Article

Sudden Unexpected Death in Childhood:A Report of 50 Cases

Department of Pathology, Children's Hospital and Health Center, San Diego, CA 92123, USA.
Pediatric and Developmental Pathology (Impact Factor: 0.87). 01/2005; 8(3):307-19. DOI: 10.1007/s10024-005-1155-8
Source: PubMed

ABSTRACT

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 (http://www.sudc.org ). 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.

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    • "Nadeau-Manning, 2005). The rate of death was 1.5 per 100,000 live births per year, and although rare medical examiners have seen these cases in children up to age 18 (Krous et al., 2005). In an effort to classify these types of death for research the term sudden unexplained death in childhood (SUDC) was created. "
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    ABSTRACT: This phenomenological study examines the lived experience of professionals who have assisted parents after the sudden unexpected death of their child from sudden infant death syndrome, sudden unexpected infant death, and sudden unexplained death in childhood. Interview material was analyzed using Creswell's six-step approach to qualitative data. Three types of involvement emerged as themes: early enmeshed emotions, emotional detachment, and compassionate detachment. Compassionate detachment marked a balance between emotional engagement with the newly bereaved parents and cognitive detachment from the trauma. All professionals mentioned relying on a philosophy of life and death as a means of coping with the stress of these cases. Having a solid cognitive belief structure seemed to be a protective factor when working with the sudden and unexplained death of a child. A case is made for the need for organizations to mitigate the deleterious effects of stress and burnout among health and emergency workers by providing psychological first aid and support to individuals that regularly respond to unexplained child deaths.
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    • "European groups as well as groups from USA and Australia proposed protocols for the management and investigation of cases of SUDI, which emphasize the multidisciplinary nature of these investigations and set the autopsy in the context of a greater whole [7]. Even though the developmental anatomy and physiology of infants and children are different, the sophisticated investigative methods developed during clinical, pathological, and laboratorial research into SIDS can and should be applied to sudden unexpected death in childhood (SUDC) [8]. Sudden death in childhood is rare. "
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    ABSTRACT: Unexpected child death investigation is a difficult area of forensic practice in view of the wide range of possible genetic, congenital, and acquired natural and nonnatural causes. Idiopathic infantile arterial calcification (IIAC) is a rare autosomic recessive disease usually diagnosed postmortem. Inactivating mutations of the ENPP1 gene were described in 80% of the cases with IIAC. We report a case of a 5-year-old girl submitted to a forensic autopsy due to sudden death and possible medical negligence/parents child abuse. Major alterations found (intimal proliferation and deposition of calcium hydroxyapatite around the internal elastic lamina and media of arteries; acute myocardial infarct, stenotic and calcified coronary artery; perivascular and interstitial myocardial fibrosis; and subendocardial fibroelastosis) were diagnostic of IIAC. We reviewed IIAC cases published in the English literature and highlight the importance of adequate autopsy evaluation in cases of sudden child death.
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