title: The role of post-mortem investigations in determining the cause of sudden unexpected death in infancy.
abstract: 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.
authors.affiliation: Department of Paediatric Pathology, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Weber
authors.forename: M T
authors.initials: MT
authors.lastname: Ashworth
authors.forename: R A
authors.initials: RA
authors.lastname: Risdon
authors.forename: J C
authors.initials: JC
authors.lastname: Hartley
authors.forename: M
authors.initials: M
authors.lastname: Malone
authors.forename: N J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: 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