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Martin Perceval L, Scherdel P, Jarry B, de Visme S, Levieux K, Gras-Le Guen C. Sudden Unexpected Death in Infancy: Current Practices in Virological Investigations and Documentation in the French Registry. J Pediatr 2023:S0022-3476(23)00020-3. [PMID: 36646248 DOI: 10.1016/j.jpeds.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe pre-COVID-19 pandemic current practices in virological investigations, including type, frequency of samplings, and documented viruses, in sudden unexpected death in infancy (SUDI) and to compare results according to the cause of death. STUDY DESIGN Between May 2015 and December 2019, infants under 2 years of age included in the French SUDI registry were classified in one of 4 groups by causes of death according to the classification by Goldstein et al. : unexplained (SIDS), infectious, explained but noninfectious, and undetermined. Sampling sites and viruses detected were described, and then SIDS and explained deaths (control group) were compared. RESULTS Among 639 infants, 3.6% died of an established viral infection. From 23 sampling sites and 2238 samples, 19 virus species were detected. Overall, 43.3% of infants carried a virus, with no significant difference between SIDS infants and the control group (P = .06). We found wide variations in frequencies of samples by site (550 for nasopharynx to one for saliva). The highest positivity rate was from the nasopharynx (195/2238; 8.7%). Rhinovirus was the predominant virus detected (135/504; 26.8%), mostly in SIDS (83/254; 32.7%). We found no significant difference between positivity rates and distribution of viruses between the SIDS and control groups. At-autopsy virological analysis never contributed to determining the cause of death. CONCLUSION Current practices in virological investigations in SUDI are heterogeneous, with wide variability despite published guidelines. Investigations should be limited to the most relevant sites, and systematic at-autopsy sampling should be reconsidered. We found no association between virus detection and SIDS.
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Affiliation(s)
| | | | | | | | - Karine Levieux
- Pediatric Emergency Care Unit, Nantes University Hospital, Nantes, France
| | - Christèle Gras-Le Guen
- INSERM CIC 1413, Nantes University Hospital, Nantes, France; Pediatric Emergency Care Unit, Nantes University Hospital, Nantes, France
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Claudet I, de Visme S, Duthoit G, Barnet L, Marchand-Tonel C, Chever M, Daussac E, Bréhin C, Levieux K. Prevalence of positive toxicology analysis from the French national registry for sudden unexpected infant death (Tox-MIN). Clin Toxicol (Phila) 2021; 60:38-45. [PMID: 34080518 DOI: 10.1080/15563650.2021.1933005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sudden unexpected infant death (SUID) remains the leading cause of postnatal mortality in many countries. French and international guidelines recommend a thorough examination with toxicology studies. OBJECTIVES The main objective was to determine the prevalence of toxic detection and positive analyses. The secondary objectives were to describe the different toxics and compare children with positive (Tox+) and negative results (Tox-) with other SUID risk factors. DESIGN AND METHODS We used the data registered from May 2015 to December 2018 by the French national SUID registry (OMIN). It collects data for all SUID cases admitted to any of the 35 participating French SUID referral centers. RESULTS Of the 624 SUID cases registered in the OMIN, a post-mortem toxicological analysis was performed in 398 infants. Thirty-six patients (9%) were positives for expected (Etox+ (n = 19 [53%], e.g., resuscitation drugs, regular treatments) and unexpected (UTox+) (n = 17 [47%]) toxics. The unexpected toxics were opioids (n = 8), cannabis (n = 4), cocaine (n = 3), cotinine (n = 2), carbon monoxide (n = 2), caffeine (n = 2), alcohol (n = 1) and GHB (n = 1). UTox + infants had a different seasonal distribution (p = .03), a higher incidence of inappropriate sleeping position and bedding at the time of death (respectively OR 3.8, p = .037 - OR 5.4, p = .026); inadequate body hygiene (OR 10.6, p = .0005), a younger maternal age (p = .045) and a higher rate of maternal drug abuse (OR 21.9, p = .0008). CONCLUSION The high rate of positive results warrants routine toxicology testing. The imputability of identified molecules is complicated by the presence of other known risk factors for SUID.
