SIDS (sudden infant death syndrome) or “cot-death” is when an apparently healthy baby dies with no obvious medical cause. Presently, SIDS claims the lives of 230 babies every year in England, and understandably it is awfully challenging for parents to accept the loss when the cause of death is not established. Neuroscience has however been making dents in the research behind the neuropathology of SIDS.
In 1996, Sally Clark was arrested and charged with two counts of murder (for the death of her 11-week-old baby boy who died in 1994, and for the death of her 8-week-old baby boy who died that year). Pathologists claimed that there were signs of abuse on the new-born’s bodies. Several paediatricians took the stand and testified that the babies did die from natural causes and that the injury on their bodies was made from attempts to resuscitate them. However, the prosecution painted Sally to be a drunkard who resented her children after she lost her well-paid job as a solicitor. The defendants doctor expert, Sir Roy Meadow, speculated initially that the babies were shaken but then changed his mind and claimed that they were in fact smothered. He placed the odds of two babies from the same household dying from SIDS at 73,000,000:1 On the back of these damaging stats from a newly knighted doctor, the jury found Clark guilty. Sally appealed after the Royal Statistical society called Meadows 73 million to one a “serious statistical error”. Meadow reached his stats without taking into consideration that the babies would have similar environments and genetical predispositions. In fact, it is more likely to have repeated cot deaths in the same household than different ones.
New evidence was raised from the hospital that a pathologist failed to disclose blood tests taken which indicated that one of the babies died from a bacterial infection. Her conviction was overruled, and she was set free. Unfortunately, Sally never recovered from this horrific ordeal, she lost two children, the media had branded her as evil, and she spent three tough years in prison. Sally passed away from alcohol poisoning at age 42, leaving her third child motherless.
This heart-breaking case demonstrates how complicated SIDS can be. It also illuminated how dangerous it is to accept what an expert says at face value- now British courts can no longer prosecute parents of babies suffering cot death on the evidence of a single expert witness. In this case, Roy Meadow was dismissed from the GMC committee.
Boston’s Children Hospital in the US examined post-mortem samples from the brainstems of thirty-one babies who passed away on cot-death and compared then to babies who had died from other causes. The serotonergic 5-HT neurons in the medulla oblongata project to autonomic and respiratory nuclei. Previously, abnormalities in 5HT binding in the medullae of infants dying from SIDS, were identified, suggesting that medullary 5HT dysfunction may be responsible for a subdivision of SIDS cases. Sporadic autonomic dysregulation because of decreased levels of Raphe nuclei seems to play a major role in SIDS. When a child has low levels of Raphe nuclei, they have elevated serotonin levels and therefore they may not be aroused to wake up at an appropriate time which could be a potential reason for SIDS.
SIDS is a frightening prospect for parents, and thankfully it remains quite rare. When investigating SIDS, it is equally as important to pay attention to the absence of causes as well as the presence of them. Although there are risk factors associated with SIDS such as overheating during sleep, soft blankets and smoking mothers, this biological failure still remains a mystery. As science evolves, optimistically we can deliver explanations in the next few decades to come and make sure no parent loses their child so early.
- sham
Poem of the week: (by my favourite Iranian poet)
In the morning
When I began to wake
it happened again
That feeling
that you, beloved
had stood over me all night
keeping watch
that feeling
that as soon as I began to stir
you put your lips on my
forehead
and lit a holy camp
inside my heart
Hafiz
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