The role of post-mortem investigations in determining the cause of sudden unexpected death in infancy.
BACKGROUND
Several autopsy protocols have been suggested for investigating sudden unexpected deaths in infancy (SUDI). The aim of this study is to provide data on the utility of such post-mortem investigations from a large paediatric autopsy series to inform future policy.


METHODS
Retrospective analysis of >1500 consecutive post-mortem examinations carried out by specialist paediatric pathologists at a single centre during a 10-year period according to a common autopsy protocol that included the use of detailed ancillary investigations. SUDI was defined as the sudden unexpected death of an infant aged from 7 to 365 days. All data capture and cause of death classification were carried out according to defined criteria.


RESULTS
Of 1516 paediatric post-mortem examinations, 546 presented as SUDI. In 202 infants (37%), death was explained by the autopsy findings. The other 344 cases (63%) remained unexplained. Of the explained deaths, over half (58%) were infective, most commonly due to pneumonia (22%). The component of the post-mortem examination that primarily determined the final cause of death was histological examination in 92 infants (46%), macroscopic examination in 61 (30%), microbiological investigations in 38 (19%) and clinical history in 10 (5%).


CONCLUSIONS
This constitutes the largest single-institution autopsy study of SUDI. Ten years on from the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) SUDI studies, the ascertainment of a cause of death at autopsy has improved. However, with almost two thirds of SUDI remaining unexplained, alternative and/or additional diagnostic techniques are required to improve detection rates of identifiable causes of death at autopsy.
Weber
M A
MA
Department of Paediatric Pathology, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, UK.
Ashworth
M T
MT
Risdon
R A
RA
Hartley
J C
JC
Malone
M
M
Sebire
N J
NJ
D017677:Age Distribution; D001344:Autopsy; D005260:Female; D005554:Forensic Medicine / Q000379:methods; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013398:Sudden Infant Death / Q000209:etiology* / Q000473:pathology