Evolución epidemiológica y causas de muerte súbita en lactantes: estudio poblacional desde 1991 a 2020 en Bizkaia / Epidemiological changes and causes of sudden unexpected death in infancy: A 30-year population-based study in Basque Country

Introducción: la muerte súbita del lactante (MSL) representa un grave problema de salud pública. El objetivo del trabajo es analizar sus características epidemiológicas y clínico-patológicas. Método: estudio retrospectivo poblacional de la MSL en Bizkaia entre 1991–2020. Se examinaron datos del Registro de Mortalidad y Servicio de Patología Forense. Resultados: se registraron 1.109 defunciones en menores de un año. En 107 se efectuó autopsia forense: 61 síndromes de muerte súbita del lactante (SMSL) y 23 MSL de causa explicada. En otros 10 casos se codificó el SMSL como causa de muerte sin autopsia forense. La incidencia del SMSL fue de 0,26/1.000 recién nacidos/año y descendió desde 0,74 (quinquenio 1991–1995) a 0,07 (quinquenios 2011–2020). El porcentaje del SMSL en relación a la mortalidad total decreció del 11,2 al 2,5%. En el SMSL predominó la categoría IB de San Diego (67%) y los lactantes entre 1–4 meses (63%). Un «ambiente de sueño inseguro» se detectó en 6 SMSL. El 56,5% de las MSL explicadas fueron infecciosas. De los 84 casos de MSL autopsiados, el 70% no tenía enfermedades previas y el 15% eran prematuros y/o recién nacidos de bajo peso. En el 32% existieron síntomas prodrómicos, principalmente infección de vías respiratorias. Hallazgos microscópicos sugestivos de infección respiratoria se diagnosticaron en 10 SMSL. Conclusiones: la incidencia del SMSL en Bizkaia es baja y ha disminuido notablemente en los últimos 30 años. La sintomatología prodrómica y los signos histopatológicos sugestivos de infección son relativamente frecuentes. En el futuro serían deseables investigaciones prospectivas multidisciplinares y multicéntricas.(AU)

Introduction: Sudden unexpected deaths in infancy (SUDI) represents a serious public health problem. The objective of this work is to analyze its epidemiological and clinical-pathological characteristics. Method: Retrospective population study of SUDI in Bizkaia between 1991–2020. Data from the Mortality Registry and Forensic Pathology Service were examined. Results: 1,109 deaths in children under one year were recorded. A forensic autopsy was performed in 107: 61 cases of sudden infant death syndrome (SIDS) and 23 SUDI of explained cause. In other 10 cases SIDS was coded as cause of death without forensic autopsy. The incidence of SIDS was 0.26/1000/year and decreased from 0.74 (1991–1995 five-year period) to 0.07 (2011–15 and 2016–20 periods). The percentage of SIDS in relation to total mortality decreased from 11.2 to 2.5%. In SIDS, category IB from San Diego (67%) and infants between 1 and 4 months (63%) predominated. An “unsafe sleep environment” was detected in 6 SIDS. 56.5% of the explained SUDI were infectious. Of the 84 autopsied SUDI cases, 70% had no pre-existing disease and 15% were premature and/or low birth weight infants. In 32% there were prodromal symptoms, mainly respiratory tract infection. Microscopic findings suggestive of respiratory infection were diagnosed in 10 SIDS. Conclusions: The incidence of SIDS in Bizkaia is low and has decreased notably in the last 30 years. Prodromal symptoms and histopathological signs suggestive of infection are relatively common. Forensic studies provide relevant data, although prospective multidisciplinary and multicenter research would be desirable.(AU)

[Sudden infant death syndrome: Do the parents follow the recommendations?] / Síndrome de muerte súbita del lactante: ¿siguen las familias las recomendaciones?

INTRODUCTION: Prone sleeping position is the main known modifiable risk factor for sudden infant death syndrome (SIDS). There are other SIDS recommendations although with less impact. The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. METHODS: Cross-sectional study carried out on 640 families with children from 0 months to 11 months. In addition to the sleep position, the adherence to four other recommendations regarding SIDS was analysed: place where infant sleeps, breastfeeding, use of non-nutritive suction, and maternal smoking. RESULTS: A total of 41.3% of infants under 6 months and 59.7% of infants aged 6 to 11 months slept in a non-recommended position. Only 6.4% of families analysed followed all five recommendations. DISCUSSION: There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS.

