Emergency Department Visits Before Sudden Unexpected Infant Death: A Touchpoint for Unsafe Sleep Reduction

ObjectivesUnsafe sleep remains a leading cause of preventable sudden unexpected infant death (SUID). Infants frequently visit emergency departments (EDs), but the frequency of visits before SUID is unknown. The objective of this study was to determine how often SUID infants visited a pediatric ED or urgent care (UC) before death.MethodsWe performed a retrospective study of infant deaths in the county of a large, academic pediatric institution. We linked institutional records with coroner reports and death scene investigations. We excluded deaths associated with childbirth, prematurity, injury, or underlying medical condition. We characterized all SUID infants, focusing on unsafe sleep factors detailed in the medical record and scene reports. The main outcome was ED/UC visit(s) before the visit for SUID.ResultsSeventy-three of 122 infant deaths met inclusion criteria for SUID over 76 months (April 2014–July 2020). Median age at death was 87 days (IQR 58, 137); 68 (93%) died before 6 months-of-age. Twenty infants (27%) had an ED/UC visit before SUID; mean visits for these infants were 1.7 (SD 0.8). Median days between the last ED/UC visit and SUID was 39; five infants visited the ED/UC within 2 weeks of SUID. Most visits were for minor medical conditions. All 73 SUID infants had at least one unsafe sleep factor; 88% had ≥2 and 56% ≥3.ConclusionsMany SUID infants visited a pediatric ED/UC before death, and unsafe sleep factors were found in every case. Early infancy ED/UC visits may present an opportunity for targeted prevention efforts.     

Sudden Infant Death Syndrome Related to Climate

ABSTRACT. In Australia the single most important factor influencing the incidence of SIDS is the climate. The incidence in mid summer in South Australia is 0.7 per 1000 live births, in mid winter in Tasmania it is 6.3 per 1000 live births. It is predicted that if infants under 6 months of age in cold weather were tied into swaddling and placed supine to sleep as in Asia and Czechoslovakia, and older infants who may object to restriction of movement, had the cot made up with the infants' feet touching the lower end, warm clothing and no more than a single thin porous cover, the incidence of SIDS as in Asia and Czechoslovakia could be reduced to < 1.0 per 1000.     

Incomplete and Atypical Kawasaki Disease: A Clinicopathologic Paradox at High Risk of Sudden and Unexpected Infant Death

Incomplete Kawasaki disease (IKD) and atypical Kawasaki disease (AKD) represent rare conditions. Two cases of unexpected or sudden infant death are reported. The diagnosis for a 3-month-old girl was determined by echocardiography, and the child unexpectedly died despite appropriate treatment, whereas autopsy determined the diagnosis of AKD for a 4-month-old boy. In both patients, giant coronary artery aneurysms with thrombosis and vasculitis, myocarditis, and coagulative necrosis were shown at autopsy. These rare forms of IKD and AKD carry a poor prognosis and represent a paradox between the severe cardiovascular damage and the clinical presentation that mimics common and usually self-limiting exanthematic infectious disease in infancy.     

Sudden Infant Death in Stockholm

ABSTRACT. During a ten year period, March 1976-February 1986, 83 non-selected consecutive cases of sudden unexpected death in infants, between one week and one year of age, were examined at the Department of Forensic Medicine in Stockholm. Forty-three deaths (52%) were classified as typical or possible cases of Sudden Infant Death Syndrome (SIDS), 35 (42%) as non-violent non-SIDS cases and 5 (6%) as non-natural deaths. Cardiovascular disease, including myocarditis, was found in 21 (25%) instances, infections with inflammatory manifestations in various organs outside the heart in 12 (14%) and miscellaneous, non-violent causes of death in 2 (2%) cases. The male: female ratio was 1.15:1 for SIDS and 1.30:1 for non-SIDS cases. A peak of incidence was found for SIDS cases in infants between two and four months of age, while non-SIDS victims tended to be somewhat older. Ninety-five percent of the SIDS fatalities occurred during the winter months (October-April) as compared to 71% of the non-SIDS cases. Outdoor temperature below the annual mean of 5.9°C in combination with a sudden decrease in temperature was associated with sudden deaths, particularly SIDS. Thirty-three percent of the SIDS victims died in their cribs compared to 51% of the non-SIDS cases. Corresponding figures for deaths outdoors in a pram were 33% and 11%, respectively. Fourteen percent of the infants in both groups died while in bed with one of the parents. Ninety-five percent of the SIDS victims were previously healthy, but in 9% one or more periods of abnormal breathing had been noted. The corresponding figures for non-SIDS were 70% and 3%, respectively. Among the cases of non-natural deaths was one infant who died of heroin poisoning and one of hypothermia.     

Sudden Unexpected Death in Childhood:A Report of 50 Cases

Sudden unexplained death in childhood (SUDC) is rare, with a reported incidence in the United States of 1.5 deaths per 100,000 live births compared with 56 deaths per 100,000 live births for sudden infant death syndrome in 2001. The objectives of this study include a proposal for a general definition for SUDC and presentation of 36 cases of SUDC and 14 cases of sudden unexpected death in childhood. Cases were accrued through referrals or unsolicited via our Web page (). Our analyses tentatively suggest a SUDC profile characterized by cases being 1 to 3 years in age, predominantly male, and frequently having a personal and family history of seizures that are often associated with a fever. A history of recent minor head trauma is not uncommon. They are usually born at term as singletons and occasionally have a family history of sudden infant death syndrome or SUDC. Most are found prone, often with their face straight down into the sleep surface. Minor findings are commonly seen at postmortem examination but do not explain their deaths. Comprehensive review of the medical history and circumstances of death and performance of a complete postmortem examination including ancillary studies and extensive histologic sampling of the brain are critical in determining the cause of death in these cases of sudden unexpected childhood death. Legislation enabling research and formation of a multicenter research team is recommended to unravel the mystery of SUDC.     

