SUDI investigations should be led by coroners, supported by experienced paediatric pathologists
Jeffery and colleagues examined how sudden unexpected deaths in infancy (SUDI) are investigated in Australia in a questionnaire‐based study,1 reported in this issue of the MJA. They unsurprisingly exposed gaps in the process and unsuitable approaches to investigating these deaths. As Jeffery and colleagues note, the definition of SUDI encompasses all cases in which an infant dies (or suffers a collapse that leads to death) before the age of twelve months, the death could not have been anticipated 24 hours earlier, and no medical cause is apparent. The SUDI definition includes all such deaths, whether they are subsequently explained or not, and thus encompasses sudden infant death syndrome (SIDS), a diagnosis that requires a complete investigation, including history, death scene investigation, and full autopsy. In the absence of generally recognised causes, the investigation of SUDI is a special situation: each case is a subject of research or a problem to be solved.
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- 1. Jeffery HE, Carberry AE, Gordon A, Arbuckle S. The investigation of sudden unexpected deaths in infancy in Australia. Med J Aust 2023; 218: 262‐263.
- 2. Hilton JMN. The pathology of the sudden infant death syndrome. In J. K. Mason, editor. Paediatric forensic medicine and pathology. Dordrecht: Springer Science+Business Media, 1989; pp. 156‐164.
- 3. Filiano JJ, Kinney HC. A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple‐risk model. Biol Neonate 1994; 65: 194‐197.
- 4. Oehmichen, M. Recent neuropathologic research in sudden infant death syndrome. A critical review with special consideration of the brain stem. In: Maehly A, Williams R, editors. Forensic science progress, volume 4. Berlin, Heidelberg: Springer; pp. 127‐139.
- 5. Morris JA, Haran D, Smith A. Hypothesis: common bacterial toxins are a possible cause of the sudden infant death syndrome. Med Hypotheses 1987; 22: 211–222.
- 6. Blackwell CC, Gordon AE, James VS, et al. The role of bacterial toxins in sudden infant death syndrome (SIDS). Int J Med Microbiol 2002; 291: 561‐570.
- 7. Blackwell C, Moscovis S, Hall S, et al. Exploring the risk factors for sudden infant deaths and their role in inflammatory responses to infection. Front Immunol 2015; 6: 44.
- 8. Goldwater PN. Infection: the neglected paradigm in SIDS research. Arch Dis Child 2017; 102: 767‐772.
- 9. Ponsonby AL, Dwyer T, Gibbons LE, et al. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med 1993; 329: 377‐382.
- 10. Helweg‐Larsen K, Lundemose J, Øyen N, et al. Interactions of infectious symptoms and modifiable risk factors in sudden infant death syndrome. The Nordic Epidemiological SIDS study. Acta Pædiatrica 1999; 88: 521‐527.
- 11. Goldwater PN. SIDS, prone sleep position and infection: an overlooked epidemiological link in current SIDS research? Key evidence for the “infection hypothesis”. Med Hypotheses 2020; 144: 110114.
- 12. Royal College of Pathologists (United Kingdom). Sudden unexpected death in infancy and childhood: multi‐agency guidelines for care and investigation. 2nd edition. Nov 2016. https://www.rcpath.org/uploads/assets/874ae50e‐c754‐4933‐995a804e0ef728a4/Sudden‐unexpected‐death‐in‐infancy‐and‐childhood‐2e.pdf
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