Impacto de una intervención educativa para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante / Impact of an educational intervention to improve adherence to the recommendations on safe infant sleep

Introducción. Las campanas públicas en países desarrollados con recomendaciones para el sueño seguro del lactante lograron aumentar la adherencia a la posición supina para dormir a más del 70% y generaron, simultáneamente, una reducción del 53% en la incidencia del síndrome de muerte súbita del lactante. Objetivo. Valorar el impacto a los 60 días de vida de una intervención educativa realizada en las maternidades para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante. Población, material y métodos. Estudio de intervención con control histórico entre el 1/2 y el 30/9 de 2014, realizado en la Maternidad Meisner y el Hospital Universitario Austral. Dicha intervención se denominó "tapeta cuna" y consistió en capacitar al equipo de salud y brindar información a las familias sobre sueño seguro a través de clases, adhesivos en las cunas y material escrito. Resultados. Fueron incluidos 550recién nacidos. Se observó un incremento del 35% en la posición supina al dormir tras la intervención (p < 0,0001); la lactancia materna exclusiva se incrementó un 11% (p= 0,01); se redujo el colecho de un 31% a un 18% (p < 0,0005). No se encontraron diferencias en la cohabitación, entre convivientes fumadores ni en la utilización del chupete a los 60 días. Conclusiones. La intervención educativa resultó útil para mejorar la adherencia a las recomendaciones sobre sueño seguro a los 60 días de vida: se evidenció una mejora en la posición supina, la lactancia materna y la reducción del colecho. No existieron cambios en la proporción de convivientes fumadores, la cohabitación y el uso del chupete.

Introduction. In developed countries, public campaigns promoting recommendations on safe infant sleep increased adherence to the supine sleeping position to more than 70% and, at the same time, reduced the incidence of sudden infant death syndrome by 53%. Objective. To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep. Population, material and methods. Intervention study with historical control conducted between February 1st and September 30th of 2014 at the Maternity Center of Hospital Meisner and Hospital Universitario Austral. The intervention was called "crib card" and consisted in training health care team members and providing families with information on safe infant sleep by means of lessons, written material and using stickers on cribs. Results. Five hundred and fifty newborn infants were included. After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p < 0.0005). No differences were observed in relation to bedroom sharing, living with tobacco users, or pacifier use at 60 days of life. Conclusions. The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.

Muerte súbita del lactante / Sudden infant death

El síndrome de muerte súbita del lactante (SMSL) consiste en la muerte inesperada de un infante menor de un año, la cual no puede ser explicada posterior a las investigaciones del caso, tales como: la anamnesis, la escena de la muerte, y la autopsia. La relevancia de este padecimiento radica en que es un fenómeno presente a nivel mundial, y es la principal causa de muerte en lactantes de 1 a 12 meses de vida. Debido a la importancia del tema, la presente investigación pretende realizar un acercamiento bibliográfico, que aborda terminología especializada; estudios de epidemiologia a nivel mundial; diversos factores de riesgo y su prevención; además del algoritmo de manejo de SMSL basado en las guías españolas de pediatría y las guías de SMSL de Massachusetts.Cabe destacar que el diagnóstico de esta muerte es de exclusión y requiere una investigación exhaustiva para poder dilucidar sus causas. Así mismo, el SMSL ha sido asociado a diferentes factores de riesgo que pueden desencadenar este evento en niños con susceptibilidad genética o adquirida, los cuales en la mayoría de los casos pueden modificarse y prevenirse educando a los padres, y a los proveedores de la salud. Debido a que el médico general, y el pediatra son los primeros profesionales en abordar al lactante y a sus familiares, es imperativo que ambos tengan conocimiento del tema en cuestión, no solo para la prevención de estos casos, sinopara el abordaje correcto en el caso que se presente una muerte súbita infantil.

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including the review of the clinical history, the examination of the death scene, and an autopsy. This condition is relevant because is a worldwide phenomenon, and it is the leading cause of death in infants between 1 to 12 months. Due to the importance of this subject, this research tries to make a bibliographic review that includes specialized terminology, worldwide epidemiology studies, risk factors, how to prevent it; and the approach, based on the Spanish and Massachusetts guidelines.The diagnosis of SIDS is based in the exclusion of causes, and requires a thorough investigation to elucidate them. Also, SIDS has been associated with different risk factors that can trigger this event in children with genetic or acquired susceptibility, which in most cases can be modified and prevented by educating the parents and the health care providers. Because the physician and the pediatrician are the first professionals to have contact with the infant and their families, it is imperative that both have knowledge of this subject, not only for the prevention of such cases, but for the correct approach in these cases.

