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Sudden Infant Death Syndrome

The etiology of Sudden Infant Death Syndrome (SIDS)

Sudden infant death syndrome (SIDS) or cot death is the leading cause of death among US infants under 1 year of age accounting for ~2,700 deaths per year. In Sweden the SIDS rate is relatively low (0.14 deaths per 1,000 live births or 16 infant deaths/year). Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained. Attempts to identify specific susceptibility genes met with limited success. That is, only few gene candidates were found so far, and those that were found explained less than 10% of the genetic variation.

A scientific graph.
Trends in unexplained male mortality in all US states between 1979 and 2019. From Elhaik (2018)

Data were obtained for SIDS all other ill-defined death codes, which represent 99% of unexplained death classification according to ICD 9 (left) and 10 (right). The grey bar represent data used by either ICD classificaton. Orange bar represent years in which the AAP recommened the supine poistion. In 1992 the AAP discouraged putting infants to sleep prone. In 2005, the supine position was recommended exclusively, a recommendation which was confrimed 2011. Areas show the percent of death classificaiton codes to SIDS (798 or R95) or other ill-defined and unspecified causes of mortality (799.9 or R99). Lines show the rates of all unexplained mortalities according to each code and the total.

Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We are interested to map adversarial childhood events and identify genes that increase the infant’s sensitivity to traumatic exposures and thereby their risk of SIDS. Finally, we are interested in developing technological interventions that can provide the parents real-time monitoring of their child and an early warning in the case of SIDS.


1.    Elhaik E: A “wear and tear” hypothesis to explain Sudden Infant Death Syndrome (SIDS). Front Neurol 2016, 7(180).
2.    Elhaik E: Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS). Journal of Clinical Translational Research 2018, 4(5).

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