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Postmortem diagnostics in sudden unexpected death in infants and children: use and utility
A M Pries1, A C van der Gugten2, H A Moll3
1Department of General Paediatrics, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands. a.pries@erasmusmc.nl.
Insights
A comprehensive postmortem evaluation, including autopsy, microbiological testing, and imaging, is crucial for determining the cause of sudden unexpected death in infants and children. These investigations aid in identifying preventable causes and improving child safety strategies.
Area of Science:
- Forensic Pathology
- Pediatric Pathology
- Public Health
Background:
- Sudden unexpected death in infants (SUDI) and children (SUDC) necessitates thorough investigation to determine causes and prevent future occurrences.
- The standardized postmortem evaluation of sudden unexpected death in infants and children (PESUDIC) procedure is utilized in the Netherlands for these investigations.
Purpose of the Study:
- To examine the utilization and effectiveness of various diagnostic tests within the PESUDIC procedure.
- To identify the contribution of different investigations in determining the cause of death in SUDI and SUDC cases.
Main Methods:
- An observational study analyzed data from 275 infants and children who underwent the PESUDIC procedure between 2016 and 2022.
- Data included medical history, postmortem examinations, and diagnostic test outcomes, with findings classified as contributory or decisive by expert consensus.
- Key investigations included medical history review, biochemical and microbiological testing, total body postmortem CT/MRI, and autopsy.
Main Results:
- The cause of death was determined in 70% (193/275) of cases.
- Autopsy (67%) and microbiological testing (44%) provided decisive findings most frequently.
- A combination of over two tests yielded contributory findings in 52% of diagnosed cases, highlighting the value of a multi-faceted approach.
Conclusions:
- A wide array of postmortem investigations, beyond autopsy alone, adds significant value in identifying the cause of death in SUDI and SUDC.
- A comprehensive SUDI/SUDC investigation should minimally incorporate autopsy, microbiological testing, and whole-body imaging.
Abstract:
Sudden unexpected death in infants (SUDI) and children (SUDC) requires thorough investigation to identify causes and prevention strategies. In the Netherlands, these deaths are investigated using the standardized postmortem evaluation of sudden unexpected death in infants and children (PESUDIC) procedure. This study examines the use of various diagnostic tests within PESUDIC and their effectiveness in determining causes of death. This observational study included infants and children who died suddenly and underwent the PESUDIC procedure from 2016 to 2022. Standardized data on medical history, postmortem examinations, and diagnostic outcomes were collected. Findings were classified by consensus of two experts as "contributory" if they supported the cause of death and "decisive" if they were leading for determination. A total of 275 cases were included. Median age was 13 months (IQR 3.5-73.3). Fifty-nine percent were boys. Over 95% of cases had a medical history, postmortem physical examination, biochemical, and microbiological testing available. Total body postmortem CT and/or MRI was done in 93% (n = 255) and autopsy in 62% (n = 171). The cause of death was determined in 193 (70%). History, imaging, and autopsy provided contributory results in 50% (n = 137/275), 40% (n = 103/255), and 67% (n = 115/171) of applicable cases, respectively. More than two different tests showed contributory findings in 52% of diagnosed cases. Autopsy and microbiological testing had decisive findings most often: in 83/171 and 44/265 cases respectively.
Conclusion:
A routinely performed wide array of postmortem investigations has additional value to an autopsy for identifying the cause of death in SUDI and SUDC. A thorough SUDY investigation should therefore minimally include an autopsy, microbiological testing, and whole-body imaging.
What Is Known:
• A thorough postmortem investigation into the cause of sudden death in infants and children can provide an explanation of the death and identify potential preventable causes.
What Is New:
• A thorough postmortem investigation for sudden unexpected death in infants and children should minimally include an autopsy, microbiological testing and whole-body imaging.
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