[Hospital Admissions due to cyanosis episodes in newborns with gestational age of 34 weeks or more]. / Hospitalización por episodios de cianosis en recién nacidos de edad gestacional igual o mayor a 34 semanas.

OBJECTIVES: A retrospective study was performed between January 2007 and December 2012 to assess the admission rates of newborns due to episodes of cyanosis PATIENTS AND METHOD: Retrospective study that included all the newborns hospitalized with episodes of cyanosis between January 2007 and December 2012. In them were employed two study protocols that considered first and second line tests, the latter in view of recurrence of events. The first line protocol considered general biochemical tests, chest x-ray and echocardiography in selected cases, while the second line protocol included electroencephalogram, electrocardiogram, nuclear magnetic resonance of the brain, expanded metabolic screening, pyruvic acid, lactic acid, and in case of seizures, cytochemical, and culture of cerebrospinal fluid (CSF) and PCR (polymerase chain reaction) for herpes. RESULTS: A total of 98 (2.8%) out of 3,454 newborns were admitted due to episodes of cyanosis. Gestational age: 37.8+1.4 weeks, birth weight: 3,145+477 g. Maternal age: 32+4.8 years. Disease was present in 19.4% of mothers; gestational diabetes (8.1%), pregnancy induced hypertension (5.1%), intrahepatic cholestasis (3.1%), and intrauterine growth retardation (3.1%). Gender: 48.8% male, 51.2% female (NS). Birth: caesarean section, 68.4%, and vaginal delivery, 31.6%. Age on admission 1.9+1.4 days. Hospital stay: 4.2+4.2 days. First line tests were performed in 100% of patients with 39.8% fulfilling the criteria for second line study. A condition was detected in 21.4%, with convulsive syndrome was the most frequent (33%). Newborns with an identified condition had 3.8+2.7 episodes versus 1.5+2,4 in those without diagnosis (NS). A home oxygen monitor was given to 15.4%. There were no re-admissions. CONCLUSIONS: Most newborns admitted due to cyanosis are discharged with a condition of unknown origin. In this study, convulsive syndrome was the most frequent cause.

Hospitalización por episodios de cianosis en recién nacidos de edad gestacional igual o mayor a 34 semanas / Hospital Admissions due to cyanosis episodes in newborns with gestational age of 34 weeks or more

Objetivo: Caracterizar la hospitalización por episodios de cianosis en recién nacidos (RN) > 34 semanas. Pacientes y método: Estudio retrospectivo que incluyó la totalidad de los RN hospitalizados por episodios de cianosis entre enero de 2007 y diciembre de 2012. En ellos se aplicaron 2 protocolos de estudio que consideraban exámenes de primera y segunda línea; estos últimos ante la recurrencia de eventos. El protocolo de primera línea consideró exámenes bioquímicos generales, radiografía de tórax y ecocardiografía en casos seleccionados, en tanto que el protocolo de segunda línea incluyó electroencefalograma, electrocardiograma, resonancia magnética nuclear encefálica, screening metabólico ampliado, ácido pirúvico, ácido láctico y en caso de convulsiones, citoquímico y cultivo de líquido cefalorraquídeo y reacción en cadena de la polimerasa para herpes. Resultados: Noventa y ocho de un total de 3.454 (2,8%) RN hospitalizados ingresaron por episodio de cianosis. La edad gestacional (EG) fue 37,8 + 1,36 semanas; peso al nacimiento: 3145 + 477 g. Edad materna: 32 + 4,8 años. El 19,4% de las madres tenía antecedentes mórbidos: diabetes gestacional (8,1%), síndrome hipertensivo del embarazo (5,1%), colestasia intrahepática (3,1%) y retardo del crecimiento (3,1%). Género: 48,8% masculino, parto por cesárea: 68,4%. Edad al ingreso: 1,9 + 1,4 días; duración de la hospitalización: 4,2 + 4,2 días. En todos los pacientes se practicaron exámenes de primera línea y en el 39,8% exámenes de segunda línea. En el 21,4% de los RN se identificó una causa, siendo el síndrome convulsivo el más frecuente (33%). Los RN con diagnóstico asociado presentaron 3,8 + 2,7 episodios de cianosis versus 1,5 + 2,4 en el grupo sin diagnóstico (NS). El 15,4% se fueron de alta con monitor; no hubo reingresos. Conclusión: La incidencia de hospitalización neonatal por episodios de cianosis fue de 6 por 1.000 RN vivos. Solo en cerca de un 20% de ellos es posible identificar una causa, siendo la más frecuente el síndrome convulsivo.

