Doppler sonographic screening of the flow in the basilar artery during head rotation reduces the risk for sudden infant death.
OBJECTIVE
Position-dependent hypoperfusion of the brain stem may be a risk factor of sudden infant death.


METHODS
From 1998 to 2009 we performed Doppler sonographic flow measurements in the basilar artery of 18 194 newborns, 9322 boys and 8872 girls, in five different positions: the neutral position with the head in the midline and during head rotation to the left and right in a supine or prone position. The peak systolic and the time average flow velocity were measured from the flow profile. The flow velocities during head rotation were converted to % of the flow in the neutral position. A decrease in the velocities during head rotation below 50 % was thought to be abnormal. Biphasic flow, flow oscillating around the zero line or retrograde flow during rotation was considered to be pathological. Head rotations, which had caused abnormal and pathological flow, were avoided. The incidence of SIDS in our study group was evaluated and compared with the incidence in a control group of 3 519 newborns.


RESULTS
In 17 929 newborns (98.54 %) the blood flow in the basilar artery was independent of head rotation and body position. In 204 newborns (1.12 %) we found an abnormal decrease under 50 %. Pathological flow alterations could be found in 61 patients (0.33 %). The overall incidence rate of SIDS in the study group was 0.055 ‰ (1:18 194). The incidence rate of SIDS in the control group was 1.14 ‰ (4:3519). The comparison of both groups showed a statistically significant (p < 0.0030) lower incidence rate in the study group.


CONCLUSIONS
Hypoperfusion of the brain stem may be a significant risk factor of SIDS.
Sozialstiftung Bamberg, Klinik für Kinder und Jugendliche, Bamberg, Germany. karl-heinz.deeg@sozialstiftungbamberg.de
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D001488:Basilar Artery / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity / Q000502:physiology; D001933:Brain Stem / Q000098:blood supply*; D003430:Cross-Sectional Studies; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D016684:Prone Position; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013398:Sudden Infant Death / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016683:Supine Position; D018615:Ultrasonography, Doppler, Color; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging*