Sudden death in children

JAMA: The Journal of the American Medical Association, 1985

The descriptive epidemiology of sudden nontraumatic death from persons aged 1 to 21 years was studied in a defined population. In nine years, the 207 deaths in this group (4.6/100,000 population/per year) comprised 22% of nontraumatic mortality. Age-specific rates were highest between 1 and 4 years (mainly infections and undetermined causes) and 14 and 21 years (mainly cardiovascular, epilepsy, intracranial hemorrhage, and asthma). Nonwhite rates were higher than whites, and white males had higher rates than white females. Referral for medicolegal evaluation was inconsistent. Only 18% died at university hospitals. Infections included lower respiratory tract and septic shock. The main cardiac diagnosis was myocarditis. Most epilepsy deaths were unwitnessed and had absent or low anticonvulsant levels. Eighty-five cases had a known associated chronic illness and 111 reported prodromal symptoms. Prevention of these events requires improved identification and management of antecedent conditions.

When a baby under the age of one happens to die unexpectedly in his sleep, it is often referred to as a sudden, unexpected death. After these cases of death are medically investigated, it is usually established that they are fatal sleep accident-a situation where a baby suffocates or is trapped/strangled by things in the sleeping environment; or Sudden Infant Death Syndrome-SIDS-a diagnosis used when medical research cannot find the cause of a baby's death.

Saudi Medical Journal, 2021

Objectives: To identify the causes, modes, and timing of death in a tertiary pediatric intensive care unit)PICU(. Methods: This is a retrospective data analysis of patients older than 48 hours and younger than 15 years who died in the PICU over a 5-year period from January 2012 until December 2016 at a tertiary hospital in Riyadh, Saudi Arabia. Results: There were 101 deaths out of 2295 admissions, representing average crude mortality rate of 4.4%. Sepsis was the most common cause of death in 31 patients)30.7%(, followed by lower respiratory tract infections in 19)18.8%(, and cardiac diseases in 12)11.9%(. Failed cardiopulmonary resuscitation was Original Article the most common mode of death in 51 patients)50.5%(, followed by withholding life-sustaining treatment in 43)42.6%(, and brain death in 7)6.9%(. Although more deaths occurred during after hours)n=70; 69.3%(, there was no significant correlation between mode of death and working hours vs. after hours)p>0.05(. Among the cohort, 63 patients)62.4%(had an infection-attributed mortality, of which 43)68.3%(were bacterial, 14)22.2%(were viral, and 10)15.9%(were fungal. Conclusion: Infections remain a significant cause of death in the PICU. Further improvement of prevention programs and early therapy of severe infections could lower pediatric mortality. This report highlights the need for enhancing palliative care programs. The low rate of brain death diagnoses warrants further investigation.

Journal of tropical pediatrics, 2005

The aim of the present study was to determine the incidence of various causes of sudden unexpected child deaths (SUCD) and to assess the importance of an autopsy in predicting the likelihood of finding a cause of death. A retrospective analysis of autopsy findings in 97 cases of SUCD between the ages of 0-11 years was undertaken at the Council of Forensic Medicine, Ankara during a 5-year period (1995-2000). Cases were classified as explained causes (80.42 per cent) and sudden infant death syndrome (SIDS) (19.58 per cent). A total of 25.77 per cent of the deaths occurred in the neonatal period, 45.31 per cent of them in the first year of life and the remaining 28.86 per cent after 1 year of life. The causes of neonatal deaths were respiratory pathology (five cases), birth complications (four cases), gastrointestinal pathology (one case), homicide (10 cases), and SIDS (five cases). The incidence of SIDS in the newborn period was 33 per cent. The incidence of unexplained causes of deaths in the postneonatal period was 31 per cent and the causes of deaths were respiratory pathology (15 cases), aspiration (five cases), gastrointestinal pathology (four cases), SIDS (14 cases), and other causes (four cases). The study of an entire population provides more reliable data regarding causes of sudden unexpected child deaths than does the study of small groups and it is also recommended that in addition to a through evaluation, a detailed autopsy must be performed for each case in experienced centers.