Objectives: A retrospective study was performed between January 2007 and December 2012 to assess the admission rates of newborns due to episodes of cyanosis Patients and method: Retrospective study that included all the newborns hospitalized with episodes of cyanosis between January 2007 and December 2012. In them were employed two study protocols that considered first and second line tests, the latter in view of recurrence of events. The first line protocol considered general biochemical tests, chest x-ray and echocardiography in selected cases, while the second line protocol included electroencephalogram, electrocardiogram, nuclear magnetic resonance of the brain, expanded metabolic screening, pyruvic acid, lactic acid, and in case of seizures, cytochemical, and culture of cerebrospinal fluid (CSF) and PCR (polymerase chain reaction) for herpes. Results: A total of 98 (2.8%) out of 3,454 newborns were admitted due to episodes of cyanosis. Gestational age: 37.8 + 1.4 weeks, birth weight: 3,145 + 477 g. Maternal age: 32 + 4.8 years. Disease was present in 19.4% of mothers; gestational diabetes (8.1%), pregnancy induced hypertension (5.1%), intrahepatic cholestasis (3.1%), and intrauterine growth retardation (3.1%). Gender: 48.8% male, 51.2% female (NS). Birth: caesarean section, 68.4%, and vaginal delivery, 31.6%. Age on admission 1.9 + 1.4 days. Hospital stay: 4.2 + 4.2 days. First line tests were performed in 100% of patients with 39.8% fulfilling the criteria for second line study. A condition was detected in 21.4%, with convulsive syndrome was the most frequent (33%). Newborns with an identified condition had 3.8 + 2.7episodes versus 1.5 + 2,4 in those without diagnosis (NS). A home oxygen monitor was given to 15.4%. There were no re-admissions. Conclusions: Most newborns admitted due to cyanosis are discharged with a condition of unknown origin. In this study, convulsive syndrome was the most frequent cause.

[The role of complementary examinations and home monitoring in patient at risk from apparent life threatening event, apneas and sudden infant death syndrome]. / Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante.

INTRODUCTION: Home apnea monitors detect abnormalities in cardiac and respiratory frequency, but their use in the diagnosis of respiratory -related sleep disturbances in children has not been demonstrated, as was originally thought. OBJECTIVE: To describe the type of patients being monitored, for how long and their outcome. MATERIAL AND METHODS: A retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital. RESULTS: During the study period 88 patients were included, 58% of them were male, with a median age of 15.5 days, and followed up for a period of 4.7 months. The reason for monitoring was in a 20.5% due to a history of sudden death without finding underlying pathology in 20.5%, 25% due to apnea of prematurity, 20.5% due to apparent life-threatening event, and 14.8% due to choking. Other causes accounted for 19.3% (apnea/hypopnea, desaturation and periodic breathing). Of these last three groups, pathological events were observed in 50% of them: reflux disease (9), apnea of prematurity (2), neurological causes (3), and apnea of unknown cause (10). CONCLUSIONS: Suspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the pediatrician. Home monitoring is useful in detecting changes in cardiac and respiratory frequency, but is necessary to limit its indications and ensure proper monitoring of these patients, avoiding the abuse of other tests or treatments.

Evaluación de la adherencia a las recomendaciones para disminuir el riesgo de Síndrome de Muerte Súbita del lactante / Adherence to recommendations to reduce the risk of Sudden infant Death Syndrome

Introduction: Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. Patients and Method: 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. Results: Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). Conclusions: The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.

