Abstract
PurposeThe purpose of this study was to determine the major subcategories and clinicopathologic features of sudden unexpected death in young children in a large retrospective cohort, and to confirm the association of sudden unexplained death in children (abbreviated by us for unexplained deaths as SUDC) with hippocampal pathology and/or febrile seizures.MethodsWe undertook analysis of a retrospective cohort of 151 cases, of which 80 % (121/151) were subclassified as SUDC, 11 % (16/151) as explained, 7 % (10/151) as undetermined, and 3 % (4/151) as seizure-related.ResultsThere were no significant differences between SUDC and explained cases in postnatal, gestational, or postconceptional age, frequency of preterm birth, gender, race, or organ weights. In contrast, 96.7 % (117/121) of the SUDC group were discovered during a sleep period compared to 53.3 % (8/15) of the explained group (p < 0.001), and 48.8 % (59/121) of the SUDC cases had a personal and/or family history of febrile seizures compared to 6.7 % (1/15) of the explained group (p < 0.001). Of the explained deaths, 56 % (9/16) were subclassified as infection, 31 % (5/16) cardiac, 6 % (1/16) accidental, and 6 % (1/16) metabolic. Two of the three cases specifically tested for cardiac channelopathies at autopsy based upon clinical indications had genetic variants in cardiac genes, one of uncertain significance. Bacterial cultures at autopsy typically revealed organisms interpreted as contaminants. Two of the four seizure-related deaths were witnessed, with two of the brains from these cases showing generalized malformations. Hippocampal anomalies, including a specific combination we termed hippocampal maldevelopment associated with sudden death, were found in almost 50 % (40/83) of the SUDC and undetermined cases in which hippocampal sections were available.ConclusionsThis study highlights the key role for the hippocampus, febrile seizures, and sleep in SUDC pathophysiology. It also demonstrates the role of known predisposing conditions such as cardiac channelopathies and infections in causing sudden unexpected death in childhood, and the need for improved ancillary testing and protective strategies in these cases, even when the cause of death is established at autopsy.
Highlights
Sudden unexplained death in childhood (SUDC) is the sudden and unexpected death of a child older than 1 postnatal year that remains unexplained after a review of the clinical history and circumstances of death, and the performance of a complete autopsy [1]
This study highlights the key role for the hippocampus, febrile seizures, and sleep in SUDC pathophysiology
It demonstrates the role of known predisposing conditions such as cardiac channelopathies and infections in causing sudden unexpected death in childhood, and the need for improved ancillary testing and protective strategies in these cases, even when the cause of death is established at autopsy
Summary
Sudden unexplained death in childhood (SUDC) is the sudden and unexpected death of a child older than 1 postnatal year that remains unexplained after a review of the clinical history and circumstances of death, and the performance of a complete autopsy [1]. In 1999, the San Diego SUDC Research Project was founded to attempt to discover the causes of these deaths through in-depth review of retrospectively accrued cases via national and international referrals to a centralized database [6, 7]. While such a dataset is limited by its retrospective, non-population based design, in an initial study we were able to identify a subset of SUDC cases with multiple structural abnormalities of the hippocampus with or without a personal and/or family history of febrile series [8]. We report the findings of the entire database from 1999 to 2011, which includes an addition of 87 cases of sudden unexpected death including 72 additional unexplained (SUDC) cases
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