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Potential Role of Febrile Seizures and Other Risk Factors Associated With Sudden Deaths in Children
Laura Gould Crandall1,2, Joyce H Lee2, Rebecca Stainman2
1Sudden Unexplained Death In Childhood Foundation, Roseland, New Jersey.
Insights
Sudden unexplained death in childhood (SUDC) is underrecognized. This study found elevated febrile seizure (FS) rates in SUDC and sudden explained death in childhood (SEDC), suggesting seizures may contribute to these deaths.
Area of Science:
- Pediatric Mortality
- Neurology
- Forensic Pathology
Background:
- Sudden unexplained death in childhood (SUDC) is a significant cause of toddler mortality, yet it remains understudied.
- Febrile seizures (FS) are common in young children, but their association with SUDC requires further investigation.
Purpose of the Study:
- To investigate the role of febrile seizures (FS) and other risk factors in sudden unexplained death in childhood (SUDC).
- To describe the epidemiology, potential mechanisms, and prevention strategies for SUDC.
Main Methods:
- A case series analysis of 622 sudden child death cases (ages 1-17) from 18 countries (2001-2017).
- Data collected via comprehensive interviews with families of 391 decedents (ages 1-6) and forensic evaluations.
- Analysis compared FS prevalence in SUDC and sudden explained death in childhood (SEDC) cases against the general population.
Main Results:
- Elevated FS prevalence was observed in both SUDC (28.8%) and SEDC (22.1%) cases compared to the general population (2%-5%).
- The odds of death during sleep were 4.6 times higher in SUDC cases than in SEDC cases.
- No premature deaths from SUDC occurred among followed-up siblings of SUDC cases.
Conclusions:
- This study confirms an increased FS rate in SUDC and identifies significantly elevated FS rates in SEDC.
- Findings suggest that seizures may be a contributing factor in some SUDC and SEDC deaths.
- Population-based studies are essential to define SUDC epidemiology, risk factors, and identify high-risk individuals for preventive strategies.
Importance:
Sudden unexplained death in childhood (SUDC) is the fifth leading category of death among toddlers but remains underrecognized and inadequately studied.
Objective:
To assess the potential role of febrile seizures (FS) and other risk factors associated with SUDC and describe the epidemiology, mechanisms, and prevention of SUDC.
Design, Setting, And Participants:
This case series study reviewed 622 consecutive sudden child death cases aged 1 to 17 years from 2001 to 2017 from 18 countries. Data were collected from family members of children who died suddenly; these families voluntarily registered with the SUDC Foundation. Data analysis was conducted from November 2017 to February 2019.
Main Outcome Measures:
Certified manner of death characterized as accident, natural, or undetermined.
Results:
A total of 391 families with decedents aged 1 to 6 years completed a comprehensive interview on medical and social histories, and circumstances of death with forensic evaluations revealing a cause of death (sudden explained death in childhood [SEDC]) or no cause of death (SUDC). Of these children, 231 (59.1%) were male, the mean (SD) age at death was 24.9 (12.8) months, and 104 (26.6%) had a history of FS. Compared with the general population FS prevalence (2%-5%), FS prevalence among SUDC (28.8%; 95% CI, 23.3%-34.2%) and SEDC (22.1%; 95% CI, 14.8%-29.3%) were elevated. The odds of death during sleep was 4.6-fold higher in SUDC than in SEDC cases (odds ratio, 4.61; 95% CI, 1.92-11.09; adjusted P = .008). The siblings of SUDC cases were followed up for 3144 life-years, and none died prematurely from SUDC.
Conclusions And Relevance:
This analysis of the largest SUDC cohort confirmed an increased FS rate and found significantly increased rates of FS among SEDC. This study suggests that seizures may contribute to some SUDC and SEDC deaths. The risk of sudden death in a sibling was low. To develop and assess preventive strategies, population-based studies are needed to define the epidemiology and spectrum of risk factors and identify biomarkers of patients with FS at high risk of sudden death.
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