Sudden Unexpected Death in Infancy [SUDI]: What the clinician, pathologist, coroner and researchers want to know

Medico-legal analysis of cases of children who died suddenly due to pneumonia undiagnosed in their lifetime

Pneumonia is one of the most common causes of children's hospitalization and death. The aim of the study was a medico-legal analysis of children who died suddenly due to pneumonia undiagnosed in their lifetime. The research was of a retrospective character and consisted in an analysis of prosecution files. The study included 47 children who died between 2011-2018 in whom pneumonia after post-mortem examination was indicated as the cause of death, as well as children in whom the cause of death, despite additional post-mortem examinations, including histopathological tests, was not established. In some cases, under additional post-mortem examinations, additional targeted immunohistochemical staining of selected lung sections was performed to establish the diagnosis. In children with prodromal symptoms, histopathological examination showed significantly more frequent atelectasis than in children without prodromal symptoms. Pneumonia is a significant clinical problem. Especially in young children, it may proceed with- out any symptoms that would cause such a diagnosis to be made. A properly conducted post-mortem diagnosis supplemented by immunohistochemical examinations allows to reduce the number of unexplained deaths in children.

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

BACKGROUND

Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known.

METHODS

National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services.

RESULTS

In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter.

CONCLUSION

In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.