Toxicological analysis in sudden infant death syndrome: A call for

In 2006 the obligation of autopsy for Sudden Infant Death Syndrome (SIDS) was introduced in Italy by the Ministry of Health and a national protocol was approved in 2014. No data are yet available concerning its systematic application and our toxicology results raise an epidemiological alert related to SIDS.

A prospective postmortem investigation including toxicological and genetic analysis on consecutive sudden unexpected death in infants < 1 year of age was conducted in North-East, Italy in the time interval 2019-2024.

Unexpected positive toxicological results were found in 7 out of 9 cases (3 males, mean age 7 ± 4.38 months, range 2-11) for ethanol and the most common drugs of abuse, otherwise normal at gross, histological and molecular investigations. Toxicological analysis was positive in fluids and tissues, but most importantly in hair. Five out of seven were found in co-sleeping with parents. In one patient, a likely pathogenic mutation in SCN5A gene was identified.

The routine application of standardized toxicological protocols as established by law improves the diagnosis of sudden unexpected death in infants for epidemiology and preventive strategies. Data collection of drug concentrations is mandatory to better understand the cause and mechanism of death in SIDS.