Classification of sudden infant death (SID) cases in a multidisciplinary setting. Ten years experience in Styria (Austria) (original) (raw)
Related papers
Sudden infant death syndrome (SIDS)—Standardised investigations and classification: Recommendations
Forensic Science International, 2007
Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the ''three hit'' or ''triple risk'' model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations
Acta Paediatrica, 2007
Infants that died suddenly and unexpectedly were studied as part of the European Concerted Action on sudden infant death syndrome (SIDS). Three paediatric pathologists, first independently of each other and later in a consensus meeting, classified 63 cases into 3 groups: SIDS (19 cases), borderline SIDS (30 cases) and non-SIDS (14 cases). The interobserver agreement among the pathologists before the consensus meeting was moderate (Kappa = 0.41) and jointly it was higher (Kappa = 0.83). The distribution of epidemiologically determined risk factors was studied over these three groups. Maternal smoking after birth, low socioeconomic status and thumb sucking were found more often in SIDS than in the other cases. Inexperienced prone sleeping was a determinant for SIDS, but not for non-SIDS. Previous hospital admission, low birthweight and/or short gestation were associated with borderline SIDS. Non-SIDS cases received more breastfeeding, the parents hardly smoked during pregnancy and after birth, a firm mattress had been used, and more often signs of illness had been reported by the parents, compared with the SIDS and borderline SIDS cases. Bedding factors and both primary and secondary prone sleeping were equally distributed over the three groups which supports the hypothesis that, in SIDS and borderline SIDS, as well as in non-SIDS cases, some similar external and preventable factors might influence the events leading to death. Research should therefore focus on all sudden unexpected deaths, after which subgroups such as SIDS cases can be separately analysed. The postmortem is an essential part of the whole work-up of each case and the results should be interpreted with all other available data to arrive at a sound evaluation of cases and thus form the basis for the prevention of all sudden unexpected infant death. ٖ Cot death, epidemiology, pathology, risk factors, sudden infant death syndrome (SIDS), SUD
Current Pediatric Reviews, 2010
The aim of this paper is to compare international trends in sudden infant death syndrome (SIDS) and postneonatal mortality (PNM) since the introduction of SIDS risk reduction and safe sleep campaigns, offer possible explanations for differences, and to provide recommendations to improve consistency in classifying and reporting infant SUDI deaths internationally. Methods: SIDS and postneonatal mortality rates were obtained for 15 countries from 1990 through the year for which most recent data were available. Results: SIDS rates have declined in all countries, with reductions well over 50% for most countries. These declines are attributed to SIDS risk reduction campaigns, which achieved success primarily in reducing rates of prone sleeping among infants. The largest declines generally occurred in the first few years after initiation of national campaigns, and there are concerning indications that these rates have reached plateaus in many countries. Conclusions and Recommendations: Diagnostic accuracy is essential to monitor and compare trends in SIDS and other sudden unexpected infant deaths. This requires establishing sudden infant death definitions and diagnostic categories that are agreed upon widely. National and local campaigns need to be re-energized to continue the early successes made in reducing SIDS incidence. Finally, data collection needs to be easy to access and this would best be accomplished by national vital statistics agencies posting data in a uniform way on their websites.
Causes of sudden infant death syndrome from post-mortem examination
Journal of Maternal-fetal & Neonatal Medicine, 2004
Sudden infant death syndrome (SIDS) was first defined in the USA as: 'The sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history'. More recently, diverse studies have shown that some cases of SIDS can be explained, when an accurate post-mortem examination is performed. The primary objective of the present paper was to delineate possible causes of SIDS as derived from a review of autoptic studies reported in the literature.