Pediatrics, 2021

There are multiple conditions that can make children prone to having a sudden cardiac arrest (SCA) or sudden cardiac death (SCD). Efforts have been made by multiple organizations to screen children for cardiac conditions, but the emphasis has been on screening before athletic competition. This article is an update of the previous American Academy of Pediatrics policy statement of 2012 that addresses prevention of SCA and SCD. This update includes a comprehensive review of conditions that should prompt more attention and cardiology evaluation. The role of the primary care provider is of paramount importance in the evaluation of children, particularly as they enter middle school or junior high. There is discussion about whether screening should find any cardiac condition or just those that are associated with SCA and SCD. This update reviews the 4 main screening questions that are recommended, not just for athletes, but for all children. There is also discussion about how to handle po...

Acta Paediatrica, 2007

Infants that died suddenly and unexpectedly were studied as part of the European Concerted Action on sudden infant death syndrome (SIDS). Three paediatric pathologists, first independently of each other and later in a consensus meeting, classified 63 cases into 3 groups: SIDS (19 cases), borderline SIDS (30 cases) and non-SIDS (14 cases). The interobserver agreement among the pathologists before the consensus meeting was moderate (Kappa = 0.41) and jointly it was higher (Kappa = 0.83). The distribution of epidemiologically determined risk factors was studied over these three groups. Maternal smoking after birth, low socioeconomic status and thumb sucking were found more often in SIDS than in the other cases. Inexperienced prone sleeping was a determinant for SIDS, but not for non-SIDS. Previous hospital admission, low birthweight and/or short gestation were associated with borderline SIDS. Non-SIDS cases received more breastfeeding, the parents hardly smoked during pregnancy and after birth, a firm mattress had been used, and more often signs of illness had been reported by the parents, compared with the SIDS and borderline SIDS cases. Bedding factors and both primary and secondary prone sleeping were equally distributed over the three groups which supports the hypothesis that, in SIDS and borderline SIDS, as well as in non-SIDS cases, some similar external and preventable factors might influence the events leading to death. Research should therefore focus on all sudden unexpected deaths, after which subgroups such as SIDS cases can be separately analysed. The postmortem is an essential part of the whole work-up of each case and the results should be interpreted with all other available data to arrive at a sound evaluation of cases and thus form the basis for the prevention of all sudden unexpected infant death. ٖ Cot death, epidemiology, pathology, risk factors, sudden infant death syndrome (SIDS), SUD

Congenital Heart Disease, 2006

To review a mortality database, and identify all sudden unexpected deaths in patients followed by the cardiac program.

Archives of Disease in Childhood - Education and Practice, 2005

A 10 day old boy called Jordan was brought into the accident and emergency department by ambulance at 4.30 am one Sunday morning in October in a collapsed state. His mother had called for an ambulance 20 minutes earlier. When the paramedic crew arrived at the house they found a pale, lifeless infant with no pulse and no respiratory effort. They had instituted cardiopulmonary resuscitation using a bag valve and mask and continued this during the transfer to hospital. His mother accompanied him in the ambulance.

Journal of Medical Ethics, 2007

Background: Despite a gradual shift in the focus of medical care among terminally ill patients to a palliative model, studies suggest that many children with life-limiting chronic illnesses continue to die in hospital after prolonged periods of inpatient admission and mechanical ventilation. Objectives: To (1) examine the characteristics and location of death among hospitalised children, (2) investigate yearwise trends in these characteristics and (3) test the hypothesis that professional ethical guidance from the UK Royal College of Paediatrics and Child Health (1997) would lead to significant changes in the characteristics of death among hospitalised children. Methods: Routine administrative data from one large tertiary-level UK children's hospital was examined over a 7-year period (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) for children aged 0-18 years. Demographic details, location of deaths, source of admission (within hospital vs external), length of stay and final diagnoses (International Classification of Diseases-10 codes) were studied. Statistical significance was tested by the Kruskal-Wallis analysis of ranks and median test (non-parametric variables), x 2 test (proportions) and Cochran-Armitage test (linear trends). Results: Of the 1127 deaths occurring in hospital over the 7-year period, the majority (57.7%) were among infants. The main diagnoses at death included congenital malformations (22.2%), perinatal diseases (18.1%), cardiovascular disorders (14.9%) and neoplasms (12.4%). Most deaths occurred in an intensive care unit (ICU) environment (85.7%), with a significant increase over the years (80.1% in 1997 to 90.6% in 2004). There was a clear increase in the proportion of admissions from in-hospital among the ICU cohort (14.8% in 1998 to 24.8% in 2004). Infants with congenital malformations and perinatal conditions were more likely to die in an ICU (OR 2.42, 95% CI 1.65 to 3.55), and older children with malignancy outside the ICU (OR 6.5, 95% CI 4.4 to 9.6). Children stayed for a median of 13 days (interquartile range 4.0-23.25 days) on a hospital ward before being admitted to an ICU where they died. Conclusions: A greater proportion of hospitalised children are dying in an ICU environment. Our experience indicates that professional ethical guidance by itself may be inadequate in reversing the trends observed in this study.

