Current Practices in Postmortem Investigation of Sudden Unexpected Death in Infancy.

Area of Science:

• Forensic Pathology
• Pediatric Pathology
• Public Health

Background:

• Sudden unexpected death in infancy (SUDI) remains a significant concern.
• Standardized postmortem investigations are crucial for determining the cause of death.
• Compliance with national guidelines ensures thoroughness and consistency in SUDI case evaluations.

Purpose of the Study:

• To evaluate the current practices of postmortem investigations in sudden unexpected death in infancy (SUDI) cases in France.
• To analyze temporal trends in these investigations from 2015 to 2024.
• To assess the adherence of performed investigations to French National Health Authority guidelines.

Main Methods:

• Retrospective analysis of 1,934 SUDI cases from the French SUDI registry (2015-2024).
• Description and temporal trend analysis of postmortem investigations performed.
• Assessment of compliance with minimum non-invasive postmortem investigation sets for detecting unnatural death, including fundus examinations, imaging, and toxicology.

Main Results:

• Laboratory tests were most frequent (93.0%), while fundus examinations were least frequent (21.6%).
• Significant increases observed in fundus examinations, laboratory tests, bacteriological tests, toxicological tests, and whole-body imaging between 2015 and 2024.
• Only 2.1% of cases met strict French guidelines; 13.2% had minimal non-invasive investigations for detecting unnatural death.

Conclusions:

• While the frequency of certain postmortem investigations has increased, overall adherence to French guidelines remains low.
• There is a need for enhanced local protocols and updated guidelines to ensure comprehensive postmortem investigations in SUDI cases.
• Improving investigation protocols can lead to a more accurate diagnostic approach for sudden unexpected death in infancy.