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Affiliation(s)
- Isabelle Claudet
- The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France.,UMR 1295, Inserm, Paul Sabatier University, UPS, Toulouse, France
| | | | - Gilles Duthoit
- The Pediatric Mobile Care Unit (SMUR), Children's hospital, Toulouse CHU, France
| | - Lucile Barnet
- The Pediatric Mobile Care Unit (SMUR), Children's hospital, Toulouse CHU, France
| | - Claire Marchand-Tonel
- Director of the Health Division, IFRASS, Toulouse, France.,The LISST laboratory, Jean-Jaurès University, UT2J, Toulouse II, France
| | - Martin Chever
- The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France
| | - Elisabeth Daussac
- The Pediatric Mobile Care Unit (SMUR), Children's hospital, Toulouse CHU, France
| | - Camille Bréhin
- The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France.,UMR 1416, Inserm, IRSD, Toulouse, France
| | - Karine Levieux
- The Pediatric Emergency Unit, Children's Hospital, Nantes CHU, France
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Lemoine S, Chabernaud JL, Jost D, Prunet B. Re: Family presence during resuscitation in paediatric cardiac arrest: A systematic review. Offering parents the choice to view resuscitation of their child in case of sudden cardiac arrest. Resuscitation 2021; 164:153-154. [PMID: 33971267 DOI: 10.1016/j.resuscitation.2021.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France.
| | - Jean-Louis Chabernaud
- Delegate for International Relations, Paris-Saclay University, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, Paris, France
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National Variations in Recent Trends of Sudden Unexpected Infant Death Rate in Western Europe. J Pediatr 2020; 226:179-185.e4. [PMID: 32585240 DOI: 10.1016/j.jpeds.2020.06.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/25/2020] [Accepted: 06/17/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To study recent epidemiologic trends of sudden unexpected death in infancy (SUDI) in Western Europe. STUDY DESIGN Annual national statistics of death causes for 14 Western European countries from 2005 to 2015 were analyzed. SUDI cases were defined as infants younger than 1 year with the underlying cause of death classified as "sudden infant death syndrome," "unknown/unattended/unspecified cause," or "accidental threats to breathing." Poisson regression models were used to study temporal trends of SUDI rates and source of variation. RESULTS From 2005 to 2015, SUDI accounted for 15 617 deaths, for an SUDI rate of 34.9 per 100 000 live births. SUDI was the second most common cause of death after the neonatal period (22.2%) except in Belgium, Finland, France, and the UK, where it ranked first. The overall SUDI rate significantly decreased from 40.2 to 29.9 per 100 000, with a significant rate reduction experienced for 6 countries, no significant evolution for 7 countries, and a significant increase for Denmark. The sudden infant death syndrome/SUDI ratio was 56.7%, with a significant decrease from 64.9% to 49.7% during the study period, and ranged from 6.1% in Portugal to 97.8% in Ireland. We observed between-country variations in SUDI and sudden infant death syndrome sex ratios. CONCLUSIONS In studied countries, SUDI decreased during the study period but remained a major cause of infant deaths, with marked between-country variations in rates, trends, and components. Standardization is needed to allow for comparing data to improve the implementation of risk-reduction strategies.
