Evidence for Infection and Inflammation in Infant Deaths in a Country with Historically Low Incidences of Sudden Infant Death Syndrome

Recent evidence indicates that with thorough, high quality death investigations and autopsies, forensic pathologists have recognized that many unexpected infant deaths are, in fact, asphyxial in nature. With this recognition has come a commensurate decrease in, and in some cases, abolition of, the label “sudden infant death syndrome” (SIDS). Current controversies often pertain to how and why some infant deaths are determined to be asphyxial in nature and whether or not apparent asphyxial circumstances are risk factors for SIDS, or rather, harbingers of asphyxial deaths. In an effort to sidestep these controversies, some forensic pathologists elected to instead use the noncommittal label “sudden unexpected infant death” (SUID), leading to the unfortunate consequence of SUID – like SIDS – gaining notoriety as an actual disease that could be diagnosed, studied, and ultimately cured. Although it is not possible to provide death certification guidance for every conceivable type of unexpected infant death, we recognize and propose a simple classification system for overarching themes that cover the vast majority of cases where infants die suddenly and unexpectedly.

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Sudden infant death syndrome in Brazil: fact or fancy?

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000100009 ◽

2008 ◽

Vol 126 (1) ◽

pp. 48-51 ◽

Cited By ~ 2

Author(s):

Francesca Maia Woida ◽

Fabiano Pinto Saggioro ◽

Maria Alice Rossato Ferro ◽

Luiz Cesar Peres

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Sudden Infant Death ◽

Mortality Rates ◽

Sudden Infant ◽

Brazilian Literature ◽

True Incidence ◽

Infant Deaths ◽

Live Births ◽

The City

CONTEXT AND OBJECTIVE: The true incidence of sudden infant death syndrome (SIDS) in Brazil is unknown. The aim here was to identify SIDS cases in the city of Ribeirão Preto, State of São Paulo, between 2000 and 2005, in order to estimate its incidence. DESIGN AND SETTING: Retrospective analysis of data on live births and infant deaths in Ribeirão Preto and from autopsies of infants performed at the Death Verification Service of the Interior (SVOI) between 2000 and 2005. RESULTS: There were 47,356 live births and 537 deaths, with infant mortality rates ranging from 12.9‰ to 10.9‰ of live births. Among the 24 infants who died possibly due to SIDS and who were autopsied at the SVOI, six were from families living in the municipality (0.13‰ of live births): three (50%) were diagnosed as SIDS, and one each (16.66%) as indeterminate cause, bronchoaspiration and cerebral edema. Two deaths occurred in the first month of life (33.33%) and one each (16.66%) at two, four, six and eight months. Two deaths each (33.33%) occurred in the months of February and December, one each in August and October (16.66%). Four cases (66.7%) occurred in the summer and one each (16.66%) in winter and spring. There was 5:1 predominance of males over females. CONCLUSIONS: The frequency of SIDS was lower than what has been reported worldwide and in the Brazilian literature, thus suggesting underdiagnosis, indicating the lack of any specific postmortem protocol for SIDS identification and showing the need to implement this.

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CONTINUOUS MICROBIOLOGICAL AND PATHOLOGICAL STUDY OF 70 SUDDEN AND UNEXPECTED INFANT DEATHS: TOXIGENIC INTESTINAL CLOSTRIDIUM BOTULINUM INFECTION IN 9 CASES OF SUDDEN INFANT DEATH SYNDROME

The Lancet ◽

10.1016/s0140-6736(85)91025-6 ◽

1985 ◽

Vol 325 (8423) ◽

pp. 237-241 ◽

Cited By ~ 60

Author(s):

OrtrudA.R. Sonnabend ◽

WolfgangF.F. Sonnabend ◽

Ulrich Krech ◽

Gisela Molz ◽

Thomas Sigrist

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Clostridium Botulinum ◽

Sudden Infant Death ◽

Sudden Infant ◽

Pathological Study ◽

Infant Deaths

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Sudden Infant Death Syndrome and Unclassified Sudden Infant Deaths: A Definitional and Diagnostic Approach

