CAMAGÜEY.- I have always aroused a certain curiosity when I heard doctors refer to sudden death in babies. Now, with Dr. Arianna Sugrañes Montalván, 1st. degree in Intensive and Emergency Therapy, pediatric profile, Master in infectious diseases and Instructor Professor, from the Eduardo Agramonte Piña provincial pediatric hospital, in this city, I just learned that it is also known as death in the cradle.

—What is this event itself?

—It is the unexpected, without explanation death in a child under one year of age, although it is worth saying that this episode can occur at other ages, even in early adulthood. However, the most described being the one with the highest number of cases is in children under one year of age, it is even said that 90% occur in those who do not reach six months of birth, almost always with a peak incidence between the two and the four.

-What are their characteristics?

—After doing a necropsy, what we call a finding that explains the death of the patient by itself is not found.

 “In the crib, deaths from bronchoaspiration can occur —it consists of the accidental aspiration of solids or liquids through the airway—; by suffocation in those who sleep with pillows and suffocate, and especially in cases of co-sleeping, that is, when the child sleeps with their parents and they compress them. But for the purposes of the autopsy, all this causes lung damage due to asphyxia and if it is due to the crushing of the relatives, it comes to light due to the compression of the chest.

 "In the case of sudden death, none of this appears to justify the death."

 —How is incidence behaving worldwide?

—Very high in developed countries, much more than in developing countries, something that seems paradoxical. Even in the developed ones it is said it can reach 1.2 or 1.5 per 1,000 live births, and in the other group (underdeveloped), between 0.4 and 0.8, well below. In the 1980s it became the leading cause of infant mortality in the so-called first world. In the USA, the American Academy of Pediatrics promoted a campaign, and with a series of measures adopted they managed to reduce it by 50%.

- What were the factors that predisposed to this fact?

—According to the research, they depended on premature children and those with delayed intrauterine growth (CIUR), also the smoking habit of mothers that increases the risk of sudden death by between 50 and 80%, whether it does so in the stage of the infant's life as during pregnancy, because it causes little formation of the lung and the respiratory system of the child.

 "Something that revolutionized this situation was putting the baby in the prone position (face down) because they realized that they were more likely to die than those who sleep supine (face up)."

—It was what was preached before and not in such distant times ...

-Indeed. However, the right thing to do is face up with the head on one side.

 —Any other risk factors in those countries?

 —The overdressing of these babies because their countries are very cold. But I insist, there is no pathological event that alone justifies this type of death, yes, the researchers analyzed these risk factors and by working to avoid them, deaths decreased by up to 50%.

 "This of putting children on their backs to sleep brought with it many doubts, especially in the grandmothers about whether they have the so-called" swish "of milk, and it has been shown that in such cases face down is worse because the stomach is compressed by the mattress.

 "Another argument that appeared was the use of very soft mattresses, due to the fact that the baby is very sunken and if it is over-wrapped even more."

— So the studies ended there?"

 -No. In necropsies´ exams at the molecular level in the central nervous system, these children had patterns in common such as: the immaturity of the central nervous system and all the neurological structures at the functional level, especially everything related to the hormone serotonin - commonly known as the hormone of Happiness is a chemical substance produced by the human body, which functions as a neurotransmitter, transmitting signals between the nerves, as it was malfunctioning in the brain.

 “The stimuli there were diminished, and to this neurological immaturity are added those of the respiratory and cardiovascular type, all this at the molecular and cellular level. Among the vulnerabilities, they found the genetic and developmental anomaly that by itself does not justify, but it is a risk factor.

"The other is the critical stage of development where there was immaturity of the neurological, respiratory and immune systems, which is why it occurs with greater frequency between two and four months of age.

 "On the other hand, other studies bring to light channelopathies, which are alterations in the channels through which sodium, calcium, and potassium exit, related to the heart muscle, with the depolarization of the muscle membrane, which is what causes its contraction. This is very specific at ion levels and causes there to be cardiac arrhythmias, which can lead to sudden death and are not detected macroscopically, they are unable to be discerned by necropsy”.

 —Does the child's sex or nutrition matter?

 —First, no. But the second yes, because it appears more in the well-nourished, hydrated and well cared for.

 —Even though they were premature?

- Yes, premature infants are more at risk due to the immaturity to which we refer, but at the moment the sudden event occurs they are in perfect condition. Sometimes sero-sanguineous content is seen through the nose, if it has been resuscitated you can see milk in the airways, it is typical in resuscitation because it may be that the parents come and try to resuscitate it, but in the end when it is studied by means of necropsy none of this was the cause of death.

 —Are there frequent cases of this type in Cuba?

 —No, they are very isolated in our country, but it is always good for parents to be aware. Today they have babies very clothed, the addiction to smoking is more frequent than in previous years and people believe that it is a ratchet of the health personnel.

 —New technologies lead to children being “watched” by video-monitor, even when they sleep alone in a room, especially in other nations, what do you think of this?

 —It is very common in developed countries, but the American Academy of Pediatrics campaigned for little ones to sleep in their parents' rooms because they have discovered that both sudden deaths and apparently fatal events are less frequent if they are within the reach of adults. That should be the practice from birth and at least until three months, although in its cradle.

 -Some recommendations?

 --Children must be watched, mothers have to watch the baby between their chores, if one goes a long time without seeing them, the mother does not know what is happening and, on the contrary, in time the respiratory system can be stimulated, for example, if you notice any alteration. Not only in this specific case, but in others that also can occur in the cradle.

“Not smoking is an essential maxim, neither the mother nor those around her after the child is born, since passive smokers are affected the same. Breastfeeding is vital, at that stage the immune and neurological system is formed and this diet provides the necessary defense to the baby's body.

 “An example is found in countries as developed as Norway, with a very high rate of breastfeeding. It is said that it is the first country in the world in the use of this practice, even among working mothers, which incidentally is also ranked as a leader in this indicator of working mothers and even so they reach more than 80% in this sense during the first year of life”.

Translated by Linet Acuña Quilez