Inconsistent classification of unexplained sudden deaths in infants and children hinders surveillance, prevention and research: recommendations from The 3rd International Congress on Sudden Infant and Child Death

Abstract This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26–27, 2018 at the Radcliffe Institute at Harvard University. The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. We describe the diagnostic shift away from SIDS and the practical issues contributing to it. The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers. SIDS was reframed as unexplained sudden death in infancy or SIDS/MH11 to emphasize that either term signifies the lack of explanation following a rigorous investigation. A distinct category for children over the age of 1 was recommended (MH12). Definitions and exclusions were provided for the alternative categories of accidental asphyxia and undetermined. As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. The conclusions will be submitted to the World Health Organization for inclusion in the upcoming ICD-11.

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Myocarditis Presenting as Sudden Death in Infants and Children: A Single Centre Analysis by ESGFOR Study Group

Pediatric and Developmental Pathology ◽

10.1177/10935266211007262 ◽

2021 ◽

pp. 109352662110072

Author(s):

Oana Neagu ◽

Amparo Fernández Rodríguez ◽

Domitille Callon ◽

Laurent Andréoletti ◽

Marta C Cohen

Keyword(s):

Sudden Death ◽

Influenza A ◽

Group A Streptococcus ◽

Acute Myocarditis ◽

Clinical History ◽

Infants And Children ◽

Group A ◽

Clinical Awareness ◽

Type 3 ◽

In Infants And Children

Background Acute myocarditis is an inflammatory disease of the heart mostly diagnosed in young people, which can present as sudden death. The etiology includes infectious agents (mostly viruses), systemic diseases and toxins. We aim to characterize infants and children with myocarditis at post-mortem presenting as sudden deaths. Methods Retrospective evaluation of 813 post-mortems in infants and children dying suddenly and unexpectedly between 2009–2019. Data retrieved included histological features, microbiology and clinical history. Results 23 of 813 post-mortems reviewed corresponded to acute myocarditis and 1 to dilated cardiomyopathy related to remote Parvovirus infection. PCR identified enterovirus (7), parvovirus (7 cases, 2 also with HHV6 and 1 case with EVB), Influenza A (1), Parainfluenza type 3 (1). Two cases corresponded to hypersensitivity myocarditis, 1 was Group A Streptococcus and 5 idiopathic myocarditis. Enterovirus was frequent in infants (7/10), and in newborns was associated with meningoencephalitis or congenital myocarditis. More than 50% were less than 2 years of age and all remained clinically unsuspected. Conclusion Myocarditis represents almost 3% of all sudden pediatric deaths. Enterovirus and parvovirus were the most common viruses. This retrospective analysis showed that patients experienced viral symptoms but remained unsuspected, highlighting the need for more clinical awareness of myocarditis.

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Investigation and Review of Unexpected Infant and Child Deaths

PEDIATRICS ◽

10.1542/peds.92.5.734 ◽

1993 ◽

Vol 92 (5) ◽

pp. 734-735

Author(s):

Keyword(s):

Public Health ◽

United States ◽

Child Abuse ◽

Child Death ◽

Significant Proportion ◽

The United States ◽

Medical Examiner ◽

Sudden Infant ◽

Child Deaths ◽

Death Investigation

A significant proportion of infant and child deaths are preventable. Of the 55 861 deaths of children aged 14 and younger in the United States in 1989, more than three fourths occurred in children under the age of 2 years.1 Approximately one third of the latter were unexpected, including those due to sudden infant death syndrome (SIDS) or trauma, or deaths that were otherwise unexplained. Child abuse deaths occur in greatest numbers among infants, followed by those in toddlers and preschool children.2 Children younger than 6 years of age are most vulnerable to abuse because of their small size, incomplete verbal skills, and often limited contact with adults other than their primary caretakers.3 With few exceptions, throughout the United States there is no uniform system for the investigation of infant and child deaths. Many jurisdictions lack appropriately trained pathologists, interagency collaboration hat would facilitate sharing of information about the family, and a surveillance system to evaluate data regarding infant deaths. As a result, progress in the understanding of SIDS is inhibited, cases of child abuse and neglect may be missed, familial genetic diseases go undiagnosed, public health threats may be unrecognized, and inadequate medical care may be undetected. Lack of adequate infant and child death investigation is an impediment to preventing illness, injury and death of other children at risk. Adequate death investigation requires the participation of numerous individuals including medical examiner/coroner, public health officials, the patient's physician, the pathologist, and personnel from agencies involved with child welfare and social services and law enforcement.