Introducción: Existen recomendaciones preventivas en el Sindrome de Muerte Súbita del lactante (SMSL), aunque es incierto el grado de adherencia a dichas medidas. El objetivo del estudio fue evaluar la adherencia a las recomendaciones para disminuir el riesgo de SMSL, buscando factores asociados al no cumplimiento de dichas recomendaciones. Pacientes y Método: Se incluyeron 468 recién nacidos de dos maternidades, pública y privada. Se efectuó una evaluación posparto y a los 4 meses de la adherencia a las recomendaciones. Se utilizó un cuestionario adaptando un modelo de encuesta validado por el International Child Care Practices Study Resultados: La adherencia a las recomendaciones obstétricas fue mayor (75,4%) que a las recomendaciones pediátricas (53,3%). A su vez en las recomendaciones pediátricas se evidenció una caída del cumplimiento de las recomendaciones a los 4 meses. Al seguimiento se observó reducción de lactancia (84,9% vs 48,6%; p < 0,001) y de posición supina (61,2% vs 21,2%; p < 0,001). Conclusiones: La disminución de la adherencia a las recomendaciones para la prevención del SMSL se observó principalmente en las mujeres de menor edad y menor nivel educativo, no estar en pareja, mala calidad habitacional y presencia de numerosos convivientes.

The clinical significance of pregnancy in Brugada syndrome.

INTRODUCTION AND OBJECTIVES: Little is known about the risks and outcomes of pregnancy in women with Brugada syndrome. We therefore evaluated pregnancy outcomes and the influence of pregnancy in patients with Brugada syndrome. METHODS: A retrospective analysis was performed in all pregnant women with Brugada syndrome. We included 104 women with a total of 219 deliveries. RESULTS: There were 15 spontaneous abortions. One infant died suddenly during the night 3 months after birth. Six pregnant women reported they had experienced at least 1 syncope during the pregnancy. Of the 3 women who received an implantable cardioverter-defibrillator before the pregnancy, none received arrhythmia episodes. There were no events during the pregnancy in 4 patients with a previously aborted sudden cardiac death. Of 24 patients with syncope when not pregnant, 18 were asymptomatic and 6 experienced a recurrent syncope during the pregnancy. During the follow-up (mean follow-up 298.9 days; 95% confidence interval, 289.6-308.2), 2 women received appropriate shocks. CONCLUSIONS: In this retrospective, single-center study, serious events were not more frequent during pregnancy and the peripartum period in women with Brugada syndrome. The occurrence of syncope during pregnancy was not associated with a worst outcome in the peri- and postpartum periods or during follow-up. The reported rate of miscarriage and sudden infant death will require further studies to confirm or rule out its association with Brugada syndrome.

Síndrome de muerte súbita del lactante: un tema para la polémica

El Síndrome de muerte súbita del lactante es una situación repentina e inexplicable, que resulta aún más difícil, pues ocurre: en los primeros meses de la vida del niño, altera el orden natural, trunca la proyección que sobre él tenían sus familiares, produce un gran vacío; y se añaden sentimientos de culpa y desvalorización que muchas veces no tienen reparación. La etiopatogenia del mismo es desconocida aún en la actualidad. Después de una actualización del tema los autores exponen el convencimiento de que es oportuno continuar investigando muchos aspectos oscuros del SMSL, dar conclusiones más exactas y a la luz de las mismas, si fuera necesario, modificar las recomendaciones establecidas y practicadas por nuestros profesionales y la población en relación al decúbito del niño en las primeras etapas de la vida. Se utilizaron las bases de datos Google, MEDLINE, EBSCO, HOST, DOYMA y la Literatura Médica cubana de los últimos años, localizada en los órganos de información del Sistema Nacional de Información de Ciencias Médicas (AU)

The sudden infant death syndrome is an unexpected and unexplained situation, which is even more difficult, as it occurs: in the first months of a child's life, it alters the natural order, cuts short the projection that had relatives, it produces a great emptiness, and feelings of guilt and low self-esteem are added which many times cannot be repaired. Its etiopathogenesis is still unknown today. After an update of the topic the authors state the belief that it is appropriate to further investigate many dark aspects of SIDS, give more accurate conclusions and in the light of the same, if necessary, modify the recommendations established and practiced by our professionals and the population in relation to child's decubitus in the early stages of life. Google, MEDLINE, EBSCO HOST and DOYMA databases were used, as well as the Cuban medical literature of the recent years, located in the information services of the National Information System of Medical Sciences (AU)

