Sudden infant death syndrome (SIDS)—Standardised investigations and classification: Recommendations

Toward a standardized investigation protocol in sudden unexpected deaths in infancy in South Africa: a multicenter study of medico-legal investigation procedures and outcomes

“…Death scene investigation can help to identify risk factors and to differentiate between natural and unnatural deaths [4], including asphyxia. The San Diego definition in fact makes death scene investigation an integral requirement for the diagnosis of SIDS.…”

“…The implementation of a standard protocol for the investigation of SUDI has been studied by numerous authors [4]. In Dundee, Pounder and Cox compiled a protocol after consultation with the Scottish Cot Death Trust, Regional Procurator Fiscal and local departments including pediatrics and pathology [5].…”

The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we—and where are we going?

“…Histological examination of tissue slides were done on more cases in Tygerberg (81.60%) than Pretoria (29.36%). Several publications stress the importance of histological examination in infant deaths [11,12]. Toxicological analyses (which included a general screening for sedatives and analgesics) were done on 6.42% of the cases admitted to Pretoria, but on none of the cases admitted to Tygerberg.…”

Review of immunological and virological aspects as contributory factors in Sudden Unexpected Death in Infancy (SUDI)

“…Exposure to cigarette smoke, poor nutrition, a mild viral infection, excessive heat while sleeping in the prone position, an immature immune system due to a critical period in development and other medical conditions all pose enough risk factors to fit the triple-risk model for SIDS [15,23,33,34]. Since SIDS is documented to be higher in the two to four month age group, this could represent a critical developmental period that coincides with a loss of immune protection due to of waning maternally transferred antibodies [5,42].…”

“…This approach gave rise to the triple-risk model, where the risk is highest when an underlying vulnerability in homeostatic control and an exogenous stressor coincide at a critical developmental stage [23,32,33,34]. The most likely environmental or exogenous trigger is a viral infection and the proposed underlying vulnerabilities include immune deficiencies and poor control or over-expression of inflammatory mediators [15,23,33].…”