Dermatoglyphics in Sudden Infant Death Syndrome

An analysis of digital and palmar dermatoglyphic patterns was conducted in 173 victims of the sudden infant death syndrome (SIDS). The results expose four dermaloglyphic regions with pattern frequencies differing from those in a control population. These are an excess of Sydney creases, hypothenar patterns, open fields (with fewer vestiges) in interdigital region IV, and arches on all digits (females only). These findings indicate a genetic or early intrauterine environmental influence in SIDS infants. An increased incidence of dysmorphism and anomalies including recognition of specific syndromes support this contention. One could speculate that these dermatoglyphic deviations reflect specific genotypes and/or phenotypes particularly vulnerable to postnatal challenges. Differences in multiple dermatoglyphic categories support the concept of heterogeneity of the SIDS population and multicausality of SIDS.     

Sudden Infant Death Syndrome: Overview and Update

The past decade and a half has seen marked changes in the epidemiology of sudden infant death syndrome (SIDS). The avoidance of certain risk factors such as sleeping prone and cigarette smoke exposure has resulted in the death rate falling dramatically. Careful evaluation of environmental factors and endogenous characteristics has led to a greater understanding of the complexities of the syndrome. The development and implementation of death scene and autopsy protocols has led to standardization in approaches to unexpected infant deaths with increasing diagnoses of accidental asphyxia. Despite these advances, there is still confusion surrounding the diagnosis, with deaths being attributed to SIDS in many communities and countries where death scene investigations and autopsies have not been conducted. The following review provides a brief overview of the historical background, epidemiology, pathology, and pathogenesis of SIDS. Contentious issues concerning the diagnosis and current problems are discussed. Despite calls to abandon the designation, SIDS remains a viable term for infants who die in their sleep with no evidence of accident, inflicted injury, or organic disease after a full investigation has been conducted according to standard guidelines.     

Sudden Infant Death Syndrome and parental smoking

Prenatal exposure to tobacco smoke is a major risk factor associated with Sudden Infant Death Syndrome (SIDS) and the risk has increased despite continued advice against this practice. Evidence from the UK suggests the prevalence of maternal smoking during pregnancy has risen amongst SIDS mothers (from 50% to 80%) when the rate amongst expectant mothers in the general population has fallen (from 30% to 20%) confirming pooled estimates from recent studies of a four-fold risk. An additional risk from postnatal exposure has also been identified; increasing with the number of smokers in the household or the daily hours the infant is subjected to a smoke-filled environment. Exposure may lead to a complex range of effects upon normal physiological and anatomical development in fetal and postnatal life that places infants at greatly increased risk of SIDS. Recent legislation prohibiting smoking in public places needs to emphasise the adverse effects of tobacco smoke exposure to infants and amongst pregnant women.     

Gastroesophageal Reflux and Sudden Infant Death Syndrome

The possible role of gastroesophageal reflux in the pathogenesis of the sudden infant death syndrome (SIDS) has not yet been clearly defined, although it does appear that infants with significant reflux are at greater risk of respiratory complications. A study was undertaken to characterize more precisely the histological features of esophageal mucosa taken from a series of infants who died of SIDS to determine the range of changes present. Full-length strips of mucosa were examined microscopically for reflux-related changes of basal layer hyperplasia, papillary elongation, and intraepithelial eosinophilia. Eight infants (21 %) showed changes considered diagnostic of reflux esophagitis, 17 infants (45%) showed minor nondiagnostic changes, and 13 infants (34 %) showed no histologic abnormalities. These findings demonstrate considerable morphological heterogeneity in a group of infants presenting with sudden and unexpected death. The absence of, or presence of only very minor, pathological alterations within the esophageal mucosae of 79% of infants suggests that reflux of a degree sufficient to cause diagnostic histologic changes is found in only a minority of infants presenting with SIDS.     

Sudden, Unexpected, Natural Death in Childhood

One thousand nine hundred and fifty four autopsies performed at British Columbia's Children's Hospital during a 7-year period were reviewed to determine the causes of sudden unexpected natural death in the age group from birth to 17 years. Of the 126 cases found, the largest group, 86 cases, was sudden infant death syndrome (SIDS). Nine deaths were the result of infection: 4 cases of H. influenza meningitis, 2 cases of meningococcemia, 2 cases of acute epiglottitis, and 1 case of necrotizing tracheo-bronchitis. Epilepsy, ruptured AV malformations, and brain tumors combined to make up an equally large group of 9 cases. Cardiac lesions were the third largest group, 6 cases. The three groups that posed the most difficulty in assigning a cause of death were (a) the group that were like SIDS yet had other confounding features, (b) the group in which metabolic death was suspected but not proven, and (c) death in epilepsy.     

Sudden, Unexpected Death Associated with Meningioangiomatosis: Case Report

We report a case of sudden, unexpected death associated with meningioangiomatosis in a 13-year-old, previously healthy male without a history of seizures, neurologic deficits, or clinical stigmata of neurofibromatosis. There was no family history of neurofibromatosis. The postmortem examination showed a 5-cm mass involving the right posterior frontal and orbital frontal cortex that had microscopic features diagnostic of meningioangiomatosis. Because no other cause of death was found, we postulate that he likely died as a result of a seizure secondary to meningioangiomatosis.