View source for Sudden Infant Death Syndrome

'''{{FULLPAGENAME}}''' (SIDS), also known as '''cot death''' or '''crib death''', is the sudden unexplained [[death]] of a child of less than one year of age.<ref name="nih2017">{{REFweb
 |url=https://www.nichd.nih.gov/health/topics/sids
 |archived=
 |title=Sudden Infant Death Syndrome (SIDS)
 |trans-title=
 |language=English
 |last=
 |first=
 |author-link=
 |publisher=National Institutes of Health
 |website=www.nichd.nih.gov/
 |date=2017-01-31
 |accessdate=2020-07-06
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}}</ref> 

SIDS remains the leading cause of infant death in many developed countries. There are around 2,700 babies who die from cot death every year in the US – and around 300 in the UK.<ref name="MedicalXpress 2019">{{REFweb
 |url=https://medicalxpress.com/news/2019-01-neonatal-circumcision-sudden-infant-death.html
 |title=Neonatal circumcision could increase the risk of sudden infant death syndrome in babies – new research
 |first=Eran
 |last=Elhaik
 |publisher=MedicalXpress
 |date=2019-01-11
 |accessdate=2020-07-02
}}</ref>

Cot death occurs when a seemingly healthy infant – under 12 months of age – dies in their sleep with no cause of death established in a post-mortem investigation. Although many risk factors are known to increase the risk of cot death – such as maternal smoking and bed sharing – nobody is exactly sure why it happens.<ref name="MedicalXpress 2019"/>

The incidence of SIDS is higher in male infants as compared with female infants,<ref name="nih2017" /> with a ratio of 60 male deaths to 40 female deaths.<ref name="elhaick2016">{{REFjournal
 |last=Elhaik
 |first=Eran
 |author-link=
 |etal=no
 |title=A "wear and tear" hypothesis to explain Sudden Infant Death Syndrome
 |trans-title=
 |languageEnglish=
 |journal=Frontiers in Neurology
 |location=
 |date=2016-10
 |volume=7
 |issue=
 |pages=
 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083856/
 |archived=
 |quote=
 |pubmedID=27840622
 |pubmedCID=5083856 
 |DOI=10.3389/fneur.2016.00180. 
 |accessdate=2020-07-07
}}</ref>

The [[American Academy of Pediatrics]] now recommends that infants be put to sleep on their back instead of on their side or stomach.<ref name="feldman-winter2016">{{REFjournal
 |last= Feldman-Winter
 |first=Lori
 |author-link=
 |last2=Goldsmith,
 |first2=Jay P.
 |author2-link=
 |etal=no
 |title=Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns
 |trans-title=
 |language=English
 |journal=Pediatrics
 |location=
 |date=2016-10
 |volume=138
 |issue=3
 |pages=e2016-1889
 |url=https://pediatrics.aappublications.org/content/138/3/e20161889
 |archived=
 |quote=
 |pubmedID=27550975
 |pubmedCID=
 |DOI=https://doi.org/10.1542/peds.2016-1889 
 |accessdate=2020-07-09
}}</ref> While this has reduced the incidence of SIDS somewhat, it certainly has not eliminated it.

==The allostasis hypothesis==

''Allostasis'' is defined as "the process of achieving equilibrium through fluctuating neuroendocrine responses to physical and psychological stressors."<ref>{{REFweb
 |url=https://medical-dictionary.thefreedictionary.com/allostasis
 |archived=
 |title=Allostatis
 |trans-title=
 |language=English
 |last=Farlex Medical Dictionary
 |first=
 |author-link=
 |publisher=Farlex
 |website=
 |date=2012
 |accessdate=2020-07-08
 |format=
 |quote=
}}</ref> Professor Eran Elhaik (2016) has postulated a hypothesis, based on allopathic (stress) load that may explain the cause of SIDS. According to Elhaik:<blockquote>
We postulate that while low-level stress can stimulate adaptation, prolonged and repetitive iatrogenic stressful, painful, or traumatic experiences during prenatal, perinatal, neonatal, and postneonatal development constitute allostatic overload and are risk factors for SIDS. Due to their total dependence, the infant’s ability to allostatically regulate exposure to stressors is severely constrained, which increases their vulnerability to disease and premature death. Due to their difficulties in maintaining homeostasis and inability to escape/avoid iatrogenic or non-medically nociceptive exposure, infants are vulnerable to toxic stress with preterm infants being the most vulnerable.<ref name="elhaick2016" /></blockquote>
Elhaik lists infant stressors such as:
* maternal smoking
* maternal caffeine consumption
* preterm births
* non-urgent pediatric surgeries
* neonatal circumcision