PEDIATRICS ◽

10.1542/peds.114.1.234 ◽

2004 ◽

Vol 114 (1) ◽

pp. 234-238 ◽

Cited By ~ 471

Author(s):

H. F. Krous

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Sudden Infant Death ◽

Diagnostic Approach ◽

Sudden Infant ◽

Infant Deaths

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Preventing sudden infant death syndrome and other sleep-related infant deaths

Journal of the American Academy of Physician Assistants ◽

10.1097/01.jaa.0000546475.33947.44 ◽

2018 ◽

Vol 31 (11) ◽

pp. 25-30 ◽

Cited By ~ 3

Author(s):

Mazal Maged ◽

Denise Rizzolo

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Sudden Infant Death ◽

Sudden Infant ◽

Infant Deaths

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Sudden Infant Death Syndrome (SIDS) in Denmark: Evaluation of the Increasing Incidence of Registered SIDS in the Period 1972 to 1983 and Results of a Prospective Study in 1987 through 1988

PEDIATRICS ◽

10.1542/peds.89.5.855 ◽

1992 ◽

Vol 89 (5) ◽

pp. 855-859

Author(s):

Karin Helweg-Larsen ◽

Lisbeth B. Knudsen ◽

Markil Gregersen ◽

Jørn Simonsen

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Respiratory Infections ◽

Sudden Infant Death ◽

Epidemiological Studies ◽

Sudden Infant ◽

Unexpected Death ◽

National Board ◽

Infant Deaths ◽

Live Births

To investigate a reported increase, from 0.4 to 1.3 per thousand live births, in the Danish incidence of sudden infant death syndrome (SIDS), a retrospective analysis of SIDS in Denmark from 1972 to 1983 was carried out. Based on data registered with the National Board of Health, a notable regional difference in SIDS rate between the western and eastern parts of Denmark was found. This difference did not correlate with the overall postneonatal mortality by region. Danish law requires medicolegal investigation in all cases of sudden unexpected death. Medicolegal autopsies are performed only in the three forensic institutes which cover all of Denmark. Despite the law and a uniform organization of the forensic medical services, differing application of postmortem examinations and individual interpretation of the history and autopsy in cases of sudden infant death existed. Differences in reporting of respiratory infections, suffocation, and cardiac malformation were found to contribute to the increase and to regional disparities in SIDS incidence. The three Danish forensic institutes examined all cases of sudden infant deaths in Denmark 1987 and 1988. These cases were classified as explained cause of death, pure SIDS, and atypical SIDS; atypical cases were evaluated by consensus. The SIDS incidence (the number of classic SIDS and atypical SIDS per thousand live births) was 1.9 in 1987 and 1.3 in 1988, and it was identical in the eastern and western part of Denmark; however, a higher incidence both of overall postneonatal and SIDS mortality was found in the middle region of Denmark. The analysis stresses the importance of high autopsy rate and expert investigation in all cases of infant death in order to obtain reliable data for epidemiological studies. A prospective joint study of all postneonatal infant deaths in Finland, Iceland, Norway, Sweden, and Denmark will be carried out to analyze the reliability and the possible cause of reported differences in SIDS incidence in the five Nordic countries.

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Sudden Infant Death Syndrome: Overview and Update

Pediatric and Developmental Pathology ◽

10.1007/s10024-002-0205-8 ◽

2003 ◽

Vol 6 (2) ◽

pp. 112-127 ◽

Cited By ~ 72

Author(s):

Roger W. Byard ◽

Henry F. Krous

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Sudden Infant Death ◽

Historical Background ◽

Cigarette Smoke Exposure ◽

Sudden Infant ◽

Death Scene ◽

Infant Deaths ◽

The Past ◽

Full Investigation

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.

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