Paroxysmal Vagal Overactivity, Apparent Life-Threatening Event and Sudden Infant Death

Abstract

The possibility of reversible cardiac asystoly due to paroxysmal vagal overactivity (VO) has been well studied, first in adults, then in children, and finally in breath-holding spells. Few studies deal with infants and the incidence of VO among preterm, apparent life-threatening event (ALTE) and sudden infant death syndrome (SIDS). In this review, we summarize data acquired during the past 20 years leading to the diagnosis of VO in infants. We describe the clinical aspects of VO in infants and young children such as Holter-ECG and oculocardiac reflex criteria. The familial aspect of VO and its possible link with SIDS (a new risk factor?) are discussed. Finally, whether or not to treat infants with symptomatic VO is discussed.

Mapping of sudden infant death with dysgenesis of the testes syndrome (SIDDT) by a SNP genome scan and identification of TSPYL loss of function

“…More important, studies of TSPYL expression and function in the developing brain may provide new insight into the genetic basis of apnea, dysphagia, cardiac arrests, and sudden unexplained deaths in infancy. Present clinical evidence suggests that in SIDDT, sudden death may result from dysregulation of the autonomic brainstem systems that control cardiac and pulmonary protective reflexes (14)(15)(16). The lethal event may be profound vagally mediated laryngobronchospasm or asystole.…”

Brainstem dysfunction: a possible neuroembryological pathogenesis of isolated Pierre Robin sequence

“…The oculocardiac reflex test consisted in progressive compression of the eyeball up to pain threshold during 10 s, during which the sinus pause was recorded. Holter-ECG recording was always performed during the 2nd month of life, after respiratory conditions were under control, and was interpreted according to the criteria of Lucet et al [25]. Children were followed-up for at least 2 years in order to evaluate their functional improvement, growth, and developmental outcome.…”

Hypotonic-hyporesponsive episodes after administration of hexavalent DTP-based combination vaccine: A description of 12 cases

“…15 There is no evidence that HHE is the unequivocal result of autonomic nervous dysfunction, but in some infants inflammation could elicit an increase in autonomous nervous system reactivity, which may produce the symptoms observed. It is known that some infants can have a paroxysmal vagal over activity 16 ; furthermore, the Brighton Collaboration HHE Working Group, despite referring that the pathogenesis of HHE remains unknown, states that "A vasovagal-syncope is clinically defined by the same triad of diagnostic signs but usually occurs in an older age group:" a vasovagal-syncope is a typical manifestation of autonomic system hyper reactivity, so it seems that, simply basing on the clinical features, an association between the 2 systems may be supposed.…”