Research Article| Volume 18, ISSUE 2, P323-338, June 1998

Sudden Natural Death in Infants and Young Children

  • Tracey Corey Handy
    Address reprint requests to Tracey Corey Handy, MD, Office of the Chief Medical Examiner, 810 Barret Ave, Louisville, KY 40204.
    From the Medical Examiner Division of the Kentucky Justice Cabinet

    The Departments of Pathology and Pediatrics, University of Louisville School of Medicine
    Search for articles by this author
  • John J. Buchino
    The Departments of Pathology and Pediatrics, University of Louisville School of Medicine

    The Department of Pathology, Kosair Children’s Hospital, Louisville, Kentucky
    Search for articles by this author
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      This discussion will highlight common natural causes of sudden unexpected death in “healthy” infants and young children. Methods employed to render these diagnoses will be reviewed. Natural causes of sudden death found more commonly in adolescents and young adults will not be discussed.
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        • Ackermann D.M.
        • Edwards W.D.
        Sudden death as the initial manifestation of primary pulmonary hypertension.
        Am J Forensic Med Pathol. 1987; 8: 97-102
        • Adelson L.
        • Hirsch C.S.
        Sudden and unexpected death from natural causes in adults.
        in: Spitz W.U. Fisher R.S. Medicolegal Investigation of Death. ed 2. IL, Charles C Thomas, Springfield1980: 88
        • Alford B.A.
        • Mcllhenny J.
        The child with acute abdominal pain and vomiting.
        Radiol Clin North Am. 1992; 30: 441-453
      1. American Academy of Pediatrics Task Force on Infant Positioning and SIDS: Positioning and SIDS.
        Pediatrics. 1992; 89: 1120-1126
        • Anderson K.A.
        • Burbach J.A.
        • Fenton L.J.
        • et al.
        Idiopathic arterial calcification of infancy in newborn siblings with unusual light and electron microscopic manifestations.
        Arch Pathol Lab Med. 1985; 105: 838-842
        • Aoki Y.
        • Terunuma H.
        • Iwasaki Y.
        • et al.
        A case of sudden infant death due to massive hemorrhage in primitive neuroectodermal tumor.
        Am J Forensic Med Pathol. 1992; 13: 199-203
        • Applegarth D.A.
        • Dimmick J.E.
        • Toone J.R.
        Laboratory detection of metabolic disease.
        Pediatr Clin North Am. 1989; 36: 49-65
        • Aretz H.T.
        • Billingham M.E.
        • Edwards W.D.
        • et al.
        A histopathologic definition and classification. Am J Cardiovasc Pathol. 1987; 1: 3-14
        • Basso C.
        • Frescura C.
        • Corrado D.
        • et al.
        Congenital heart disease and sudden death in the young.
        Hum Pathol. 1995; 26: 1065-1072
        • Bennett M.J.
        • Allison F.
        • Pollitt R.J.
        • et al.
        Fatty acid oxidation defects as causes of unexpected death in infancy.
        in: Tanaka K. Coates P.M. Fatty Acid Oxidation. Liss, New York1989: 349-364
        • Berry C.L.
        Causes of sudden natural death in infancy and childhood.
        in: Mason J.K. Paediatric Forensic Medicine and Pathology. Chapman and Hall Medical, London1989
        • Byard R.W.
        Cardiac conditions.
        in: Byard R.W. Cohle S.D. Sudden Death in Infancy, Childhood and Adolescence. Cambridge University Press, New York1994
        • Byard R.W.
        Infectious conditions.
        in: Byard R.W. Cohle S.D. Sudden Death in Infancy, Childhood and Adolescence. Cambridge University Press, New York1994: 114
        • Byard R.W.
        Respiratory conditions.
        in: Byard R.W. Cohle S.D. Sudden Death in Infancy, Childhood and Adolescence. Cambridge University Press, New York1994: 276
        • Byard R.W.
        Sudden infant death syndrome.
        in: Byard R.W. Cohle S.D. Sudden Death in Infancy, Childhood and Adolescence. Cambridge University Press, New York1994: 417-497
        • Byard R.W.
        Vascular conditions.
        in: Byard R.W. Cohle S.D. Sudden Death in Infancy, Childhood and Adolescence. Cambridge University Press, New York1994: 175-261
        • Byard R.W.
        • Bourne A.J.
        • Adams P.S.
        Subarterial ventricular septal defect in an infant with sudden unexpected death: Cause or coincidence?.
        Am J Cardiovasc Pathol. 1990; 3: 333-336
        • Byard R.W.
        • Bourne A.J.
        • Hanieh A.
        Sudden and unexpected death due to hemorrhage from occult central nervous system lesions.
        Pediatr Neurosurg. 1991-1992; 17: 88-94
        • Byard R.W.
        • Edmonds J.F.
        • Silverman E.
        • et al.
        Respiratory distress and fever in a 2-month-old infant.
        J Pediatr. 1991; 118: 306-313
        • Byard R.W.
        • Jimenez C.L.
        • Carpenter B.F.
        • et al.
        Four unusual cases of sudden and unexpected cardiovascular death in infancy and childhood.
        Med Sei Law. 1991; 31: 157-161
        • Carles D.
        • Serville F.
        • Dubecq J-P.
        • et al.
        Idiopathic arterial calcification in a stillborn complicated by pleural hemorrhage and hydrops fetalis.
        Arch Pathol Lab Med. 1992; 116: 293-295
        • Carpenter H.M.
        • Wilkins R.M.
        Autopsy bacteriology: Review of 2033 cases.
        Arch Pathol. 1964; 77: 73-81
        • Case M.E.
        Central nervous system trauma.
        in: Nelson J.S. Parisi J.E. Schochet Jr, S.S. Principles and Practice of Neuropathology. Mosby, St Louis1993
      2. Centers for Disease Control: Case definitions for public health surveillance. Reye syndrome. MMWR 39:No. RR-13, 1990, pp 29-30

