A standardized postmortem protocol to assess the real burden of sudden infant death syndrome

Abstract

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.

The multiagency approach to Sudden Unexpected Infant Deaths (SUID): eleven years’ experience in the Tuscany Region

“…Our data were obtained from the SUID case registry from 2009 to 2019. We found that gender, age of death, and seasonality were similar to those reported in a recent study carried out in Veneto, another Italian region [10], as well as those previously reported in other countries [11,12]. The seasonality shows a prevalence in autumn-winter similar to the other Italian study but it differs from that reported in more recent studies which show a spring/summer prevalence [13], while a winter prevalence occurred before the reduce the risk campaigns [14].…”

Feasibility of postmortem examination in the era of COVID-19 pandemic: the experience of a Northeast Italy University Hospital

“…In case of macroscopic gross findings or clinical history suggestive for other organs involvement, additional sampling is carried out several fields of human disease, particularly in the areas of cardiovascular diseases and infectious disease, allowing for instance significant progresses in the elucidation of pathogenetic mechanisms underlying sudden death [17], prion disease [18], Alzheimer disease [19], perinatal mortality [20], and sudden infant death syndrome [21]. The opportunity of performing postmortem examination of patients deceased for COVID-19 virus infection has raised significant concerns motivated by the potential risk of infectivity, to the extent that the Italian Ministry of Health has issued a recommendation that in principle tends to discourage from performing autopsies [6].…”

Epidemiology of sudden infant death syndrome in Mexico, 2005–2020

“…This increase in mortality rates may be due to excessive diagnosis without an exhaustive investigation of the underlying cause of death, including the analysis of the circumstances in which the death occurred, and the lack of an autopsy in the majority of cases. In addition, this may be due to inadequate training of forensic and medical staff and scarcity of human and economic resources ( 9 , 10 ).…”

“…SIDS is defined as “the sudden unexpected death of an infant younger than one year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history” ( 1 – 10 ).…”