In reply to Mage and Donner, there are indeed limitations to the operational 1-year cutoff for sudden infant death syndrome (SIDS) and, in fact, our group has brought forth research challenging age conventions. However, the general Pediatrics readership understands definitions as they are conventionally used, and we did not believe our analysis was compromised by using terms as they are generally understood. Regarding the diagnoses included in the analytic composites, there is room for debate about what might be best included. We do not agree with the point about intrapartum asphyxia codes, however. We understood intrapartum asphyxia codes as being applied with the intent of capturing a specific mechanism of death observed during delivery, which would make the cause of mortality explained and thus outside of the analytic composite. As for the “fiction” of the developmental period, our interest was to faithfully present the theory as proposed by Filiano and Kinney.2 Finally, we recognize that sudden unexpected death can occur without an extrinsic stressor, an observation made by the estimable Dr Farber but by others as well.3 Our group, Robert’s Program on Sudden Unexpected Death in Pediatrics, is dedicated to approaching SIDS as an undiagnosed disease, and we believe that many unexplained deaths remain so because they are not fully explored. We believe our perspective is also shared by many coroners and medical examiners responsible for making the diagnosis.
In reply to Goldwater and Bettelheim, we do not disagree that infectious and/or immunologic etiologies are an important part of the puzzle of SIDS. Furthermore, we strongly agree that linking risk factors with potential causes of a given condition deserves serious consideration. Our group devotes considerable energy toward reconciling the pathologic and laboratory findings with the outcome of SIDS. Insofar as our list of potentially contributing causes was incomplete, it was due to the fact that it was not the focus of our research. As such, only a few such causes were mentioned as plausible examples when bringing forth our conclusion of biological underpinnings reflected in epidemiologic trends. Goldwater and Bettelheim make a fair point, although the same could be said about the use of routine paralysis of ventilated newborns, for example. We thank them for making this aspect of our article clearer.
Conflict of Interest: None declared
- Copyright © 2016 by the American Academy of Pediatrics