Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. 909-910 (doi:10.1542/peds.2008-2420)

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LETTER TO THE EDITOR

Head Covering, Sweating, and the Risk of Sudden Infant Death Syndrome: In Reply

Edwin A. Mitchell, FRACP, DSc
Department of Paediatrics
University of Auckland
Private Bag 92019, Auckland, New Zealand

Mechtild M. Vennemann, MD, MPH
University of Münster
Institute of Legal Medicine
38129 Münster, Germany

Thomas Bajanowski, MD, PhD
University of Duisburg-Essen
Institute of Legal Medicine
45122 Essen, Germany

We acknowledge that children with congenital central hypoventilation syndrome (CCHS) may be found sweating in their sleep. The main manifestation of CCHS is alveolar hypoventilation. Although CCHS was originally considered a disorder of ventilatory control, there is considerable evidence that CCHS is a generalized abnormality of the autonomic system¹ and that sweating is but 1 manifestation of this. The majority of cases of CCHS result from PHOX2B polyalanine repeat expansion mutations,² which has not been described in cases of sudden infant death syndrome.³

In both the German and New Zealand studies, being found very sweaty was associated with head covering. There are numerous causes of sweating, including thermal stress, hypoglycemia, heart failure, and hypercapnea from rebreathing of expired gases. Within the New Zealand Cot Death Study we have examined the factors associated with being found very sweaty (unpublished data). Factors implicated with the rebreathing hypothesis,⁴ such as prone sleeping and sleeping on a sheepskin, were not associated with being found very sweaty, whereas duvet use, which is known to be associated with excess thermal insulation, was associated with being found very sweaty. This supports our contention that head covering is associated with a thermal mechanism.

REFERENCES

1. Gozal D. Congenital central hypoventilation syndrome: should we rename it congenital autonomopathy? In: Pharmacology and Pathophysiology of the Control of Breathing (Lung Biology in Health and Disease). Ward D, Dahan A, Teppema L, eds. New York, NY: Marcel Dekker; 2005:295–312
2. Berry-Kravis EM, Zhou L, Rand CM, Weese-Mayer DE. Congenital central hypoventilation syndrome: PHOX2B mutations and phenotype. Am J Resp Crit Care Med. 2006;174 (10):1139 –1144[Abstract/Free Full Text]
3. Kijima K, Sasaki A, Niki T, et al. Sudden infant death syndrome is not associated with the mutation of PHOX2B gene, a major causative gene of congenital central hypoventilation syndrome. Tohoku J Exp Med. 2004;203 (1):65 –68[CrossRef][Web of Science][Medline]
4. Kemp JS, Kowalski RM, Burch PM, Graham MA, Thach BT. Unintentional suffocation by rebreathing: a death scene and physiologic investigation of a possible cause of sudden infant death. J Pediatr. 1993;122 (6):874 –880[Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Mitchell, E. A. Articles by Bajanowski, T. Search for Related Content PubMed Articles by Mitchell, E. A. Articles by Bajanowski, T. Related Collections Premature & Newborn Social Bookmarking                         What's this?