Diagnostic Options for Investigating Viral Respiratory Pathogens in Sudden Unexpected Death in Infancy (SUDI) Cases - Abstract
Sudden and unexpected deaths in infants have occurred for centuries. It has
generally been referred to as sudden infant death syndrome (SIDS). A new concept,
called sudden unexpected death in infancy (SUDI) was introduced in 1989, which is
used for all unexpected deaths in infants and babies, usually during sleep, where fatal
injury can be excluded. By definition, cases that remain unexplained after thorough
investigation are still classified as SIDS.
Many risk factors have been associated with SUDI, e.g. poor socioeconomic
conditions and prenatal care, multiple pregnancies, parental drug use and smoking,
gender, low birth weight, recent infection and the sleeping environment. Ultimately,
SUDI is most probably a result of a combination of predisposing factors, external
stresses and underlying vulnerabilities, although the exact mechanism of death remains
unknown.
Viral infections are common in infants and have repeatedly been implicated
in SUDI. Respiratory infections occur frequently in infancy and early childhood and
inflammatory changes in the respiratory tract in SUDI cases is often found.
Different diagnostic approaches for investigating respiratory viruses in SUDI
cases have been reported in the literature, but in the absence of standardised SUDI
investigation protocols, research from different centres cannot be compared. Viral
viability is compromised in post-mortem samples and results should be interpreted
with care, as the mere presence of a pathogen does not confirm that to be the cause
of death. It is therefore imperative to use a combination of diagnostic approaches in
parallel with epidemiological and clinical information in SUDI cases.