Could a Test Predict the Risk of SIDS?
The 7-week-old's case helps to validate the previous work, Schwartz believes. "Maybe 25 to 30% of SIDS cases may be related to this," he says, "And what is important is that it is preventable." Schwartz is chairman of the department of cardiology at Policlinico San Matteo Istituto di Ricovero e Cura a Carattene Scientifico and the University of Pavia.
The findings have stirred debate among pediatricians and SIDS experts about whether screening all infants for the heart problem is feasible or even necessary, whether it will help reduce SIDS deaths, and whether the research evidence linking long QT with SIDS is convincing enough.
Based on his work over the past 20 years, Schwartz believes that all infants should be screened for long-QT syndrome. He points out that even if the syndrome doesn't lead to SIDS, it can cause death later in childhood.
But Michael Corwin, MD, believes it's inappropriate to perform EKGs on all newborns to screen for long-QT syndrome.
"This new article only provides an example of one case of long-QT in an infant that has a genetic basis," he tells WebMD. "And it does not in any way speak to the key issues, such as what percentage of SIDS cases may be related to long QT, and is it possible to screen infants in order to identify those who are at sufficient risk." Corwin, who was not involved in the study, is an associate professor of pediatrics at Boston University School of Medicine and team leader of data and evaluation at the National SIDS and Infant Death Program Support Center.
Whether the cost of screening every infant outweighs the potential risk is a major issue. Towbin believes it may be better to concentrate on screening infants who are at high risk of long-QT syndrome, such as those with a family history of irregular heartbeats, or those who had a very slow heart rate while still in the womb.
"Only a few babies will actually have this abnormality, and screening a million to find a few may not be as good a focus as screening a few to find a few," says Towbin, who wrote an editorial accompanying Schwartz's 1998 study in The New England Journal of Medicine. "One life lost is one too many, but you still have to do the evaluation in a way that is cost-effective --so you need a combination of what is both medically effective and cost-effective."