‘Cot death’ key found, says U.S. doctor

Press, 17 April 1978, Page 2

‘Cot death’ key found, says U.S. doctor

NZPA Boston A pediatric surgeon believes he has found a key to “cot death,” a mysterious killer that claims the lives of 10.000 apparently healthy babies each year in the United States.

Dr Lucian Leape says susceptible infants may choke to death when overflowing stomach juices touch off a reflexive closing of the vocal chords.

He has devised a surgical way to stop the stomach overflow. He has not been able to explain vocal cord “sensitivity,” which he says helps close off the cords in some infants.

He says “We are a long way off” from the next step — identifying patients before they have the spells. Dr Leape, of tne Tufts New England Medical Centre, says one factor in sudden infant death syndrome is a relatively common condition known as “oesophageal reflux,” a failure of the valve that normally closes off the stomach juices. Sensitive babies have had non-fatal daytime spells in which mouth-to-mouth resuscitation has prevented the cot death, and “if you stop the reflux, it has been 100 per cent effective in stopping the spells,” Dr Leape says.

I “From that standpoint, it !is an operation that works,” says Dr Leape. He says he or his colleagues have performed 50 operations in which the stomach is stitched about the lower oesophagus to form a valve, ,

“What sensitises the larym; we don’t know . . . maybe previous episodes of reflux have caused irritation of the vocal cord. Maybe the child has some congenital abnormality.” The reflux spells can be avoided by feeding affected babies smaller amounts of heavy food more frequently and have them sleep in an inclined position, Dr Leape says. He prefers the surgical answer.

Dr Leape says the nonfatal spells provide a good way for doctors to study cot deaths.

“There is a very essential thing about cot deaths, and that is that they are unobserved. The child is found dead in bed.

"That is very interesting because the near misses are the ones seen in the process of dying and they are resuscitated . . . these near misses are probably no different from the cot deaths except that someone saw them and caught them at it,” Dr Leape said.