[Sudden infant death syndrome (SIDS)]. / La sindrome della morte improvvisa del lattante (SIDS).

Sudden Infant Death Syndrome (SIDS) is the term first proposed in 1969 for a distinctive subgroup of unexpected infant deaths occurring during the first months of life, with relatively consistent clinical, epidemiological and pathological features, which remain unexplained after a thorough case investigation, including a complete autopsy, examination of death scene and review of clinical history. Sudden infant death unnecessary means SIDS. According to definition, SIDS remains a diagnosis of exclusion, distinguished from others only by subjective and permissive variables. Despite the vague and permissive nature of the definition, epidemiological studies identified some risk factors as prematurity and social disadvantage. Nevertheless, the most interesting findings are those related to environmental and care features, as drug addiction and/or smoke exposition during pregnancy, sleep position of the infant, environmental temperature, parental bed sharing and breast feeding. Those factors play a variable role, but their correction reduced SIDS incidence. Sudden infant death is a diagnosis made by expert pathologists with pediatrician's and investigator's advice, based primarily on autopsy findings and death scene investigation performed through the severe application of investigative protocols.

[Cardiorespiratory monitoring in hospital and at home]. / Il monitoraggio cardiorespiratorio nella pratica ospedaliera e domiciliare.

Apnoea become a medical problem when associated with a symptomatology cohort characterized by skin colour modifications, muscular tone modifications and consciousness. This syndrome named ALTE, from the acronym Apparent Life Threatening Event, well describes the near death sensation in the witnesses. Only 60% of this events may be revealed in his etiopathogenesis, also even a strong diagnostic protocol is applied; the remaining part, called idiopathic represent a open doubt and stressing factor for the physicians. ALTE may be analyzed in his rising and resolving ways, throughout a complete and accurate report of the history and throughout his association with other several symptoms eventually associated, able to leading at diagnosis. The child must be investigated about his metabolic status near the crisis, particularly for each disease life threatening as cardiac arrhythmias, electrolytes alterations and hide or beginning infections. The use of instruments for domestic surveillance is based on old observations, denied by a lot of studies, there is an high relation between ALTE and SIDS. Really the monitoring has different rules in the management of child with ALTE: it is a useful tool to evaluate in continuous child's life parameters in order to be able to make a quick intervention in case of life threatening alterations for child. It also represents a diagnostic and prognostic way because it allows to evaluate respiratory and cardiac patterns and their modifications time related. There are some side effects as anxiety elicited in parents, cause of high frequency in false alarms. This allows the need of a strict relation between a SIDS Center and the family in order to increase the parents compliance.

QT interval prolongation and risk of life-threatening arrhythmias during toxoplasmosis prophylaxis with spiramycin in neonates.

We recently reported two cases of QT interval prolongation and cardiac arrest in newborns receiving antibiotic therapy with spiramycin, a macrolide agent extensively used for toxoplasmosis prophylaxis. In this study we assessed the effects of this drug on ventricular repolarization and on the potential risk of lethal arrhythmias in eight newborn infants in whom toxoplasmosis prophylaxis after birth was necessary. Electrocardiograms (ECGs) and echocardiograms were recorded during spiramycin therapy (350,000 i.u./kg/ day) and after its withdrawal. In a control group of eight healthy newborns matched for age and sex, no differences were found between two ECGs analogously recorded. The QT interval corrected for heart rate (QTc) was longer during spiramycin therapy than after drug withdrawal (448 +/- 32 msec vs 412 +/- 10 msec, +9%, p = 0.021). QTc dispersion, expressed as the difference between the longest and the shortest value in 12 different leads (QTcmax-min), was also higher during spiramycin therapy (60 +/- 32 msec vs 34 +/- 8 msec, +76%, p = 0.021), mainly because of a major lengthening of the longest QTc (QTcmax). QTc and QTc dispersion were markedly increased in the two newborns who experienced cardiac arrest after beginning treatment compared with the six neonates who had no drug-induced symptoms. During therapy seven of eight newborns had a rare abnormality in the thickening of the left ventricular posterior wall similar to that observed in patients with congenital long QT syndrome. This abnormality disappeared after drug withdrawal. Thus antibiotic therapy with spiramycin in the neonatal period may induce QT interval prolongation and increase QT dispersion. When this effect on ventricular repolarization is more marked, it may favor the occurrence of torsades des pointes and lead to cardiac arrest.