title: Sudden Infant Death Syndrome - Role of Trigeminocardiac Reflex: A Review.
abstract: Sudden infant death syndrome (SIDS) is an unexplained death in infants, which usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR), a peripheral subtype of trigeminocardiac reflex (TCR), is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex that manifests as bradycardia, hypotension, apnea, and gastric hypermotility. The TCR shares many similarities with the DR, which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath holding (apnea), bradycardia, and vasoconstriction, leading to increase in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation, or decreased neuronal density of arcuate nucleus, hypoplasia, and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field.
authors.affiliation: Department of Neuro-Anesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Gyaninder Pal
authors.initials: GP
authors.lastname: Singh
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Manitoba , Winnipeg, MB , Canada.
authors.forename: Tumul
authors.initials: T
authors.lastname: Chowdhury
authors.affiliation: Department of Neuro-Anesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Barkha
authors.initials: B
authors.lastname: Bindu
authors.affiliation: Department of Research, University of Southampton , Southampton , UK.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schaller
keywords: asystole; bradycardia; diving reflex; oxygen-conserving reflex; prenatal nicotine exposure; smoking; sudden infant death syndrome; trigeminocardiac reflex