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The Interface between Sudden Infant Death Syndrome and Chiropractic
Andrew S. Bond, B.A. and Conrad D. Wynne

Abstract

The etiologies of sudden infant death syndrome (SIDS) are rich in diversity and complexity. They suggest intimate union and interplay of development and environment. Presented here is the intimacy between chiropractic theory and SIDS etiology

Introduction

Sudden infant death syndrome(SIDS) is defined as the sudden, unexpected death of an apparently healthy child. Review of the literature on SIDS represents this syndrome as a multifactorial, diverse interplay between environmental and developmental phenomena. The theories on the possible etiology of SIDS range from biochemical abnormalities to spinal birth trauma 13. It is important for the chiropractic physician to recognize and understand those faCtors which predispose an infant to SIDS and which also pertain to the practice of chiropractic. It is equally important for the chiropractic physician and his colleagues to examine the data accumulated on sudden infant death syndrome in light of some major,chiropractic theories. Such,an investigation may not only shed light on the SIDS paradigm but will ,also illuminate the chiropractic paradigm.

Discussion
There, appears to be a failure of the dynamic interplay in the maturational development of the neuromusculoskeletal system of the SIDS infant. Neuronal development of the cervical portion of the spinal cord and the brain stem is strongly suspect of aberrant development andl maturation. 1.7.3 These centers play a vital role in the rhythmic and cyclic patterns of the cardiac as well as the respiratory cycles.
Studies done on infant monkeys have revealed the altered response of cardiac and respiratory rhythmic pattern during the stimulatior of the superior laryngeal nerve. 4 Stimulation oj the superior laryngeal nerve produced dyspneaapnea and bizarre changes in the heart rate and the blood pressure of the monkeys. 4 There is evidence revealing that the composition of the vagus nerve is altered in there being fewer preganglionic myelinated fibers contain therein. 5 ,
The oculocardiac reflex mechanism of newborn infant has demonstrated a marked devia, tion from normal in infants who died as a result of an unplanned death and those who were near miss infants. 5 The elicited oculocardia reflex was noted to produce an expectec bradycardia in all infants. Noteworthy was the significantly prolonged, periods of asystole elicited in infants who were near miss; these responses were considered to be due to hyper-reactive, exaggerated vagal responses. 5 .In addition to these abnormal vagal manifestations were observed to be weak and breathy crying of newborns. 6
Upper, respiratory infrections have been thought to be a primary cause of sudden death. 2. Neurodystrophic mechanisms may be responsible for the appearance of upper respiratory infections seen in many of the victims of sudden unexplained death as a result of com promise of the trophic supply through the vagus nerve. 1.7 .
Prospective stud es done by Naeye, Ladis and Drage (1976) have demonstrated that there is a disturbance of the entire central nervous system. This has been illustrated by alterations in the muscle tone and reflexes of the
newborn. 8 Therefore, abnormally low Apgar scores and aberrant reflexes may aid the physician in predicting infants which are at high risk for sudden death. 8.9 Anderson-Huntington and Rosenblith noted abnormal muscle tonus, cry, skin color, and visual assessments which they believe to be caused by central nervous system damage or anoxia or both. 10
In light of the axoplasmic aberration hypothesis, it is reasonable that with a neuronal developmental and maturational lag there is a resultant and concomitant maturational lag in the musculoskeletal structures which re supplied by these neuronal centers. 7 Therefore, it is also reasonable to surmise that this resultant maturationallag of the cervical musculoskeletal structures predisposes the infant to structural derangements of the cervical spine, which in turn gives way to functional distortions of the cervical cord and the brain stem.
This presents a cyclical pattern of central nervous system maturational lag weakening the very structures which are provided for the protection of the central nervous system. This unmature and weakened state of the musculoskeletal structures of the cervical spine is illprepared to serve maximally in a protective capacity .for the central nervous system which is mainly the brain stem that it encases. The end result is a cervical spine which is disposed to a greater degree to .lethal birth trauma as well as other lethal cervicopathies to which the fully matured neonate has a greater resistance.
It is reasonable to surmise that integral loss of the normal mechanical stabilization and dynamic reflex mechaJrlsms as described above will also predispose the infant to an hypoxic/ anoxic state. Destabilization of the cervicocranial junction complex will dispose the infant to vertebrobasilar insufficiencies which can be lethal or at least crippling. 11
In a recent study by Rognum, Saugstad, Oyasaeter and Olaisen, measurements of the hypoxanthine levels in the vitreous humor of SIDS victims were elevated which suggest that SIDS may not be a "sudden" process but' rather a process of long duration. 12 Perhaps there is vertebrobasilar insuUiciency suffered by SIDS victims which is insidious and begun in utero. This might then be responsible for a low grade hypoxic event creating the maturational lag of the reticular neurons of the brain stem. This is evident by the retention of the dendritic spines on the reticular cells of the brain stem. 1.2.3.13
No discussion of SIDS and chiropractic would be complete without dealing directly with the subject of birth trauma and lethal subluxation. It has been suggested that birth trauma to the upper cervical region can be directly responsible for the demise of many SIDS victims. 1.14-19
Naeye's prospective study reported no remarkable or significantly different birthing occurrences between controls and victims. This suggests that under similar circumstances a routine delivery, benign and uneventful for one infant, could be potentially lethal for a weakened, susceptible infant who falls into the SIDS population.
Therefore, it may be said that there exists in the SIDS infant a propensity of congenital predisposition to injury at birth which is significantly greater than that experienced by the control infants. AS this weakness gives way to mechanical derangement then this derangement exacerbates the underlying cause, accelerating and magnifying the process.

Conclusion

It would certainly be within the scope of the chiropractic profession to devise a protocol for the screening of SIDS candidates, to monitor their neuromusculoskeletal development and maintain the proper integrity of the cervical spine. Chiropractic may be able to reestablish the integrity of the cervical spine. By doing so, vertebrobasilar perfusion wiUimprove, neuronal tension and compromise can be alleviated and maturational lag in the central nervous system can be equilibrated.

It is prudent for all possiule etiologies of SIDS to be entertained and pursued in basic and applied research circles. It is, therefore, equally important for SIDS to be investigated in the light of the chiropractic paradigm. Those theories which apply to both the chiropractic paradigm and the etiology of SIDS are those which propose an axoplasmic aberration-reflexogenic mechanism. .

Acknowledgment
The authors wish to express their appreciation to Student Doctor Michele Bond and Dr. C.Ray Ratliff for their help in the preparation of this manuscript.

References
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80 Jounvzl o(ChiroprGt:tic Resurch I Spring 1989

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»(Andrew Bond and Conrad Wynne are students at.
Ocvcland Chiropractic College. Requests for reprints may be directed to Mr. Bond at Oeveland Chiropractic College, 6401 Rockhill Road, Kansas Oty, MO 64131.)

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