Biomarker of infant ‘crib death’ discovered

(ORDO NEWS) — Thanks to the discovery of Australian scientists, doctors will be able to develop a screening test to identify babies at risk of “crib death” and prevent tragedies.

Australian scientists at Westmead Children’s Hospital and the University of Sydney have identified a biomarker for sudden infant death syndrome (SIDS), which accounts for almost 50 percent of unexpected deaths worldwide each year.

SIDS, also known as “crib death,” is the sudden and in most cases unexplained death from respiratory arrest during sleep in an apparently healthy child.

Despite the diligence of specialists in recent decades, the mechanisms leading to SIDS remain unclear, and the cause cannot be established even after careful post-mortem examination, examination of the place of death and examination of the infant’s medical history.

It is believed that this syndrome is not a consequence of any one factor, but depends on their many. Scientists have proposed several models to partially explain the nature of SIDS, and the “triple risk model” has become the most popular.

According to her, sudden death occurs if three conditions are met: a vulnerable infant, a critical age period of development, and an exogenous stressor (environmental factors). There was also an opinion that newborns should be placed on their backs in the crib and not allowed to overheat there.

However, the authors of the new study suggested that infants who had SIDS had altered levels of butyrylcholinesterase (BChE) activity, an enzyme known as pseudocholinesterase, from the group of esterases , even at birth.

Butyrylcholinesterase, along with acetylcholinesterase (AChE), hydrolyzes acetylcholine (ACh) in cholinergic synapses , the main neutrotransmitter (biologically active chemicals that transmit an electrochemical impulse from a nerve cell through the synaptic space between neurons) of the autonomic and parasympathetic nervous systems.

AChE and BChE – cholinesterases – are present in almost all tissues of the body, but their activity differs. Different levels of these enzymes have previously been observed in parasympathetic dysfunction and inflammatory diseases.

Therefore, it has been suggested that cholinesterase levels may act as biomarkers of cholinergic deficiency and parasympathetic dysfunction, as well as inflammation-related diseases.

Using the dry spot method of blood taken on the second to fourth day after birth using a heel prick (Guthrie test), scientists assessed butyrylcholinesterase activity in 67 infants who suffered from sudden infant death syndrome and died before the age of 24 months, and healthy children.

Deaths were recorded from July 2018 to July 2020 in the Australian state of New South Wales. It was not possible to measure acetylcholinesterase due to its denaturation during the drying of the samples.

As a result, it turned out that initially the activity of BChE was significantly lower in infants who died from SIDS, compared with control groups. Since this enzyme plays an important role in the brain’s arousal pathway, it becomes clear why sudden death syndrome usually kicks in during sleep.

“This is the first study to identify a biochemical marker in infants with SIDS prior to their death that helps distinguish them from controls and those who died of other causes.

From the point of view of SIDS and the triple risk model, this decrease in butyrylcholinesterase activity, in our opinion, means that the innate vulnerability of an infant with SIDS is an autonomic cholinergic dysfunction,” the researchers explained.

The discovery provides an opportunity, using a screening test, to identify infants at risk of “crib death” in advance and develop intervention strategies before the child dies.

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