0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

The Disappearance of Sudden Infant Death Syndrome—Reply ONLINE FIRST

Ernest Cutz, MD, FRCPC1,2,3
[+] Author Affiliations
1Baby’s Breath Foundation, St Catharines, Ontario, Canada
2Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
3Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
JAMA Pediatr. Published online August 29, 2016. doi:10.1001/jamapediatrics.2016.1782
Text Size: A A A
Published online

Extract

In Reply In response to Dr Schmidt regarding the JAMA Pediatrics article “The Disappearance of Sudden Infant Death Syndrome: Has the Clock Turned Back?,”1 the purpose of this article was to bring attention to the dismal state of practices dealing with sudden unexpected infant deaths including sudden infant death syndrome (SIDS). It is unfortunate that Dr Schmidt disagrees with several issues raised in my article. For example, he states that “plenty of research is going on, much of it confirming that infants have no pathologic changes,” or that “the research is meaningless and describes findings no one can reproduce.” However, Dr Schmidt fails to consider other possibilities to explain why, in many cases of SIDS, no anatomical cause of death is apparent (which in fact is one of the criteria for SIDS diagnosis). Data suggest that the main abnormality/defect in such cases occurs at a submicroscopic/molecular level, not detectable by tools used in routine forensic practice. Increasing evidence is accumulating indicating that SIDS is not a single disease entity but rather a heterogeneous disorder with up to one-third of SIDS cases owing to genetic/molecular defects including cardiac and other organ channelopathies, defects in genes involved in the neurotransmission, immune/inflammatory response, and metabolic pathways.2 In many of these conditions, no obvious gross or microscopic changes are evident. These facts, together with the lack of appropriate technology, could account for the failure of previous research studies to provide a single “pathognomonic or diagnostic” finding. The San Diego protocol, with the aim to improve the investigation of sudden unexpected infant deaths and SIDS is dismissed as unknown or ignored “because it is an abomination that legitimizes shoddy death scene investigation.” I wish to point out that this protocol was developed by an international panel of SIDS experts composed of pediatric and forensic pathologists including the former President of National Association of Medical Examiners, hardly a group that would advocate shoddy death scene investigation practices.3

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

August 29, 2016
Carl J. Schmidt, MD, MPH
1Chief Medical Examiner, Wayne County, Detroit, Michigan
JAMA Pediatr. Published online August 29, 2016.;():. doi:10.1001/jamapediatrics.2016.1811.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

237 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();