PEDIATRICS Vol. 87 No. 3 March 1991, pp. 306-310
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Hypoxanthine Levels in Vitreous Humor: Evidence of Hypoxia in Most Infants Who Died of Sudden Infant Death Syndrome

Torleiv O. Rognum MD1 and Ola D. Saugstad MD1

1 From the Institute of Forensic Medicine, Departments of Pediatrics and Pediatric Research, and the Institute for Surgical Research, National Hospital, Oslo, Norway

Postmortem changes of the hypoxanthine in vitreous humor in humans were investigated. Hypoxanthine is formed from hypoxic degradation of adenosine monophosphate. Repeated sampling was performed in 13 deceased adults. Keeping the bodies at +6°C, the increase of the hypoxanthine levels was estimated to 3.5 µmol/L per hour when sampling was started more than 12 hours after death (range 2.8 to 5.6 µmol/L per hour). Results of hypoxanthine measurements from vitreous humor in 73 infants with sudden infant death syndrome, 17 infants and children who died sudden violent deaths, and 6 neonates who died suddenly without hypoxemia prior to death were corrected according to the expected postmortem hypoxanthine increase. The time between death and autopsy was similar in the three groups studied. The corrected median hypoxanthine level in the group with sudden infant death syndrome was 227 µmol/L, which is significantly higher than in the other groups; 22 µmol/L in the group who had violent deaths (P < .01), and 0 µmol/L in the neonate group (P < .01). The findings seem to confirm that sudden infant death is preceded by a relatively long period of tissue hypoxia in most cases.

Key Words: hypoxanthine • tissue hypoxia • vitreous humor • sudden infant death syndrome

Submitted on January 11, 1990
Accepted on March 20, 1990




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