Sudden Unexpected Death of Two Infants in Baby Carriers

Sudden unexpected death in infancy (SUDI), previously termed sudden infant death syndrome (SIDS), is the second leading cause of death in infants beyond the neonatal period in Germany, and a major cause of infant mortality in economically well developed countries (OECD Health Statistics, 2019). The risk of SUDI peaks at the age of 2–4 months and then decreases continuously till the end of the first year. A complex multifactorial cause, rather than a single characteristic factor, may cause SUDI within a critical period of infant development (Guntheroth WG et al., Pediatrics 2002; 110: e64–e64). Risk factors include prematurity, male gender, bottle-feeding, prone sleeping position, overheating, as well as exposure to smoke amongst others (Carpenter RG et al., Lancet 2004; 363: 185–191). Thus, health professionals consistently advise and educate parents about avoidable risk factors of SUDI at routine well-baby examinations. Since the advent of SUDI prevention strategies in the 1980s, the incidence has decreased 10fold, from 1,55/1.000 live births in 1991 to 0,15/1000 in 2015. This number seems to have reached a steady state (Statistisches Bundesamt Germany, 2015).

Update on the Genetic Basis of Sudden Unexpected Death in Epilepsy

Epilepsy is a common neurological disorder associated with increased morbidity and mortality. Sudden unexpected death in epilepsy, also known as SUDEP, is the main cause of death in patients with epilepsy. SUDEP has an incidence of 1.2 per 1000 person-years in adults and 0.2 per 1000 person-years in children. SUDEP accounts for 8–17% of deaths in patients with epilepsy. It is commonly associated with a history of generalized tonic-clonic seizures, and its risk may be increased by other factors such as postictal electroencephalographic suppression, prone sleeping position, altered heart rate variability, conduction abnormalities, gender, or antiepileptic medications. Recently, electrocardiograms, electroencephalograms, and imaging markers have helped clinicians stratify SUDEP risk and identify patients in need of close monitoring. However, the pathophysiology of SUDEP is likely multifactorial and still unknown. Improving the knowledge of SUDEP incidence, risk factors, and biomarkers can help design and implement effective prevention strategies.

Rightward and Leftward Head Rotation Influence the Geometric Features of the Healthy Carotid Bifurcation

Posture changes may influence the geometry and hemodynamics of the carotid bifurcation [1]. As a result, head rotation may cause geometric changes that alter the hemodynamic variables previously cited to correlate with the development of atherosclerosis. Such variables include oscillating wall shear stress (WSS) and particle residence times. Glor et al. [1] had reported changes in the right carotid bifurcation geometry with leftward rotation of the head. We have previously reported that geometric differences in the right and left carotid bifurcation occur with a rightward rotation of the head [2]. To investigate the geometric changes in the carotid geometry that occur in the prone sleeping position with rightward and leftward head rotation, we have performed studies in two healthy young volunteers. We defined specific geometric parameters of the carotid bifurcation, such as bifurcation angle, internal carotid artery (ICA) angle, ICA planarity angle, in-plane asymmetry angle, tortuosity, curvature, area and diameter ratios, and compared their corresponding values in three head postures: 1) the supine neutral position, 2) the prone sleeping position with head rotation to the right (∼80 degrees), and 3) the prone sleeping position with head rotation to the left (∼80 degrees).