- SIDS =
- sudden infant death syndrome
I have been an avid reader and admirer of the New England Journal of Medicine since I was a medical student many years ago. As an editor, I confess I envy the journal its large circulation and the many fine articles it publishes. Recently, however, the journal published an article by Schwartz et al entitled “Prolongation of the QT Interval and the Sudden Infant Death Syndrome,” (N Engl J Med.1998;338:1709–1714), and an editorial by Friedman and Towbin complimenting the study. The commentary cited the study as offering “compelling evidence” of a link between the sudden infant death syndrome (SIDS) and prolonged QT interval, and suggested that “the development of a more useful tool that can be used in the physician's office to measure QT would be welcome.” Did they read the same article that I read? Even more alarming was the suggestion implying “some patients should receive β-blockers.” I was dismayed. The SIDS field of research is still bogged down by apnea monitors, which have proven of little value. Hundreds of millions of dollars have been wasted over the last 25 years. Worse still, the device continues to be used! The apnea monitoring business has become a religion. More people are living off of SIDS than dying from it.
I was worried that a similar, well-intentioned, stampede would occur or that somebody would suggest a large controlled trial be done to confirm the study of Schwartz et al. I don't believe this hypothesis is worth a multimillion-dollar study. The single major advance in this field in the last 20 years has been the introduction of the Back to Sleep Program. The incidence of SIDS in the United States has decreased to below one case per thousand live births (1997). As compliance with the program improves, this decrease could continue. Highly specialized pathologists are finding defects in the brain and conduction system of the heart in so-called SIDS cases. Rare metabolic diseases and infanticide are also being detected more often. SIDS is a diagnosis of exclusion, so the more we know, the less likely SIDS will remain useful as a diagnosis.
At first glance, the study is impressive, 34 442 infants over an 18-year period with a 1-year follow-up on 33 034 infants! Close examination of the data, however, reveals many serious, if not fatal, flaws. A long, detailed letter to the editor, raising questions is the traditional response. I decided that the article warranted a more forceful critique, lest it ignite yet another misadventure in this frustrating field.
I wanted to see what would happen if I asked some of our expert reviewers in the SIDS field for their opinion of the article. I recommend that you read the views of these experts, which appear in this section of special commentaries. They raise important points of concern.
Developing a new gadget for use in the office or experimenting with an unproven drug therapy is not the way to go.
- Received November 20, 1998.
- Accepted November 20, 1998.
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- Copyright © 1999 American Academy of Pediatrics