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Breast Feeding versus Formula Feeding and Diarrheal Diseases in Infants and Children- A Review

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v32i1.21033 ◽

2014 ◽

Vol 32 (1) ◽

pp. 26-30 ◽

Cited By ~ 1

Author(s):

MUH Begum

Keyword(s):

Breast Feeding ◽

Exclusive Breastfeeding ◽

Diarrheal Disease ◽

Formula Feeding ◽

Infants And Children ◽

World Health ◽

Human Breast Milk ◽

Diarrheal Diseases ◽

Health Organization ◽

In Infants And Children

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life. Human breast milk is the healthiest form of milk for babies. Breastfeeding promotes health and helps to prevent diseases including diarrheal diseases. It contains all nutrients including antibodies (IgA),and lactoferrin, that potentially prevent infection and diarrhea in infants and children. Studies conducted in both developed and under developed nations have found that breast feeding is associated with significantly ( upto 64%) less diarrheal disease and the protective effect of breast feeding does not persist beyond two months after breast feeding is stopped. On the other hand, formula fed infants are found an upto 80% increased in the risk of developing diarrhea compared to breast fed infants and there is significantly more diarrheal disease in formula fed infants. Infection may be attributable to contamination of bottles, teats, milk, and food in infants who are not exclusively breastfed. Exclusive breastfeeding for the first six months of life and there after complementary feedings while breastfeeding continues for up to two years of age or beyond, enthusiastic support and involvement from clinicians, obstetricians and pediatricians, are essential in breastfeeding vs formula feeding issue and to reduce incidence of diarrheal diseases in infants and children. DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21033 J Bangladesh Coll Phys Surg 2014; 32: 26-30

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The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2020.110093 ◽

2020 ◽

Vol 135 ◽

pp. 110093

Author(s):

Luca Verrecchia ◽

Katarina Galle Barrett ◽

Eva Karltorp

Keyword(s):

Cochlear Implant ◽

Infants And Children ◽

Validity And Reliability ◽

Vestibular Assessment ◽

Child Friendly ◽

In Infants And Children

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Esophageal Hiatal Hernia in Infants and Children

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000420 ◽

1981 ◽

Vol 90 (4) ◽

pp. 387-391 ◽

Cited By ~ 5

Author(s):

Blair Fearon ◽

Israel Brama

Keyword(s):

Hiatal Hernia ◽

Sudden Infant Death ◽

Infants And Children ◽

High Rate ◽

Sudden Infant ◽

Esophageal Hiatal Hernia ◽

Esophageal Strictures ◽

Sick Children ◽

Medical Regime ◽

In Infants And Children

Although prior to 1950 esophageal hiatal hernia (EHH) in children was a seldom recognized entity, it has since then become well known. The symptoms in children are considerably different from those in adults. The cause of EHH is still somewhat in doubt. The term gastroesophageal reflux (GER) is often applied as a diagnosis where the diagnosis is uncertain. The authors have reviewed case histories of 56 patients admitted to the Hospital for Sick Children, Toronto, from 1972 to 1980. A comparison is made with 101 cases admitted between 1952 and 1960. It is our firm belief that all patients with symptoms of GER should be esophagoscoped for definitive diagnosis as well as for assessment of the esophagus. Because there is a high rate of respiratory complications in infants and children with GER, bronchoscopy should be carried out concurrently with the esophagoscopy. Infants with GER are at risk from the possibility of aspiration and it is possible that an unknown number of sudden infant death syndrome is due to this factor. The majority of patients with EHH can be managed by a medical regime. Those with esophageal strictures are treated by dilatation but many require surgical correction.