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Tuchtan L, Delteil C, Levrat F, Bacquet J, Garcia P, Fayol L, Gorincour G, Zandotti C, Girard N, Drancourt M, Léonetti G, Piercecchi Marti MD, Bartoli C. Sudden unexpected infant death characteristics in the French region of West Provence-Alpes-Côte d'Azur. Paediatr Int Child Health 2019; 39:104-110. [PMID: 30382004 DOI: 10.1080/20469047.2018.1533734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Although the incidence of sudden unexpected infant death (SUID) has decreased since the 'Back to Sleep' campaign in English-speaking countries and other preventive campaigns, the circumstances of such deaths remain unclear. Aim: To analyse infant deaths recorded at the referral centre for sudden infant death of the West Provence-Alpes-Côte d'Azur region of France (West PACA) and the forensic medicine department of Marseille University Hospital. Methods: Information on all SUID cases from 2000 to 2017 was extracted from the referral centre for sudden infant deaths in West PACA and the forensic medicine department of Marseille. Results: The study included 130 infants over the 17 years with a very similar distribution. There was a marked male preponderance, with 61.6% of boys whatever the age at death (sex ratio 1.6). Half of the deaths occurred in the first 6 months of life and the majority (61%) of infants died during autumn and winter. Nearly one-third (33.2%) had presented with minor infections and 21% had been seen by a doctor or had been admitted to hospital. Most deaths (86.4%) occurred during sleep (night or day). Nearly half of the infants (47.7%) were discovered in a prone position. A large majority of parents (90.7%) agreed to a post-mortem examination. Only 6.2% of deaths led to legal proceedings. Nearly 16.9% remained unexplained after compiling all the data included in the protocol and 9.2% remained unexplained because of incomplete investigation, including refusal of post-mortem examination. Abuse was involved in 2.3% of cases. Conclusions: Asymptomatic infectious conditions were associated with a high proportion of SUID cases. Non-supine sleep positions were still practised. There is a need to increase SUID prevention campaigns. Abbreviations: HAS, Haute Autorité de Santé: French National Health Authority; NICHD, National Institute of Child Health and Human Development; PACA, Provence-Alpes-Côte d'Azur region of France; SUID, sudden unexpected infant death; SIDS, sudden infant death syndrome; CépiDc, Centre d'Epidémiologie sur les Causes Médicales de Décès/Center for Epidemiology on the Medical Causes of Death.
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Affiliation(s)
- Lucile Tuchtan
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Clémence Delteil
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Flore Levrat
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France
| | - Juliette Bacquet
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Patricia Garcia
- c Service de Néonatologie , APHM, Hôpital de la Conception , Marseille , France
| | - Laurence Fayol
- c Service de Néonatologie , APHM, Hôpital de la Conception , Marseille , France
| | - Guillaume Gorincour
- d Département d'Imagerie Médicale , APHM, Hôpital de la Timone , Marseille , France
| | - Christine Zandotti
- e Département de Microbiologie , APHM, Hôpital de la Timone , Marseille , France
| | - Nadine Girard
- d Département d'Imagerie Médicale , APHM, Hôpital de la Timone , Marseille , France
| | - Michel Drancourt
- e Département de Microbiologie , APHM, Hôpital de la Timone , Marseille , France
| | - Georges Léonetti
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Marie Dominique Piercecchi Marti
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Christophe Bartoli
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
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Delteil C, Meyronet D, Maues de Paula A, Jouvet A, Piercecchi-Marti MD. [Neuropathology of sudden infant death syndrome: Review of the literature and proposal of a protocol for neuropathological examination]. Ann Pathol 2018; 38:103-109. [PMID: 29429858 DOI: 10.1016/j.annpat.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/05/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
According to the French High Authority for Health, sudden unexpected death in infants (SUDI) is defined as "a sudden death that occurs in an infant, whereas nothing in its known history could have predicted it". This is an exclusion diagnosis. There are great interregional disparities despite the professional recommendations established in February 2007. For the examination of the brain, instructions are not adapted to current and research practice. The role of the pathologist, like anyone involved in SUDI, is to eliminate an abuse head trauma and to determine the cause of death. Major neuropathological lesions by definition do not exist. Lesions of hypoxia/ischemia are the most frequent but not specific. The accessibility of anti-APP immunoblotting has highlighted the role of anoxia in the development of axonal diffuse damages. Many studies are looking for a neurological substratum of the SUDI (neuropathological and/or neurobiochinic). This article aims to define a detailed sampling protocol based on foreign consensus and current data of science in order to assist pathologists and to promote a homogeneous data bank in France.
