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Paediatric Respiratory Research Centre, Mater
Children's Hospital, South Brisbane, Queensland 4101, Australia
Correspondence to: Professor Hills.
Accepted 6 May 1997
Previous studies of the abnormal physical properties of lung
surfactant derived from infants experiencing prolonged expiratory apnoea, or who have died of sudden infant death syndrome (SIDS), have
led to a search for the agent responsible. Bronchoalveolar lavage (BAL)
has been performed upon 12 infants under 12 months at necropsy and the
rinsings analysed for up to 26 bile acids using high performance liquid
chromatography, which requires nanomolar quantities. They were also
analysed for simultaneously retrieved phospholipid and proteolipid
a
minor component of lung surfactantas markers of lavage efficiency.
Total bile acid (TBA) was found to be higher in six SIDS cases,
reaching a mean (SE) 8.54 (2.24) µmol/l in the BAL fluid compared
with 4.66 (1.47) µmol/l in the six controls of similar age. When
related to the concomitant surfactant yield, the TBA/proteolipid and
TBA/phospholipid ratios both showed highly significant differences between index lungs and controls, providing another postmortem marker
of SIDS with potential for development as a test of risk. Since
the bile:phospholipid ratio determines whether phospholipase A2 synthesises or hydrolyses phospholipid, the raised
TBA/phospholipid ratio could be highly significant, causing this enzyme
to function more like its role in the gut than in the lung.
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