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Assessment of Anemia Levels in Infants and Children in High Altitude Peru

Global Journal of Health Science ◽

10.5539/gjhs.v9n7p87 ◽

2017 ◽

Vol 9 (7) ◽

pp. 87 ◽

Cited By ~ 3

Author(s):

Roxanne Amerson ◽

Lisa Duggan ◽

Michelle Glatt ◽

Kate Ramsey ◽

Jenna Baker

Keyword(s):

Pilot Study ◽

High Altitude ◽

Public Health Problem ◽

Dietary Factors ◽

Infants And Children ◽

World Health ◽

Prevalence Rates ◽

Chi Square ◽

Anthropometric Measures ◽

In Infants And Children

When prevalence rates of anemia exceed 40%, the World Health Organization recognizes this as a severe public health problem. In Peru, approximately 43.5% (urban) and 51.1% (rural) of children between the ages of 6 and 36 months have anemia. Currently, limited data exists regarding prevalence rates in many of the high altitude regions of Peru. The main purpose of this pilot study was to establish evidence of anemia in infants and children (7 months through 5 years of age) living in the rural, mountainous region of Ollantaytambo District. This pilot study utilized a quantitative, cross-sectional design to assess the presence of anemia in infants and children. Hemoglobin levels were collected from 160 children across 12 villages where elevations ranged from 2800 to 4100 meters above sea level. Chi Square tests compared anemia with age ranges, altitude, anthropometric measures, breastfeeding patterns, and types of communities. Adjusted hemoglobin levels established 47.5% of the 160 participants were anemic. Chi Square results indicated children aged 25-36 months and children living in communities at 3100 and 4100 meters displayed higher than expected rates of anemia. Results confirmed high rates of anemia and the need for education related to dietary factors.

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Are SIDS, SUDC and SUDEP the different masks of the same great mystery?

Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) ◽

10.21508/1027-4065-2021-66-5-10-14 ◽

2021 ◽

Vol 66 (5) ◽

pp. 10-14

Author(s):

L. A. Kravtsova

Keyword(s):

Infant Mortality ◽

Sudden Death ◽

Child Death ◽

Well Being ◽

Developed Countries ◽

Early Morning ◽

Sudden Infant ◽

Unexpected Death ◽

Night Time ◽

Unexplained Death

The cases of sudden, unexpected child death against the background of relative clinical well-being, i.e., in the absence of apparent reasons take a special place in the structure of infant mortality. Sudden Infant Death Syndrome (SIDS), which is recognized as one of the leading causes of postnatal infant mortality in most developed countries, is the most common cause of unexpected out-ofhospital death of a child. Today SIDS remains one of the most mysterious problems in medicine. The lack of identifiable mechanisms causing SIDS has led to a large number of theories about the mechanisms responsible for death due to this syndrome. Also, sudden unexplained death in childhood (SUDC), which is the unexplained death of children over one- year-old, is currently distinguished among cases of unexpected death. The main clinical features of SUDC include: more common in boys; death occurs at night time, children are found in the early morning in a prone position, face down; children often have convulsions, including febrile ones in the clinical symptom complex during life. Several authors have noted that in some cases, the death due to SUDC resembles Sudden Death in Epilepsy (SUDEP), which is the leading cause of death in epilepsy. To date, it has already been shown that SUDEP is one of the forms of canalopathies characteristic of young children and it is associated with a high risk of sudden death. The mechanisms of thanatogenesis in SUDEP remain unknown. SIDS, SUDC, and SUDEP are a series of fatal syndromes united by multifactorial pathophysiological mechanisms, the causes of which are not fully understood. In fact, these syndromes represent a catastrophic multisystem failure, which is caused by an extremely unfavorable combination of autonomic, respiratory and cardiogenic disorders.

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