A standardized postmortem protocol to assess the real burden of sudden infant death syndrome
Virchows Archiv, 2020
Sudden unexpected infant death (SUID) is a major cause of death in infants < 1 year of age. Sudden infant death syndrome (SIDS) is a SUID still unexplained after post-mortem examination. In 2014, a protocol of post-mortem investigation was introduced to assess both the prevalence and the etiopathogenesis of SUID. Our aim was to compare SUID data before and after the application of a standardized autopsy protocol of investigation. In the time interval 2004-2018, SUID cases occurring in the Veneto Region, NorthEast Italy, were referred to our Core Lab. Since 2014, a complete autopsy was performed, including gross and histological study with toxicologic and molecular analysis carried out at the referral center. A total of 36 SUIDs (22 M, mean age 95.5 ± 80 days), 17 before (group A) and 19 after (group B) 2014, were collected. In group A, only 1 (6%) resulted as explained SUID, due to lymphocytic myocarditis and 16 (94%) were SIDS. In group B, 8 were SIDS (42%) and 11 (58%) explained SUID cases (p < 0.01), consisting of interstitial pneumonia and bronchiolitis in 9 and lymphocytic myocarditis in 2 cases. Molecular analysis was positive for viruses in 8 of them (73%). In conclusion, since the application of a standardized protocol of post-mortem investigation, inflammatory, mostly infective, cardio-pulmonary diseases have been identified as the most common cause of SUID, with SIDS falling from 94 to 42% of SUID. Efforts must be made to implement a uniform autopsy protocol to provide reliable epidemiological data on SIDS.
Research and sudden infant death syndrome: Definitions, diagnostic difficulties and discrepancies
Journal of Paediatrics and Child Health, 2004
The diagnosis of causes of sudden infant death is an often complex and difficult process. Variable standards of autopsy practice and the use of different definitions for entities such as sudden infant death syndrome (SIDS) have also contributed to confusion and discrepancies. For example, the term SIDS has been used when the requirements of standard definitions have not been fulfilled. In an attempt to correct this situation recent initiatives have been undertaken to stratify cases of unexpected infant death and to institute protocols that provide frameworks for investigations. However, if research is to be meaningful, researchers must be scrupulous in assessing how extensively cases have been investigated and how closely cases fit with internationally recognized definitions and standards. Unless this approach is adopted, evaluation of research findings in SIDS will be difficult and the literature will continue to be beset by contradictions and unsubstantiated conclusions.
Sudden infant death syndrome — a ‘diagnosis’ in search of a disease
Journal of Clinical Forensic Medicine, 1995
week and 1 year in Western countries, it is one of the most enigmatic conditions encountered in paediatric forensic practice. SIDS has been recognized since Biblical times, and yet the definition continues to be debated and the aetiology remains obscure. In addition, there are no accepted pathognomonic features at post-mortem and the diagnosis is still one of exclusion. Emery once asked whether the term 'SIDS' is in reality more of a 'diagnostic dustbin' into which are placed a variety of unrelated entities. 1 To a certain extent this is true, as it is now recognized that a range of disorders can result in the sudden and unexpected death of an infant in a cot. It is also likely that the aetiology of SIDS is heterogeneous and that the term SIDS is not so much a diagnosis but a term covering a variety of mechanisms which result in a common lethal outcome. There are a number of controversies in the SIDS field which complicate the use of the term and which confound the assessment of causes and mechanisms of sudden infant death.
2008
Avon SIDS epidemiology paper 18/11/2008 1 draft Acknowledgement. Abstract 249 words (limit 250 words) Background: Recent case-control studies suggest the epidemiology of Sudden Infant Death Syndrome (SIDS) may have changed since the 1991 'Back to Sleep' campaign and subsequent fall in rates. A unique collection of longitudinal data is used to measure these potential changes. Methods: Population-based data from home visits have been collected for 369 consecutive unexpected infant deaths (300 SIDS and 69 explained deaths) in Avon over a 20 -year period (1984-2003). Data collected between 1993-6 from 1300 control infants with a chosen sleep prior to interview has also been used for reference. Findings: Social deprivation was increasingly more common amongst SIDS families; the proportion of social class IV,V & unemployed families rose from 47% to 74% (p<0.003), 86% of the mothers smoke, 40% are now single, and 16% are aged less than 20. Although many SIDS infants come from large families, first-born infants are now the most common group. The proportion of co-sleeping SIDS deaths increased from 12% to 50% (p<0.0001), but the actual number of SIDS deaths in the parental bed fell significantly (p=0.01). This rise in proportion is due partly to the limited effect of the "Back to Sleep" campaign on factors in this sleeping environment and partly to a rise in the number of bedsharing deaths on sofas. Infants who die as SIDS whilst bedsharing are now 4-5 weeks younger at death than in the 1980's. Interpretation: Changes in the epidemiology of SIDS have implications both in the interpretation of causal mechanisms and how we should conduct future studies. Avon SIDS epidemiology paper 18/11/2008 3 draft 1 Daltveit AK, Oyen N, Skjaerven R, Irgens. The epidemic of SIDS in Norway 1967-93: changing effects of risk factors.