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Sudden unexplained death in childhood (1-4 years) in Ireland: an epidemiological profile and comparison with SIDS
Cliona M McGarvey1, Myra O'Regan, Jane Cryan
1National Paediatric Mortality Register, Children's University Hospital, Temple St, Dublin 1, Ireland. cliona.mcgarvey@cuh.ie
Insights
Sudden Unexplained Death in Childhood (SUDC) is a distinct entity from Sudden Infant Death Syndrome (SIDS), with differing risk factors. Further research is needed to understand SUDC and improve diagnostic protocols for sudden deaths.
Area of Science:
- Pediatric Pathology
- Epidemiology
- Child Mortality
Background:
- Sudden Unexplained Death in Childhood (SUDC) is a critical area of pediatric mortality research.
- Understanding the epidemiology of SUDC is essential for public health initiatives.
Purpose of the Study:
- To determine the incidence of SUDC in children aged 1-4 years in Ireland.
- To compare the epidemiological characteristics of SUDC with those of Sudden Infant Death Syndrome (SIDS).
Main Methods:
- Review of all sudden unexplained deaths in children under 5 years in Ireland (1994-2008).
- Analysis of epidemiological data from parental questionnaires and post-mortem reports.
- Comparison of cases aged ≥52 weeks (SUDC) with cases <52 weeks (SIDS).
Main Results:
- SUDC represented 5% of deaths in 1-4 year olds; its rate increased while SIDS rates declined.
- SUDC cases had a median age of 71.5 weeks, with a 1.3:1 male/female ratio.
- Significant differences were observed between SUDC and SIDS regarding maternal smoking, bed-sharing, and infant sleeping position.
Conclusions:
- SUDC exhibits distinct epidemiological features compared to SIDS.
- Further investigation is required to ascertain if SUDC and SIDS share a common pathophysiological basis.
- Standardized protocols for investigating sudden deaths are crucial for accurate SUDC diagnosis.
Objective:
To examine the incidence of sudden unexplained death in children 1-4 years old (SUDC) in Ireland and to compare the epidemiological profile of SUDC with that of SIDS.
Design:
All cases of sudden unexplained death in children <5 years in Ireland between 1994 and 2008 were reviewed. Epidemiological information obtained from parental questionnaires and post-mortem reports was examined, and data on cases ≥52 weeks compared with cases <52 weeks.
Results:
SUDC accounted for 5% (n=44) of deaths in children aged 1-4 years during 1994-2008. During this period, the SIDS rate dropped from 0.71 to 0.34 per 1000 live births, while the SUDC rate increased from 0.08 to 0.18 deaths per 10 000 population aged 1-4 years. The median age of SUDC cases was 71.5 weeks, and the male/female ratio was 1.3:1. All died during a sleep period, 71% between 10pm and 8am, and more than two-thirds were found prone. Fewest cases occurred during July-September (11%), and a greater proportion occurred at weekends (55%). 52% (17/33) had symptoms (any) in the 48 h before death, and 35% (11/31) visited their general practitioner because of illness in the week preceding death. SUDC differed from SIDS in prevalence of maternal smoking (38% vs 72%, p<0.001), bed-sharing (17% vs 49%, p<0.001), and whether found prone (72% vs 23%, p<0.001).
Conclusion:
While SUDC shares some characteristics with SIDS, there are also some important differences. Further data collection will help determine whether SIDS and SUDC represent the same pathophysiological entity. Standardisation of protocols for investigating sudden deaths is urgently required for accurate diagnosis of cases.
