Sudden Infant Death Syndrome and Sudden Unexpected Infant Death

Sudden infant death has haunted humanity since Biblical times, and many people are still confused about how to differentiate sudden infant death syndrome from other causes of sudden infant death, such as myocarditis or congenital heart disease. Because of the difficulty of diagnosis, the authors say that SIDS has become a “diagnostic dustbin,” but unnecessarily so. They provide the diagnostic criteria for SIDS, review other causes of sudden infant death that may mimic SIDS, and make several recommendations regarding ways to reduce its incidence as well as ways to improve investigations of SIDS cases. They advocate for the adoption of a universally accepted SIDS definition, as well as standardized protocols for investigation into the circumstances of death and the postmortem examination. The use of standardized protocols will improve diagnostic accuracy, which in turn impacts vital statistics, as well as resource allocation for further study. Most importantly, accurate diagnoses may help bereaved parents and other survivors who struggle to understand this painful loss. Introduction Sudden infant death has haunted humanity since Biblical times when King Solomon was called upon to determine the true mother of an infant who died in the night (I Kings 3:19). Many natural and unnatural causes, including accidental overlaying and inflicted suffocation, have been proposed to explain its occurrence (Behlmer, 1979; Byard, 1994; Byard & Hilton, 1997; Bacon, 2003). A diagnosis of sudden infant death syndrome (SIDS) is made today when an infant is found lifeless and a careful review of the medical and family history, investigation of the scene where the infant was discovered unresponsive, and a thorough postmortem examination yield no satisfactory explanations. Yet, it must be remembered that the postmortem findings after accidental or inflicted asphyxia as well as some natural diseases are often minimal (Byard, 1996; Byard & Krous, 1999; Byard & Beal, 1993). Nevertheless, the suggestions that SIDS is a “diagnostic dustbin”(Emery, 1989) or a “diagnosis in search of a disease”(Byard, 1995) reflect imprecision in diagnoses and the uncertainties that surround possible etiologies and mechanisms. So it is as true today as in decades before that accurate diagnosis remains critically dependent upon competent and thorough case investigation. In addition, as new technology becomes available, new diseases are being discovered that will explain some of these deaths (Byard, 2004). This review focuses upon causes of sudden infant death, emphasizing SIDS; and places SIDS in perspective with other entities that may mimic it. It concludes with recommendations for the investigation of these cases. Sudden Death Infant Syndrome