      3. Centers for Disease Control: Guidelines for death scene investigation of sudden, unexpected infant deaths: Recommendations of the interagency panel on sudden infant death syndrome. MMWR 45:No. RR-10, 1996, pp 1-22

        • Coe J.I.
        Postmortem chemistry update.
        Am J Forensic Med Pathol. 1993; 14: 91-117
        • Cohle S.D.
        • Graham M.A.
        • Dowling G.
        Sudden death and left ventricular outflow disease.
        Pathol Annu. 1988; 23: 97-124
        • Dahms B.B.
        The gastrointestinal tract.
        in: Stocker J.T. Dehner L.P. Pediatric Pathology. JP Lippincott, Philadelphia1992: 673-674
        • Davies M.J.
        The cardiomyopathies: A review of terminology, pathology and pathogenesis.
        Histopathology. 1984; 8: 363-393
        • Dehner L.P.
        Central nervous system and neuromuscular system.
        in: Dehner L.P. Pediatric Surgical Pathology. ed 2. Williams and Wilkins, Baltimore1987: 1034
        • Demick D.A.
        Cerebrovascular malformation causing sudden death.
        Am J Forensic Med Pathol. 1991; 12: 45-49
        • Ding J.H.
        • Roe C.R.
        • Iafolla A.K.
        • et al.
        Medium chain acyl-coenzyme A dehydrogenase deficiency and sudden infant death [letter to the editor].
        N Engl J Med. 1991; 325: 61
        • DuMoulin G.C.
        • Paterson D.G.
        Clinical relevance of postmortem microbiologic examination.
        Hum Pathol. 1985; 16: 539-548
        • Dwyer T.
        • Ponson A-L.
        • Blizzard L.
        • et al.
        The contribution of changes in the prevalence of prone sleeping position to the decline in sudden infant death syndrome in Tasmania.
        JAMA. 1995; 273: 783-789
        • Gelb A.B.
        • Van Meter S.H.
        • Billingham M.E.
        • et al.
        Infantile histiocytoid cardiomyopathy-myocardial or conduction system hamartoma: What cell type is involved?.
        Hum Pathol. 1993; 24: 1226-1231
        • Goldberg J.
        • Hornung R.
        • Yamashita T.
        • et al.
        Age at death and risk factors in sudden infant death syndrome.
        Aust Paediatr J. 1986; 22: 21-28
        • Green A.
        • Hall S.M.
        Investigation of metabolic disorders resembling Reye’s syndrome.
        Arch Dis Child. 1992; 67: 1313-1317
        • Hanzlick R.
        Cause of Death Statements and Certification of Natural and Unnatural Deaths: Protocols and Opinions.
        College of American Pathologists, Northfield, IL1997
        • Hanzlick R.L.
        Lingual thyroglossal duct cyst causing sudden death in a four-week-old infant.
        J Forensic Sei. 1984; 29: 345-348
      4. Hartman A, Stocker JT, Moriarty R: A 7-week-old with respiratory congestion. J Pediatr, in press

