Sudden infant and fetal death: comparative analysis of international legislation and medico-legal issues

Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Fetal Death (SUFD) raise complex clinical, ethical, legal, and forensic issues. Determining the cause of death is essential both for family bereavement support and for prevention strategies.

A comparative analysis was conducted on national regulations and standard practices in five selected countries (Italy, France, Spain, Germany and United Kingdom). Sources included national legislation, implementing regulations, and peer-reviewed literature. Comparison focused on: (1) performance of post-mortem examination/autopsy, (2) use of post-mortem imaging, and (3) implementation of national registries.

In Italy, with parental consent, post-mortem examinations may be authorized by hospital medical directors; in all five countries, judicial authorities can mandate autopsies in suspected criminal cases, while the role of hospital physicians varies by national context. In the UK, authority lies with the coroner, an independent judicial officer empowered to investigate unexplained deaths. Post-mortem imaging is fully integrated only in the UK; it remains non-standardized in other countries. The UK (NCMD) maintains a compulsory national database, while France (OMIN) operates a voluntary national observatory for sudden infant deaths. Spain launched a stillbirth registry in 2023 (for gestational age ≥ 6 months), though clinical-epidemiological implementation is pending. Italy lacks a national registry, relying instead on a surveillance network coordinated by the Italian National Institute of Health (ISS).

Marked differences in regulatory and operational frameworks persist across Europe. Harmonizing protocols, standardizing imaging use, and establishing national registries are essential steps toward improving diagnostic accuracy and implementing effective SIDS and SUFD prevention measures.