Sri Lanka Journal of Child Health, 2012

Background: Deaths in paediatric intensive care units (PICUs) are sometimes unavoidable. The decision to withdraw or withhold treatment is important especially in places where there are limited resources. Objective: To evaluate the modes of death and underlying diseases of patients' deaths in a PICU. Method: We retrospectively reviewed the clinical features and management of consecutive nonsurvivors in the PICU at a tertiary care University Hospital in a developing country over a three-year period. Results: Of 1,389 admissions, 110 (8%) patients died. The median age of the deaths was 4.1 years. Most (86%) patients had underlying diseases including congenital heart diseases (27%) and malignancies (23%). Forty-seven patients died with active treatment (AT), 60 died with life support limitation (LSL), and 3 had brain death (BD). The median length of stay (LOS) in AT group was 3 days and this was not significantly different (p=0.056) from the median LOS in LSL group which was 5 days. LOS less than 3 days, postoperative cases and underlying diseases of the cardiovascular system were factors associated with the AT group. The three common complications leading to death were multi-organ failure, septicaemia with septic shock and respiratory failure. Conclusions: Congenital heart diseases and malignancies were the two common underlying diseases found in non-survivors. LSL was the common mode of death in PICU.

Jornal de Pediatria, 2006

Objectives: To quantify the incidence of sudden infant death syndrome in the town of Passo Fundo, in Rio Grande do Sul, Brazil, and to describe the profile of the deaths observed. Methods: A population-based cohort study of the live births from February 2003 to January 2004 to parents resident in the urban area. Infants were excluded if they had been hospitalized since birth, were in the process of being adopted or had died before data collection. 2,411 children were included from the total of 2,634 live births and 2,285 (94.8%) of these were followed-up. Data were obtained from the Live Births Information System (Sistema de Informações Sobre Nascidos Vivos), death registers, records of the Committee on Infant Mortality and from interviews with the social mother during home visits. Data collection instruments were adapted from previously validated forms. Data were analyzed on Epi-Info with descriptive statistics. Results: Ten deaths were registered (0.4%). Four deaths of unknown causes could be included in sudden infant death syndrome category III. These deaths took place at home, between 4 and 6 months of age. The children slept on their sides, sharing a bed with adults, and had soft mattresses, pillows and diapers on the surface. They were the children of young mothers, smokers, with incomplete prenatal care and previous births from underprivileged economic classes. The incidence of suspicion of this syndrome was 1.75/1,000. Conclusion: The incidence rate of suspected sudden infant death syndrome in Passo Fundo is comparable with the highest international coefficients, which suggests the need for vigilance and risk prevention measures.

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi

Sudden Infant Death Syndrome (SIDS) represents the third cause in postnatal mortality. The pathogenesis is multifactorial. SIDS victims can present sign of preexisting chronic asphyxia, persistent increase in dendritic spine and delayed maturation of synapses in medullary respiratory centers, if a decreased reactivity of 5 hydroxytryptamine 1A (5-HT1A) and 5-HT2A in the dorsal nucleus of the vagus, solitary nucleus and ventrolateral medulla. SIDS is an exclusion diagnosis, so that inexplicable SIDS is the accepted term. The objective of this report is to present current data about the pathogenesis oh this syndrome and the medico-legal measures applied in preventive and curative aim. The “face-up” sleeping position has cut in half the SIDS frequency. In conclusion, the infant sleep studies represent an important line for the future research to provide sufficient explanation of the sudden death in these infants.

Forensic Science International, 2003

Sudden unexplained death (SUD) on children and young people is unusual, although the real magnitude is unknown. The clinical and physiopathological characteristics are poorly defined.

Chapter, 2005