Harris, Lloyd E.

In two children who had multiple aneurysms in the aorta and systemic arteries, and who subsequently died, the histopathologic findings were those of giant-cell arteritis. We have designated this condition as infantile giant-cell arteritis. The etiology is unknown.

Among 210 deaths in infants aged 2 weeks to 2 years in Olmsted County, Minnesota, during the 20-year period 1946 through 1965, review of the clinical and pathologic reports disclosed 37 instances of sudden, unexpected, unexplained death (SUUD). The incidence rate was 1.2/1,000 live births. The death occurred between midnight and noon in 90% of cases, and all but one of the children were found dead in bed. Some seasonal variation was noted. Autopsy was done in 75% of the 210 instances, including 86% (32) of the SUUD cases. More than two thirds of the cases of SUUD coming to autopsy had some evidence of an infectious disease, but these findings were minimal and in no case sufficient in themselves to cause death. Therefore, it was concluded that a second factor is necessary to initiate the sequence of events that leads to death, although the specific trigger mechanisms are unknown and may be quite variable.

Anorectal rings were found in 13.8% of 1,716 consecutive newborn infants. The anorectal ring was detected in four times as many females as males. Anorectal rings of the grades discovered in this study dilated spontaneously and did not require treatment. The incidence of constipation, colic, blood in the stool, excessive straining, distention, tear of the anal skin, and crying with defecation was the same in a group of 168 infants with anorectal rings as it was in a group of 160 infants in whom the anorectal ring was absent. A thick, fibrous anorectal ring which does not dilate spontaneously may cause obstructive symptoms and require treatment. This type of anorectal ring did not occur in this group of 1,716 infants.