TREATMENT OF THREATENED S.I.D.S. WITH MEGADOSF THIAMINE HYDROCHLORIDE

Abstract

Steinschneider presented good evidence that infants who died suddenly and unexpectedly frequently have premonitory symptoms which enable the alert physician to recognize the danger (Pediat 50:646, 1972). Fehily (Br. Med. J. 2:590, 1944) described a syndrome of sudden death in Chinese infants in Hong Kong called “breast milk toxicity syndrome”. It commonly occurred in infants who were breast fed by their B₁ avitaminotic mothers and was related to caloric intake. When maternal calorie intake was forcibly reduced by Japanese invaders, the syndrome disappeared. It reappeared when rationing of rice was discontinued. Rarity of the syndrome under the age of 1 month and over 5 months, a peak incidence at 3-4 months, predilection for “well nourished” males, higher incidence in early spring, death during sleep and lack of autopsy histopathology, were identical to the epidemiology of modern S.I.D.S. with the exception of breast Vs bottle feeding. Japanese investigators showed that thiamine deficiency produced autonomic dysfunction and detected histopathology within the central and peripheral components of the system. In 9 infants within this age group, symptoms of autonomic dysfunction suggested candidacy for S.I.D.S. and included life threatening apnea in all. Monitoring in hospital confirmed the symptoms. All of the infants were treated with thiamine hydrochloride, varying from 30 to 300 mg/day. No damaging side effects were seen and symptoms disappeared rapidly in all. All are well in follow up and only 2 have remained extensively dependent upon thiamine.