Current Practices in Postmortem Investigation of Sudden Unexpected Death in Infancy

To assess postmortem investigations performed in sudden unexpected death in infancy (SUDI) cases in daily practice in France.

Children deceased from SUDI and registered in the French SUDI registry from 2015 to 2024 were included retrospectively. The postmortem investigations performed in SUDI cases were described, their temporal trends since 2015 and their compliance with the French National Health Authority guidelines were assessed. The minimum set of non-invasive postmortem investigations performed in cases required to detect unnatural death, including fundus examinations, imaging and toxicological tests, was studied.

We examined 1 934 SUDI cases. Laboratory tests were the most frequently performed procedures (93.0%), and fundus examinations were the least frequent (21.6%). There was a significant increase in fundus examinations (9.3% to 31.6%), laboratory tests (87.6% to 97.3%), bacteriological tests (91.4% to 97.2%), toxicological tests (79.0% to 91.0%), and whole-body imaging (75.2% to 87.3%) from 2015 to 2024. Only 2.1% of cases were investigated strictly according to the French guidelines. We found that 13.2% of cases underwent minimal non-invasive postmortem investigation for detecting unnatural death.

Although certain investigations are performed more frequently, efforts to improve local protocols and updated guidelines are needed to ensure thorough postmortem investigations, resulting in an improved diagnostic approach.