Despite the recent emphasis, we still consider prolonged QT interval to be a rare cause of SIDS. For this reason, SIDS experts are not recommending routine electrocardiogram screening of infants. Even if a prolonged QT interval were found on routine screening, the risk of SIDS is probably very low, and it is not clear that any medication would be of more benefit than potential harm. For an excellent overview of SIDS and QT see - http://www.sidsalliance.org/media/default.asp?goto=76 Parents who have previously lost a child to SIDS are often desperate to find a defining reason and protection (i.e. if you can show us something with this baby then we can prevent it) for their subsequent baby. Of course, this is a perfectly natural response. The most current research however, is indicating that perhaps the most important thing we can do is to counsel parents on the Back to Sleep AND soft bedding guidelines. As the Back to Sleep program becomes more successful, soft bedding and inappropriate surfaces are really emerging as a significant risk factors. This can be an emotionally fine line to walk - especially if there were some position or bedding issues with the previous death. However, we usually try to assure parents that they did the best they could with the information they had at the time. I have printed and distributed from the following - http://www.aap.org/advocacy/releases/softbedding.htm More on QT from SIDS experts - "Comments from Henry Krous, M.D. June 11, 1998 I find this an interesting and provocative study which puts prolonged QTc interval and SIDS risk back on the table for further investigation. SELECTED STRENGTHS of the study are large size, apparent strength of association, pressure for other investigators to confirm or refute, possible means of screening in early newborn period and possible preventative measures. SELECTED WEAKNESSES are lack of blinded EKG review, lack of linking QTc results with sleep state, wakefulness, activity level, sleep position, postmortem data, listing of other causes of death, and use of Seattle SIDS definition that does not require scene investigation. CONCERNS: stampede to have EKGs performed on every baby with highly variable technical and interpretative skills of techs and docs, possible prescription of unwarranted and potentially medications or failure to prescribe medications when actually indicated (this flies in the face of health care reform in the USA with the dumbing down of health care services). Henry Krous San Diego" "The response from the SIDS Alliance is really quite a good one. The NEJM article also made the point that even with this significant correlation between SIDS and a prolonged QT at birth you would need to treat 100 babies with the long QT to potentially save two lives. This assumes that the treatment would be effective and does not even address the risks involved in the treatment drug(s). The Schwartz study was certainly a large trial that did find a significant correlation between SIDS and prolonged QT at birth. They found was that 50% of the infants that died of SIDS had a prolonged QTc on the EKG done during the first week of life. However, they did not report the positive predictive value of having a prolonged QTc and subsequent death in the first year of life from SIDS. >From their data you would calculate that there were about 850 babies who had a prolonged QTc at birth (= 2.5% of the total infants studied 34,000; about 2 standard deviations from the mean). Of that 850 with prolonged QTc at birth 12 died of SIDS (1.4%) and 838 survived the first year. In this particular case above, it is not routine to obtain an EKG on all infants in the US. In the Italian study, all infants get an EKG after 2 days of life when there is less variability in the heart rhythm. This is not the case in the US where more than half the infants are home by the third day of life. While there was no history of prolonged QT in the parents in the Italian study of 34,000 births, we do know that sudden unexpected death can occur in adults with prolonged QT. This sudden death by arrhythmia can be prevented with treatment. I hope this helps. JDDeCristofaro, MD Assistant Professor of Pediatrics Medical Director, Infant Apnea Program UMC Stony Brook, NY" "Some has suggested that prolonged QT interval may be a cause of SIDS. However, most investigators do not currently believe this is an important cause of SIDS. I hope this is helpful. Thank you. Tom Keens Children's Hospital Los Angeles " Dogwood Ridge wrote: > Would you do an EKG in a newborn who's older sibling died of SIDS at age 2 > months? There is no family history of prolonged QT. Thanks- Kim > Burlingham, MD peds, Texas >