Síndrome de muerte súbita del lactante: revisión del tema desde una perspectiva médico forense / Syndrome of sudden infant death syndrome: review of the issue from a perspective medical examiner

El síndrome de muerte súbita del lactante es sin duda alguna uno de los trastornos más misteriosos en la historia de la medicina. Aún hoy en día no contamos con una teoría científica convincente que permita explicar de una manera clara estas muertes. Desde una perspectiva médico forense es de suma importancia para el patólogo forense el contar con un conocimiento claro sobre el manejo de este tipo de casos y como diferenciarlo de otras entidades, incluyendo el abuso infantil, porque será él, como perito, el que tendrá en última instancia la responsabilidad de emitir el diagnóstico final. Debido a la importancia de este tema la cual se ha incrementado en años recientes debido a sus implicaciones legales, se considera importante una revisión de los aspectos más relevantes sobre el manejo de esta patología.

Sudden infant death syndrome is undoubtedly one of the most mysterious disorders in the history of medicine. Even today we don`t have a convincing scientific theory to explain these infant deaths. From a forensic point of view, it is very important for the forensic pathologist to have a clear knowledge of how to manage these type of cases and how to differentiate it from other entities, including child abuse, because it will be him, as an expert, who will ultimately have the responsibility of giving the final diagnosis. Given the importance of this topic which has increase in recent years due to it´s legal implications, it is important to make a review of the most relevant aspects of the management of this syndrome.

Síndrome de muerte súbita del lactante: un tema para la polémica / Sudden infant death syndrome: debating a polemic topic

El Síndrome de muerte súbita del lactante es una situación repentina e inexplicable, que resulta aún más difícil, pues ocurre: en los primeros meses de la vida del niño, altera el orden natural, trunca la proyección que sobre él tenían sus familiares, produce un gran vacío; y se añaden sentimientos de culpa y desvalorización que muchas veces no tienen reparación. La etiopatogenia del mismo es desconocida aún en la actualidad. Después de una actualización del tema los autores exponen el convencimiento de que es oportuno continuar investigando muchos aspectos oscuros del SMSL, dar conclusiones más exactas y a la luz de las mismas, si fuera necesario, modificar las recomendaciones establecidas y practicadas por nuestros profesionales y la población en relación al decúbito del niño en las primeras etapas de la vida. Se utilizaron las bases de datos Google, MEDLINE, EBSCO, HOST, DOYMA y la Literatura Médica cubana de los últimos años, localizada en los órganos de información del Sistema Nacional de Información de Ciencias Médicas

The sudden infant death syndrome is an unexpected and unexplained situation, which is even more difficult, as it occurs: in the first months of a child's life, it alters the natural order, cuts short the projection that had relatives, it produces a great emptiness, and feelings of guilt and low self-esteem are added which many times cannot be repaired. Its etiopathogenesis is still unknown today. After an update of the topic the authors state the belief that it is appropriate to further investigate many dark aspects of SIDS, give more accurate conclusions and in the light of the same, if necessary, modify the recommendations established and practiced by our professionals and the population in relation to child's decubitus in the early stages of life. Google, MEDLINE, EBSCO HOST and DOYMA databases were used, as well as the Cuban medical literature of the recent years, located in the information services of the National Information System of Medical Sciences

Canalopatías arritmogénicas como causa de muerte súbita en pediatría / Arrhythmic canal diseases causing sudden death in children

La muerte súbita cardíaca de niños con corazón estructuralmente sano está estrechamente relacionada con las canalopatías arritmogénicas. Se presenta una revisión actualizada sobre las canalopatías y la relación de éstas con la muerte súbita. Se analiza especialmente la aplicación del método clínico y la importancia del trazado electrocardiográfico como herramientas indispensables para el certero diagnóstico de estas entidades.

Cardiac sudden death in children with a heart structurally healthy is closely related to arrhythmic canal diseases. An update review on canal diseases and its relation to the sudden death is presented. The application of clinical method is analyzed, as well as the significance of electrocardiographic recordings like essential tools for an accuracy diagnosis of these entities.