        • Huser C.J.
        • Smialek J.E.
        Diagnosis of sudden death in infants due to acute dehydration.
        Am J Forensic Med Pathol. 1986; 7: 278-282
        • Kaplan M.H.
        • Klein S.W.
        • McPhee J.
        • et al.
        Group B coxsackie infections in infants younger than three months of age: A serious childhood illness.
        Rev Infect Dis. 1983; 5: 1019-1032
        • Keeling J.W.
        • Knowles S.A.S.
        Sudden death in childhood and adolescence.
        J Pathol. 1989; 159: 221-224
        • Koneman E.W.
        • Davis M.A.
        Postmortem bacteriology: III. Clinical significance of microorganisms recovered at autopsy.
        Am J Clin Pathol. 1974; 61: 28-30
        • Lalu K.
        • Karhunen P.J.
        • Rautiainen P.
        Sudden and unexpected death of a 6-month-old baby with silent heart failure due to anomalous origin of the left coronary artery from the pulmonary artery.
        Am J Forensic Med Pathol. 1992; 13: 196-198
        • Lambert E.C.
        • Menon V.A.
        • Wagner H.R.
        • et al.
        Sudden unexpected death from cardiovascular disease in children.
        Am J Cardiol. 1974; 34: 89-96
        • Landing B.H.
        • Larson E.J.
        Pathologic features of Kawasaki disease (mucocutaneous lymph node syndrome).
        Am J Cardio vase Pathol. 1987; 1: 215-229
        • Leestma J.E.
        Neuropathology of child abuse.
        in: Forensic Neuropathology. Raven Press, New York1988: 345
        • Levin M.
        • Tizard E.J.
        • Dillon M.J.
        Kawasaki disease: Recent advances.
        Arch Dis Child. 1991; 66: 1369-1374
        • Lipsett J.
        • Byard R.W.
        • Carpenter B.F.
        • et al.
        Anomalous coronary arteries arising from the aorta associated with sudden death in infancy and early childhood.
        Arch Pathol Lab Med. 1991; 115: 770-773
        • Lipsett J.
        • Cohle S.D.
        • Berry P.J.
        • et al.
        Anomalous coronary arteries: A multicenter pediatric autopsy study.
        Pediatr Pathol. 1994; 14: 287-300
        • Losty H.C.
        • Lee P.
        • Alfaham M.
        Fatty infiltration in the liver in medium chain acyl CoA dehydrogenase deficiency.
        Arch Dis Child. 1991; 66: 727-728
        • Manning J.A.
        Sudden unexpected death in children.
        Am J Dis Child. 1977; 131: 1201-1202
        • Martin A.B.
        • Webber S.
        • Fricker F.J.
        • et al.
        Acute myocarditis.
        Rapid diagnosis by PCR in children. Circulation. 1994; 90: 330-339
        • McCowen C.
        • Henderson D.C.
        Sudden death in incomplete Kawasaki’s disease.
        Arch Dis Child. 1988; 63: 1254-1271
        • McKenna W.J.
        • Deanfield J.E.
        Hypertrophic cardiomyopathy: An important cause of sudden death.
        Arch Dis Child. 1984; 59: 971-975
        • Montana E.
        • Etzel R.A.
        • Allan T.
        • et al.
        Environmental risk factors associated with pediatric idiopathic pulmonary hemorrhage and hemosiderosis in a Cleveland community.
        Pediatrics. 1997; 99: 5
        • Moore L.
        • Byard R.W.
        Sudden and unexpected death in infancy associated with a single coronary artery.
        Pediatr Pathol. 1992; 12: 231-236
        • Moran J.J.
        Idiopathic arterial calcification of infancy: A clinicopathologic study.
        Pathol Annu. 1975; 10: 393-417
      5. NAME News 4(2), 1996

