Cot death in the 20th century - facts and fallacies

With the decline of the former main causes of death in early childhood - in fections and starvation - sudden infant death syndrome (SIDS) has emerged a s the most important single cause of postneonatal infant mortality. It has adopted the role of a major indicator for the standard of public health car e. Despite extensive input into research, its pathophysiology has remained rather obscure. The resulting helplessness of scientists and health care pr ofessionals have lead to adherence to unconfirmed pathophysiological hypoth eses and to pursuit of preventive strategies of doubtful efficacy. In this overview, the medical and technical background of five major hypoth eses is being presented. A lot can be learnt from the history of their deve lopment, efforts to refute them, and the reasons for unreflected adherence to them. (1) Due to its illustrative nature, the so-called 'status thymico- lymphaticus', the theory of asphyxation by an enlarged thymus, could not be eradicated although well-reknowned physicians - including the Austrian pat hologist Paltauf - have repeatedly attempted to do so. (2) Assumed familiar ity, an aspect which attracted the attention of pediatricians to SIDS initi ally, has been excluded, but an increased risk of SIDS for the siblings of affected babies is still common belief. (3) The sleep-apnea-hypothesis has turned out a complete error with serious consequences, but home apnea monit ors are still being widely recommended. (4) The rise of SIDS in the 80ies a nd its subsequent decline in the 90ies has been interpreted as the advent a nd successful control of an epidemic although significant numbers of cot de ath have been reported long before the turn of the century, and the apparen t increase which paralleled the introduction of the 9th edition of the ICD code is most likely due to improved registration. (5) Finally, SIDS is stil l being considered a random event - ignoring all evidence of an obvious rol e of socioeconomical factors.