable screening for at-risk children, and eventually enable interventions that address the root cause. (Current interventions are mostly about attempting to ensure infants never experience a drop in oxygen that could trigger that reflex, which can never reduce the risk to zero.)

flatiron 4y ago

I am not a doctor. SIDS seems to be a catch all for a lot of things. Putting babies on their back, removing objects and bumpers from the crib, etc did reduce SIDS but didn’t eliminate it. This may be a major chunk of what is still considered SIDS but is not 100% of what is considered SIDS

petercooper 4y ago
I'm also very much not a doctor, but I read a lot of medical texts for fun and I have a naive interpretation to float out there (that hopefully someone in the know can correct or refute!) The paper talks about "cholinergic deficit" (a situation that is also common in dementia sufferers). The parasympathetic nervous system is heavily reliant on cholinergic agents which is why if you take medication that's anticholinergic (including many antihistamines like promethazine) it tends to dull the senses, send people to sleep, make it harder to wake up, etc. (This is what a lot of those "sleep aids" you find in US airports are doing at a low level.) My layman's attempt at jumping to a conclusion, then, is that death is not caused merely by cholinergic deficit, but that if someone has such a deficit and is harder to self-rouse, asphyxiation during sleep becomes somewhat more likely?

abcc8 4y ago

Not a physician either. This is an interesting result and is deserving of being followed up. That being said, there are many acknowledged causes of SIDS so this biomarker is unlikely to end up being predictive (or correlated) with all causes of SIDS. As has been mentioned elsewhere in the tread, suffocation on objects within the crib was responsible for at least some cases. What is interesting to me is that this is a biochemical marker and biochemical disorders are known causes of SIDS. Newborn screening, which varies from state to state, can catch many of these disorders. This result is interesting because it may lead to other studies that identify other pathways/enzymes that represent markers or causes of less common causes of SIDS. MCAD deficiency, the most common inborn error in fatty acid oxidation, is a biochemical disorder that is one of the more common causes of SIDS. The infants simply run out of easily available fuel for their metabolism if untreated and can die during fasting (i.e. in their cot in the middle of the night). Giving starch or other complex carbs before bedtime is one of several treatments for this disease, with the overall goal of treatment to prevent the individual from entering a fasting state, as that is when they metabolically decompensate.

roguecoder 4y ago

This didn't establish a causal mechanism or even whether this particular enzyme is a contributing factor. It looked at an enzyme also associated with disfunction of the autonomic nervous system & finding that it is associated with SIDs deaths, but not other deaths. This is additional evidence supporting a hypothesis advanced in the last decade associating SIDs deaths with a reflex that causes infants to stop breathing instead of try to breath faster when they aren't getting enough oxygen. It doesn't establish much on its own, but it could enable screening for at-risk children, and eventually enable interventions that address the root cause. (Current interventions are mostly about attempting to ensure infants never experience a drop in oxygen that could trigger that reflex, which can never reduce the risk to zero.)