Sudden Infant Death Syndrome (SIDS), Sudden Unexpected Death in Infancy (SUDI), and Sudden Unexplained Death in Childhood (SUDC)

Krous, Henry F.

doi:10.1007/978-1-61779-403-2_32

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…We classified the sudden and unexpected deaths into four categories: SUDC, explained, undetermined, and (non-febrile) seizure-related disorder. SUDC was defined as above [ 1 ]. Explained deaths were those in which postmortem studies revealed a known cause of death, including natural diseases and accidental trauma.…”

Section: Methodsmentioning

confidence: 99%

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Sudden unexpected death in early childhood: general observations in a series of 151 cases

Hefti

Kinney

Cryan

et al. 2016

Forensic Sci Med Pathol

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PurposeThe purpose of this study was to determine the major subcategories and clinicopathologic features of sudden unexpected death in young children in a large retrospective cohort, and to confirm the association of sudden unexplained death in children (abbreviated by us for unexplained deaths as SUDC) with hippocampal pathology and/or febrile seizures.MethodsWe undertook analysis of a retrospective cohort of 151 cases, of which 80 % (121/151) were subclassified as SUDC, 11 % (16/151) as explained, 7 % (10/151) as undetermined, and 3 % (4/151) as seizure-related.ResultsThere were no significant differences between SUDC and explained cases in postnatal, gestational, or postconceptional age, frequency of preterm birth, gender, race, or organ weights. In contrast, 96.7 % (117/121) of the SUDC group were discovered during a sleep period compared to 53.3 % (8/15) of the explained group (p < 0.001), and 48.8 % (59/121) of the SUDC cases had a personal and/or family history of febrile seizures compared to 6.7 % (1/15) of the explained group (p < 0.001). Of the explained deaths, 56 % (9/16) were subclassified as infection, 31 % (5/16) cardiac, 6 % (1/16) accidental, and 6 % (1/16) metabolic. Two of the three cases specifically tested for cardiac channelopathies at autopsy based upon clinical indications had genetic variants in cardiac genes, one of uncertain significance. Bacterial cultures at autopsy typically revealed organisms interpreted as contaminants. Two of the four seizure-related deaths were witnessed, with two of the brains from these cases showing generalized malformations. Hippocampal anomalies, including a specific combination we termed hippocampal maldevelopment associated with sudden death, were found in almost 50 % (40/83) of the SUDC and undetermined cases in which hippocampal sections were available.ConclusionsThis study highlights the key role for the hippocampus, febrile seizures, and sleep in SUDC pathophysiology. It also demonstrates the role of known predisposing conditions such as cardiac channelopathies and infections in causing sudden unexpected death in childhood, and the need for improved ancillary testing and protective strategies in these cases, even when the cause of death is established at autopsy.

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Section: Methodsmentioning

confidence: 99%

“…Sudden unexplained death in childhood (SUDC) is the sudden and unexpected death of a child older than 1 postnatal year that remains unexplained after a review of the clinical history and circumstances of death, and the performance of a complete autopsy [ 1 ]. It is a subset of sudden and unexpected death—the subset without explanation.…”

Section: Introductionmentioning

confidence: 99%

Sudden unexpected death in early childhood: general observations in a series of 151 cases

Hefti

Kinney

Cryan

et al. 2016

Forensic Sci Med Pathol

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“…Sudden unexpected infant death and sudden unexplained death in childhood refer to death of infants and children up to 18 years of age whose cause of death remains unexplained after review of clinical history, circumstance of death, and a thorough investigation including an autopsy 1–3 . This requires a multidisciplinary team working together diligently to support the grieving parents and conducting investigations in a delicate, respectful, and timely manner.…”

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confidence: 99%

Does Postmortem Imaging Provide Additional Findings After Unexpected Deaths in Infants and Children?

et al. 2022

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ObjectivesThe yield of postmortem imaging (PMI) after sudden unexpected deaths in children has not been well studied. Findings consistent with physical abuse detected on PMI may alert the physician to this diagnosis before the autopsy results. Our objectives are to describe the PMI performed and their diagnostic yield after unexpected deaths in children and to adherence to the American Academy of Pediatrics guidelines regarding performance of skeletal survey and autopsy in infants at our institution.MethodsWe performed a retrospective study of unexpected deaths in children 2 years or younger between 2008 and 2018. Children with known traumatic deaths and those transferred after a cardiopulmonary arrest at an outside institution were excluded. We collected patient demographics, physical examination findings, and type of PMI performed along with their results.ResultsWe analyzed 150 deaths with majority (128; 85.3%) being infants. No PMI was performed in 20 children (13.3%). An autopsy was not performed in 22 children (14.6%). A skeletal survey and an autopsy were performed only in 72.6% (93/128) infants. PMI provided additional findings in 51 infants (34%) and 13 children (59.1%) aged 13 to 24 months. PMI identified abuse in 11 children with a negative physical examination result, 3 of whom had a negative autopsy.ConclusionsThe American Academy of Pediatrics recommendations of performance of a skeletal survey and an autopsy were not adhered to after all infant deaths. PMI is useful in identification of additional findings in children 2 years or younger, especially those concerning for physical abuse in infants with a negative physical examination.

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Sudden death in epilepsy: the overlap between cardiac and neurological factors

Shlobin,

Thijs,

Benditt

et al. 2024

Brain Communications

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People with epilepsy are at risk of premature death, of which sudden unexpected death in epilepsy (SUDEP), sudden cardiac death (SCD) and sudden arrhythmic death syndrome (SADS) are the primary, partly overlapping, clinical scenarios. We discuss the epidemiologies, risk factors and pathophysiological mechanisms for these sudden death events. We reviewed the existing evidence on sudden death in epilepsy. Classification of sudden death depends on the presence of autopsy and expertise of the clinician determining aetiology. The definitions of SUDEP, SCD and SADS lead to substantial openings for overlap. Seizure-induced arrhythmias constitute a minority of SUDEP cases. Comorbid cardiovascular conditions are the primary determinants of increased SCD risk in chronic epilepsy. Genetic mutations overlap between the states, yet whether these are causative, associated or incidentally present is often unclear. Risk stratification for sudden death in people with epilepsy requires a multidisciplinary approach, including a review of clinical history, toxicological analysis and complete autopsy with histologic and, preferably, genetic examination. We recommend pursuing genetic testing of relatives of people with epilepsy who died suddenly, mainly if a post-mortem genetic test contained a Class IV/V (pathogenic/likely pathogenic) gene variant. Further research may allow more precise differentiation of SUDEP, SCD and SADS and the development of algorithms for risk stratification and preventative strategies.

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Sudden Infant Death Syndrome (SIDS), Sudden Unexpected Death in Infancy (SUDI), and Sudden Unexplained Death in Childhood (SUDC)

Cited by 3 publications

References 27 publications

Sudden unexpected death in early childhood: general observations in a series of 151 cases

Sudden unexpected death in early childhood: general observations in a series of 151 cases

Does Postmortem Imaging Provide Additional Findings After Unexpected Deaths in Infants and Children?

Sudden death in epilepsy: the overlap between cardiac and neurological factors

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