International Congress on SUDDEN INFANT DEATH SYNDROME

"The Role of Environmental Factors in Infant Morbidity and Mortality"

GRAZ-AUSTRIA May 24 to 27, 1995

 SLEEPING POSITION, FORMULA FEEDING, ENDOTOXIN AND SIDS Robert C Reisinger, DVM, MS, 3810 Dustin Road, Burtonsville, MD 20866 U.S.A.

 Formula fed infants have 1,000 to 10,000 times more E. coli in their g.i. tracts than do breast fed infants. Numerous viruses, avitaminosis A, C, B-6, etc., chilling, overheating, and various other environmental stressors may make the infant 10,000 times more susceptible to E.coli endotoxin (lipopolysaccharide) . . . Raising ambient temperature increases susceptibility to endotoxin . . . Formula feeding increases body heat . . . Being in the prone position increases body heat . . . Prone positioning thus may increase susceptibility of formula fed infants to SIDS . . . Prone positioning would not equally increase susceptibility of the totally breast fed infant to SIDS . . .

Sudden Death Syndrome (SDS) in young of other mammalian species, including the calf and rhesus monkey, is associated with greatly increased numbers of E.coli in the proximal ileum and jej unum . . . J. Bendig and H. Haenel have reported similar increased E.coli in the proximal intestinal tract of 24 of 29 SIDS cases . . . Absorption of increased amounts of endotoxin into the general blood circulation through a temporarily dysfunctional reticuloendothelial system causes decrease of phosphoenolpyruvate carboxykinase (PEPCK) in the liver, release of large amounts of serotonin from blood platelets, non-coagulability of blood, pulmonary edema and hemorrhage by diapedesis. . . Serotonin initiates in some cases the coronary chemoreflex (Bezold-Jarisch reflex) in which there is inhibition of sympathetic outflow and increased activity of the cardiac (efferent) vagus leading to profound bradycardia, hypotension and cardiac collapse . . . Minimal lethal dose of endotoxin given over hours of time is so small as to be undetectable by any clinical test presently in use.

 Bendig, J. and Hacnel, H.: Gastrointestinal Microecology of Sudden Unexpected Death of InfantsNutrition, Proc. Eight Congress Nutr., Prague, Sept. 1969. (ed) Josef Masek, Prague, & Sir David P. Cuthbertson, Glasgow. Exccrptica Medica, pub., Amsterdam p.212-214-1970.

Reisinger, RC.: A final mechanism of cardiac and respiratory failure. Pub. in SIDS 1974. Proc. of Camps International. Symp. on SUD in Infancy. Pub: Canadian Found. for Study of Infant Deaths. 4 Lawson Blvd., Toronto M4V 1Z4. 77-X2-1974.

Reisinger, RC.: Pathogenesis and prevention of infectious diarrhea (scours) of newborn calves. J Amer Vet. Med. Assoc 147:1377-1386, 1965.

Reisinger, RC: Studies on the pathogenesis of diarrhea of newborn calves. M.S. thesis. U Wisconsin, Madison, 1957.

Reisinger, RC: Parainfluenza 3 virus in cattle. Ann NY Acad Sci 101: 576-582, 1962.

Woodruff, P.W.H., O'Carroll, D.L, Kuizumi, S., and Fine, J.: Role of Intestinal Flora in Major Trauma J. Inf. Dis. 128 Supl: S290-294, July 1973.

Wells, J.C.K, Davies, P.S.W.: Sudden Infant Death Syndrome. Archives of Disease in Childhood 1994 70:252-253.