Histological examination in sudden unexpected death in infancy: evidence base for histological sampling

• DOI: 10.1136/jclinpath-2011-200224
• Publication Date: 2011-10-01T02:42:42Z
• Authors: M A Weber; J W Pryce; M T Ashworth; M Malone; N J Sebire
• Keywords: Chi-Square Distribution; Evidence-Based Medicine; Time Factors; Myocardium; Infant, Newborn; Infant; Kidney; Risk Assessment; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Liver; Predictive Value of Tests; Risk Factors; Cause of Death; London; Odds Ratio; Humans; Autopsy; Forensic Pathology; Lung; Sudden Infant Death; Retrospective Studies

Aim Pathologists currently follow the ‘Kennedy guidelines’ when performing autopsies for sudden unexpected death in infancy (SUDI); these include extensive histological sampling. This study establishes frequency with which examination of visceral organs determines cause and examines associations between clinical, macroscopic microscopic findings. Methods Retrospective review 546 SUDI performed a 10-year period (1996–2005) at single centre. The proportion cases non-neuropathological directly determined was identified, findings autopsy were compared. Results Of 510 SUDIs included, 166 explained SUDI, these, 54% (89/166) identified solely on examination, based histology lungs 71 (43%), heart 13 (8%), liver 4 (2%) kidneys 1 (<1%). proportions macroscopically normal significant 26% lungs, 2% 1% each kidneys, but none spleen, thymus, pancreas or adrenals. Macroscopically abnormal more likely to yield features. Symptoms preceding common heart, Conclusion A can be established from kidneys. Significant abnormalities may detected selected appearances. Routine sampling other absence specific clinical history has low establishing death.