Elhaik lists stressors from non-therapeutic neonatal circumcision as:
* intense pain
* bleeding
* shock
* sepsis
* circulatory shock
* hemorrhage 
that can result in death. He points out that post-operative circumcision pain can last for 10-14 days.<ref name="elhaick2016" />

Elhaik lists skin breaking procedures such as heel sticks and seasonal respiratory viral infection as additional stressors.<ref name="elhaick2016" />

Elhaick observes that the SIDS rate in the UK where the NHS does not perform non-therapeutic circumcision is 0.38 per 1000 as compared with the US rate of 0.55 per 1000 where most male infants are circumcised.<ref name="elhaick2016" />

==Evidence of association with circumcision== 

Elhaik (2019) published data from  15 countries and 40 U.S. states to provide evidence of an association between non-therapeutic neonatal [[circumcision]] and SIDS.<ref name="elhaik2019">{{REFjournal
 |last=Elhaik
 |first=Eran
 |author-link=
 |etal=no
 |title=Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS)
 |trans-title=
 |language=English
 |journal=J Clin Transl Res.
 |location=
 |date=2019-01-10
 |volume=4
 |issue=2
 |pages=136-51
 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412606/
 |archived=
 |quote=
 |pubmedID=30873502 
 |pubmedCID=6412606
 |DOI=
 |accessdate=2020-07-09
}}</ref>

Elhaik found Anglophone countries practice  significantly more non-therapeutic neonatal circumcision than non-Anglophone countries and have a significantly higher SIDS rate than non-Anglophone countries.<ref name="elhaik2019" />

Elhaik found great variation in the SIDS mortality rate. Of the 15 countries studied, The Netherlands, where the Dutch do not practice infant circumcision, was the lowest at 0.06 per 1000 births, while the United States where non-therapeutic infant circumcision is commonplace had the highest at 0.82 per 1000 births.<ref name="elhaik2019" />

Hispanic people do not favor circumcision, so relatively few Hispanic boys are circumcised. Elhaik reported a lower incidence of unexplained neonatal death in states with a high Hispanic population.  

Elhaik reported that the incidence of SIDS in states where [[Financial_Incentive#Medicaid_pays_for_it| Medicaid pays for non-therapeutic circumcision]] is higher than that of states where Medicaid does not pay for non-therapeutic circumcision.<ref name="elhaik2019" />

Elhaik pointed out why infant circumcision has such an effect:
<blockquote>
Our finding that MNC is associated with SIDS is not surprising. Circumcision is associated with intra-operative and postoperative risks, including bleeding, shock, sepsis, circulatory shock, hemorrhage, pain, and long-term consequences – all of which contribute toward allostatic load and, thereby, SIDS through various mechanisms. For instance, during circumcision there is an increase in the blood pressure, breathing rate, and heart rate. Even with the most advanced techniques, bleeding occurs in over 15% of the cases, in which case there is a danger that a lower blood volume would result in low blood pressure and reduced amount of oxygen that reaches the tissues. Reduced blood pressure has been associated with obstructive sleep apnea (OSA), a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. Unsurprisingly, SIDS victims experienced significantly more frequent episodes of OSA. Preterm neonates experience over twice the rate of bleeding complications than full-term neonates. MNC-related complications are unavoidable. For instance, in 1949, Gairdner reported that 16 out of 100,000 UK boys under 1-year old died due to circumcision. In tandem with the lack of evidence of a meaningful and relevant health benefits to the infant, several countries chose to opt out of the operation.<ref name="elhaik2019" />

</blockquote>

{{SEEALSO}}
* [[Circumcision_risks#Post-operative_risks_.28A-Z.29|Circumcision risks: Post-operative risks A-Z]]

{{LINKS}}

* {{REFweb
 |url=https://theconversation.com/neonatal-circumcision-could-increase-the-risk-of-sudden-infant-death-syndrome-in-babies-new-research-109311
 |archived=
 |title=Neonatal circumcision could increase the risk of sudden infant death syndrome in babies – new research
 |trans-title=
 |language=English
 |last=Ehaik
 |first=Eran
 |author-link=
 |publisher=The Conversation
 |website=theconversation.com
 |date=2019-01-11
 |accessdate=2020-07-08
 |format=
 |quote=
}}

* {{REFweb
 |url=https://www.doctorsopposingcircumcision.org/circumcision-linked-to-sids
 |title=Circumcision linked to SIDS
 |publisher=Doctors Opposing Circumcision
 |date=2019-01-11
 |accessdate=2020-07-04
}}

{{REF}}

[[Category:Circumcision risks]]