Canalopatías arritmogénicas como causa de muerte súbita en pediatría / Arrhythmic canal diseases causing sudden death in children

La muerte súbita cardíaca de niños con corazón estructuralmente sano está estrechamente relacionada con las canalopatías arritmogénicas. Se presenta una revisión actualizada sobre las canalopatías y la relación de éstas con la muerte súbita. Se analiza especialmente la aplicación del método clínico y la importancia del trazado electrocardiográfico como herramientas indispensables para el certero diagnóstico de estas entidades(AU)

Cardiac sudden death in children with a heart structurally healthy is closely related to arrhythmic canal diseases. An update review on canal diseases and its relation to the sudden death is presented. The application of clinical method is analyzed, as well as the significance of electrocardiographic recordings like essential tools for an accuracy diagnosis of these entities(AU)

Consideraciones específicas para el entendimiento del Síndrome de Muerte Súbita del Lactante / Specific considerations for understanding the Sudden Infant Death Syndrome / Consideracões especificas para o entendimento do sindrome de morte subita do lactante

El síndrome de muerte súbita del lactante (SMSL) es un desorden complejo y multifactorial, sobre el cual no están plenamente entendidas sus causas. Avances recientes en investigación relacionada con genética molecular y patofisiología desarrollada en víctimas de este síndrome, muestran que este, como todas las demás condiciones humanas en salud y enfermedad, representa la confluencia de factores de riesgo ambientales específicos que interactúan con vías metabólicas complejas. La presente revisión analiza las condiciones generales necesarias para comprender este síndrome.

Sudden infant death syndrome (SIDS) is a complex, multifactorial disorder, the cause of which is still not fully understood. Recent advances in research related to molecular genetics and pathophysiology performed in victims of SIDS show that this, like all other human conditions in health and disease represents the confluence of specific environmental risk factors interacting in complex metabolic ways. The present review analyses the general conditions needed to understand this syndrome

A síndrome de morte súbita do lactante (SMSL) é uma desordem complexo e multifatorial, sobre o qual não estão plenamente entendidas suas causas. Avanços recentes em investigação relacionada com genética molecular e patofisiológica desenvolvida em vítimas desta síndrome mostram que este, como todas as demais condições humanas em saúde e enfermidade, representa a influencia de fatores de risco ambientais específicas que interatuam com vias metabólicas complexas. A presente revisão análise as condições gerais necessárias para compreender este síndrome

Maltrato infantil y síndrome de muerte súbita del lactante: estrategias para el diagnóstico diferencial / Child abuse and sudden infant death syndrome: strategies for differential diagnoses

Las causas de muerte inesperada en el lactante son diversas, y en este grupo se pueden incluir las ocasionadas en el síndrome del niño maltratado (SNM). Cuando no se precisa la etiología del deceso después de un análisis exhaustivo de la historia clínica, la autopsia y la escena de la muerte, se puede hablar del síndrome de muerte súbita del lactante (SMSL). El SNM es una realidad creciente a nivel mundial. El maltrato físico, un tipo de SNM, puede ocurrir en formas tan sutiles o graves que causen la muerte del menor. Se ha reportado que de 3.5 a 5% de casos diagnosticados como SMSL correspondieron a SNM. En México sólo se ha mencionado esta asociación, pero no se ha precisado su verdadera frecuencia. La similitud en los antecedentes familiares y sociales, y los hallazgos clínicos iniciales que existen en ambas entidades nosológicas, complican el logro de un diagnóstico correcto. En este ensayo se señalan los avances clínicos y la utilidad de la autopsia para establecer un diagnóstico certero. El seguimiento de un algoritmo preciso para el análisis de estos pacientes, permitirá evitar errores en el diagnóstico y un manejo legal inadecuado de los mismos.

In the last 2 decades there has been an alarming increase in violent behavior which has resulted in severe injuries to children, that is, child abuse (CA). There is a large number of forms of child aggression, physical abuse being one of them (PHA). While it is not the most common, it may be the cause of severe bodily and emotional harm; it may present as a subtle event or as major aggression which could be fatal. The sudden infant death syndrome (SIDS) is an unexpected and sudden occurrence for which no clinical nor autopsy explanation can be given. There are reports on the possible relation between PHA and the CA based on the fact that between 3.5 and 5% of the cases of SIDS are actually instances of CA. The incidence of this problem in Mexico is not known. Given the great similarity of family and social history as well as initial clinical findings in both settings, the accurate diagnosis is very difficult. In order to make an accurate diagnosis between these 2 conditions, we propose in this paper a specific approach to be followed by every professional involved in child care, especially by those who handle cases of violence in this age group.