A New Approach To The Investigation Of Sudden Unexpected Death

Abbreviations:

• OCME — Office of the Chief Medical Examiner
• SIDS — sudden infant death syndrome
• SUDP — sudden unexplained death in pediatrics

Sudden unexplained death in pediatrics (SUDP) is an inclusive term for sudden deaths in children that remain unexplained by standard autopsy and death scene investigation, including sudden infant death syndrome (SIDS), sudden unexpected infant death, sudden unexplained death in childhood, and undetermined deaths. Mortality from SUDP is significant and exceeds that from either cardiac disease or cancer in children <19 years of age.1 Its diagnostic considerations overlap with sudden unexpected death in epilepsy and unexplained sudden cardiac death in youth, also occurring predominantly during sleep, although salient findings in such cases include a history of epilepsy or notable cardiac results. Among children ultimately diagnosed with SUDP, those dying unexpectedly who are <3 years of age are the least likely to have explanations found with the current standard approach to investigation.

Pediatricians have focused largely on preventive measures in the child’s sleep environment and the detection of child abuse in SUDP. Achievements in research and new approaches in medical care have created possibilities for understanding unapparent biological vulnerabilities in a small child that may become lethal. Research continues to find evidence for a biological basis in SUDP, including abnormalities in the hippocampus seen both across the age ranges of SUDP and epilepsy. The epidemiology of SIDS is predicted by general trends in infant mortality that are themselves attributed to biological risk reduction and medical care. Undiagnosed diseases programs, where living patients undergo extensive clinical evaluation to …

Address correspondence to Richard D. Goldstein, MD, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, D2008, Boston, MA 02115. E-mail: richard_goldstein@dfci.harvard.edu

Story Credit: http://pediatrics.aappublications.org/content/early/2017/07/03/peds.2017-0024