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Affiliation(s)
- Clémence Delteil
- Institut médicolégal de Marseille, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; CNRS, EFS, ADES UMR 7268, Aix-Marseille université, 13916 Marseille, France.
| | - David Meyronet
- Service de biopathologie, hôpital mère-enfant, Lyon Est-Bron, 32, avenue Doyen-Jean-Lépine, 69500 Bron, France
| | - Andre Maues de Paula
- Laboratoire d'anatomie pathologique-neuropathologique, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Anne Jouvet
- Service de biopathologie, hôpital mère-enfant, Lyon Est-Bron, 32, avenue Doyen-Jean-Lépine, 69500 Bron, France
| | - Marie-Dominique Piercecchi-Marti
- Institut médicolégal de Marseille, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; CNRS, EFS, ADES UMR 7268, Aix-Marseille université, 13916 Marseille, France
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7
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Levieux K, Patural H, Harrewijn I, Briand Huchet E, Kugener B, Pidoux O, de Visme S, Adjaoud C, Gras Le Guen C, Hanf M. Sudden unexpected infant death: Time for integrative national registries. Arch Pediatr 2018; 25:75-76. [PMID: 29395889 DOI: 10.1016/j.arcped.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/30/2017] [Accepted: 12/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- K Levieux
- Pediatric Intensive Care Unit, Nantes University Hospital, 9, Quai-Moncousu, 44093 Nantes cedex 1, France; Pediatric Intensive Care Unit, Saint-Étienne University Hospital, 42100 Saint-Étienne, France; Pediatric Intensive Care Unit, Montpellier University Hospital, 34090 Montpellier, France; Pediatric Intensive Care Unit, Antoine-Béclère University Hospital, AP-HP, 92140 Clamart, France; Department of Pediatric Medicine, HFME Lyon, 69677 Bron, France; Inserm CIC1413, Nantes University Hospital, 44093 Nantes, France.
| | - H Patural
- Pediatric Intensive Care Unit, Saint-Étienne University Hospital, 42100 Saint-Étienne, France
| | - I Harrewijn
- Pediatric Intensive Care Unit, Montpellier University Hospital, 34090 Montpellier, France
| | - E Briand Huchet
- Pediatric Intensive Care Unit, Antoine-Béclère University Hospital, AP-HP, 92140 Clamart, France
| | - B Kugener
- Department of Pediatric Medicine, HFME Lyon, 69677 Bron, France
| | - O Pidoux
- Pediatric Intensive Care Unit, Montpellier University Hospital, 34090 Montpellier, France
| | - S de Visme
- Inserm CIC1413, Nantes University Hospital, 44093 Nantes, France
| | - C Adjaoud
- Pediatric Intensive Care Unit, Nantes University Hospital, 9, Quai-Moncousu, 44093 Nantes cedex 1, France; Pediatric Intensive Care Unit, Saint-Étienne University Hospital, 42100 Saint-Étienne, France; Pediatric Intensive Care Unit, Montpellier University Hospital, 34090 Montpellier, France; Pediatric Intensive Care Unit, Antoine-Béclère University Hospital, AP-HP, 92140 Clamart, France; Department of Pediatric Medicine, HFME Lyon, 69677 Bron, France; Inserm CIC1413, Nantes University Hospital, 44093 Nantes, France
| | - C Gras Le Guen
- Pediatric Intensive Care Unit, Nantes University Hospital, 9, Quai-Moncousu, 44093 Nantes cedex 1, France; Pediatric Intensive Care Unit, Saint-Étienne University Hospital, 42100 Saint-Étienne, France; Pediatric Intensive Care Unit, Montpellier University Hospital, 34090 Montpellier, France; Pediatric Intensive Care Unit, Antoine-Béclère University Hospital, AP-HP, 92140 Clamart, France; Department of Pediatric Medicine, HFME Lyon, 69677 Bron, France; Inserm CIC1413, Nantes University Hospital, 44093 Nantes, France
| | - M Hanf
- Inserm CIC1413, Nantes University Hospital, 44093 Nantes, France; Inserm UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Versailles Saint-Quentin University, 78000 Villejuif, France
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