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Sudden Unexpected Death in Neonates: A Clinico-pathological Study.
Jeanette A Reyes1, Gino R Somers1,2, David A Chiasson1,2
11 Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Summary
Sudden unexpected death in neonates (SUD-N) has various causes, including infections and congenital issues. Pathological review is crucial for determining the cause of death in these vulnerable infants.
Area of Science:
- Forensic Pathology
- Neonatal Medicine
- Pediatric Autopsy
Background:
- Sudden unexpected death in the neonatal period (SUD-N) is infrequently studied.
- Understanding anatomical causes of death (CODs) in neonates is critical for public health.
Purpose of the Study:
- To determine the frequency and spectrum of anatomical causes of death (CODs) in sudden unexpected death in neonates (SUD-N).
- To correlate established causes of death with premortem clinical and circumstantial information.
Main Methods:
- Retrospective review of 104 neonatal autopsy reports (1997-2015).
- Analysis of clinical data (obstetrical, neonatal course, circumstances of death).
- Evaluation of autopsy findings, including pathology and ancillary tests to establish COD.
Main Results:
- A cause of death (COD) was established in 44% of cases (46/104).
- Common CODs included infections, congenital abnormalities, and inborn errors of metabolism.
- Prodromal illness and signs of physiological stress were more frequent in cases with an established COD (COD-E) versus undetermined (COD-U).
- Factors associated with COD-U included death during sleep, bed-sharing, heavy lungs, and petechial hemorrhages.
Conclusions:
- Infections, congenital abnormalities, and metabolic disorders are key causes of neonatal death.
- Clinical history and pathological findings aid in determining COD, but absence of prodrome does not exclude it.
- Specialized pediatric autopsy expertise is recommended for SUD-N cases due to diverse pathologies.
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