        • Neuspiel D.R.
        • Kuller L.H.
        Sudden and unexpected natural death in childhood and adolescence.
        JAMA. 1985; 254: 1321-1325
        • Norman M.G.
        • Taylor G.P.
        • Clarke L.A.
        Sudden, unexpected, natural death in childhood.
        Pediatr Pathol. 1990; 10: 769-784
        • O’Shea P.A.
        Congenital and acquired systemic infectious diseases.
        in: Stocker J.T. Dehner L.P. Pediatric Pathology. JP Lippincott, Philadelphia1992
        • Perper J.A.
        • Ahdab-Barmada M.
        Fatty liver, encephalopathy, and sudden unexpected death in early childhood due to medium-chain acyl-Co A dehydrogenase deficiency.
        Am J Forensic Med Pathol. 1992; 13: 329-334
        • Pfalzgraf R.R.
        • Zumwalt R.E.
        • Kenny M.R.
        Mesodiverticular band and sudden death in children.
        Arch Pathol Lab Med. 1988; 112: 182-184
        • Prahlow J.A.
        • Teot L.A.
        Histiocytoid cardiomyopathy: Case report and literature review.
        J Forensic Sei. 1993; 38: 1427-1435
        • Rosenberg H.S.
        Coarctation of the aorta: Morphology and pathogenetic considerations.
        Perspectives in Pediatric Pathology. 1973; 1: 339-368
        • Ruszkiewiez A.R.
        • Vemon-Roberts E.
        Sudden death in an infant due to histiocytoid cardiomyopathy.
        Am J Forensic Med Pathol. 1995; 16: 74-80
        • Sanghavi D.M.
        Epidemiology of sudden infant death syndrome (SIDS) for Kentucky infants bom in 1990: Maternal, prenatal, and perinatal risk factors.
        Kentucky Medical Association Journal. 1995; 93: 286-290
        • Schryer M.J.P.
        • Karnauchow P.N.
        Endocardial fibroelastosis: Etiologic and pathogenetic considerations in children.
        Am Heart J. 1974; 88: 557-565
        • Shehata B.H.
        • Patterson K.
        • Thomas J.
        • et al.
        Histocytoid cardiomyopathy-the new cases and a review of the literature.
        Pediatric and Developmental Pathology. 1998; 1: 56-69
        • Silka M.
        • Krön J.
        • McAnulty J.
        Supraventricular tachyarrhythmias, congenital heart disease, and sudden cardiac death.
        Pediatr Cardiol. 1992; 13: 116-118
        • Singer D.B.
        Postsplenectomy sepsis.
        Perspectives in Pediatric Pathology. 1973; 1: 285-311
        • Smith E.T.
        • Davis G.J.
        Medium-chain acylcoenzyme-A dehydrogenase deficiency.
        Am J Forensic Med Pathol. 1993; 14: 313-318
        • Stocker J.T.
        Pathologic features of long-standing “healed” bronchopulmonary dysplasia.
        A study of 28 3- to 40-month-old infants. Hum Pathol. 1986; 17: 943-961
        • Stocker J.T.
        The respiratory tract.
        in: Pediatric Pathology. JP Lippincott, Philadelphia1992: 535
        • Sturner W.O.
        Sudden infant death syndrome-the medical examiner’s viewpoint.
        Perspectives in Pediatric Pathology. 1995; 19: 76-86
        • Taylor G.P.
        Cardiac causes of sudden unexpected natural death in childhood.
        Perspectives in Pediatric Pathology. 1995; 19: 141-174
        • Tazelaar H.D.
        Myocardial lymphocytes.
        Fact, fancy, or myocarditis? Am J Cardiovasc Pathol. 1987; 1: 47-50
        • Terhune P.E.
        • Buchino J.J.
        • Rees A.H.
        Myocardial infarction associated with supraclavicular aortic stenosis.
        J Pediatrics. 1985; 105: 251-254
        • Topaz O.
        • Edwards J.E.
        Pathologic features of sudden death in children, adolescents, and young adults.
        Chest. 1985; 87: 476-482
        • Trump B.F.
        • Jones R.T.
        • Mergner W.J.
        Principles of autopsy techniques.
        in: Ludwig J. Current Method of Autopsy Practice. WB Saunders, Philadelphia1979: 3
        • Valdes-Dapena M.
        A pathologist’s perspective on the sudden infant death syndrome-1991.
        Pathol Annu part 1. 1992; 27: 133-164
        • Valdes-Dapena M.
        • Huff D.
        Perinatal Autopsy Manual.
        Armed Forces Institute of Pathology, Washington DC1983
        • Valdes-Dapena M.
        • McFeeley P.A.
        • Hoffman H.J.
        • et al.
        Histopathology Atlas for the Sudden Infant Death Syndrome.
        Washington DC, Armed Forces Institute of Pathology1993
        • Wasserfallen J.B.
        • Schaller M.D.
        • Feihl F.
        • et al.
        Sudden asphyxic asthma: A distinct entity?.
        Am Rev Respir Dis. 1990; 142: 108-111
        • Willinger M.
        Sleep position and sudden infant death syndrome.
        JAMA. 1995; 273: 818-819
        • Wilson S.J.
        • Wilson M.L.
        • Reller B.
        Diagnostic utility of postmortem blood cultures.
        Arch Pathol Lab Med. 1993; 117: 986-988
        • Young T.W.
        Reye’s syndrome: A diagnosis occasionally first made at medicolegal autopsy.
        Am J Forensic Med Pathol. 1992; 13: 21-27