Sudden Infant Deaths are rare in Chinese -- But WHY ?
(by Yeung, Chap-Yung)



Unexplained sudden infant deaths are rare in Chinese - a fact noted by experienced pediatricians for a long time.

Increasing frequency is happening in recent years, especially among immigrants in overseas countries - highly suggestive of changing environment and traditional practices as important factors.

HYPOTHESES/FACTORS FOR SIDS       (Occurring in Chinese)
1. Infants sleeping in prone position -       (most Chinese in supine position)
2. Parental infant-care behaviours -       (more over-potective)
3. Immunologic functions -       (more mature)
4. Bed-sharing with parents -       (common, especially among lower socio-economic stratra, yet much less SIDS)
5. Re-breathing suffocation -       ( ? )
6. Low birth weight -       (higher frequency in Chinese, yet much less SIDS)
7. Over-heating -       ( ? )
8. Long QT syndrome -       ( ? )
9. Non-breast-feeding -       (common in some places, like Hong Kong, yet much less SIDS)
Author's Hypotheses:
  1. Factors known to prevent SIDS have been identified in Chinese. These include the followings :-
    1. Infants lying supine - The "Back to Sleep" campaign in U.S. since 1994 and similar changes of sleeping position in other countries have shown the marked benefit to protect against SIDS.
    2. Immunologic maturity - Chinese infants were found to have higher IgG levels at birth and a different pattern (more mature) of serum immunoglobulins all through early childhood. Their leucocyte functions have also been found to be more capable in phagocytosis and intra-cellular killing compared to reports from Causasians. These might protect against inappropriate response to seemingly trivial infections which often are the antecedent events of SIDS.
    3. Parental "Over-caring / Over-proctive behaviors" - closer and more vigilant supervision of infant-caring behaviors could have corrected many minor Near-MISS events, preventing real SIDS.


  2. Factors reported to be associated with SIDS in Causaian are apparently NOT important in Chinese :-
    1. Low birth weight rate - surprisingly although LBW rate has been reportedly higher among Chinese communities, SIDS rate is usually much lower.
    2. Sharing bed with adults - this practice is common especially among the lower socio-economic group,
    3. Non-breast-feeding - Chinese communities, like Hong Kong, with low frequency of breast-feeding, still demonstrate much lower SIDS .


  3. Suggested Hypotheses
    1. Immunologic maturity - As most SIDS are known to have antecedent infection-like illnesses, the more mature immune fuctions in Chinese may offer more protection.
    2. Increasing frequency of SIDS in Chinese are to be expected - as living condition and life-style are changing, antigenic stimulations are expected to be less in-utero and in early life. These would contribute to less functional maturity of the immune system.
    3. Other factors - to be identified


Why are sudden infant deaths rare in Chinese ?


Any other identified hypotheses / factors for SIDS ?


Any other identified unique features in Chinese as exemplified in the listed references ?


Any other observations / research data ?


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