SUDDEN DEATH OF BABIES

THERE ARE FEW THINGS IN LIFE so sad as the sudden death of a baby. It is not surprising then that the subject has long been one of medical and public interest, and the scholarly historical account by Froggatt and his colleagues includes biblical and other ancient descriptions.' Today certain publicized efforts have brought new attention to research on the subject,2 which is as yet largely unexplained despite a wide spectrum of proposed theories. One theory has suggested that the final common pathway may be mediated by electrical instability of the heart in young babies, a situation in part the consequence of a normal developmental process occurring in all infants but at the same time rendering the behavior of the conduction system capricious.3 In this issue of Circulation Drs. offer some important additional observations on the morphology of the conduction system in this crucial period of life.' As indicated by Lie and his colleagues, there have now been several such studies of the cardiac conduction system of human infants, but while it seems to me that most of the anatomical descriptions are quite similar or identical, the interpretations of what the findings mean have been at variance. In my original report there was no suggestion that the finding of an active molding and shaping of the atrio-ventricular (A-V) node and His bundle represented a pathological process.3 On the contrary, I emphasized that the process was ubiquitous at the newborn period, that it was in this sense a normal phenomenon rather than a pathological one, but that ubiquity could not be read as synonymous with safety or stability. Despite my precautionary phrases, Valdes-Dapena and her colleagues took me to task' about the "histopathologic changes" (her quotation marks, not mine) even though I had assiduously avoided calling these pathological in nature. In her study with Ray Truex and others they concluded that there were no dead cells, no phagocytosis, no replacement fibrosis, nor any evidence of rapid (sic) remodeling, and therefore they questioned the validity of attributing malfunction of this or any other anatomical system to features of its normal development. In the article she did admit that our differences were largely ones of interpretation, although in her own accompanying editorial' she was a bit more critical. R. H. Anderson and his colleagues7 essentially agreed with Valdes-Dapena. On the other side of the argument, both W. R. Anderson and his associates8 and …