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COMMENTARY

Assigning cause for sudden unexpected infant death Carl E. Hunt • Robert A. Darnall • Betty L. McEntire Bruce A. Hyma

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Accepted: 26 December 2014 Ó The Author(s) 2015. This article is published with open access at Springerlink.com

Abstract We have reached a conundrum in assigning cause of death for sudden unexpected infant deaths. We summarize the discordant perspectives and approaches and how they have occurred, and recommend a pathway toward improved consistency. This lack of consistency affects pediatricians and other health care professionals, scientific investigators, medical examiners and coroners, law enforcement agencies, families, and support or advocacy groups. We recommend that an interdisciplinary international committee be organized to review current approaches for assigning cause of death, and to identify a consensus strategy for improving consistency. This effort will need to encompass intrinsic risk factors or infant vulnerability in addition to known environmental risk factors including unsafe sleep settings, and must be sufficiently flexible to accommodate a progressively expanding knowledge base. Keywords Sudden unexpected infant death
Sudden infant death syndrome
Infant mortality

C. E. Hunt (&) Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA e-mail: [email protected] R. A. Darnall Geisel School of Medicine at Dartmouth, Hanover, NH, USA B. L. McEntire American SIDS Institute, Naples, FL, USA B. A. Hyma Miami-Dade Medical Examiner Department, Miami, FL, USA

History of the term SIDS Sudden infant death syndrome (SIDS) was originally defined in 1969 [1], focusing attention on sudden death in infants without an identified cause. These infants had a similar age at death and a strong association with sleep in common. Naming the sudden death SIDS instead of calling it ‘‘cause unknown’’ facilitated an enhanced focus on parental support and on research. Later studies identified prone sleep as a significant risk factor for SIDS-classified deaths [2–4]. The definition of SIDS was expanded in 1991, with an emphasis on scene investigation [5]. Although further modifications have been recommended [6–9], no consensus has been achieved. Indeed, a review of recent publications reported that the 1969 definition continues to be used 7 % of the time, the 1991 definition 35 % of the time, other modifications 26 % of the time and in 20 % no definition was mentioned [10]. Initially there were no candidate etiologies to explain these deaths. In the intervening years, however, much has been learned about environmental, biological, and genetic risk factors for deaths classified as SIDS. Once prone sleep was identified as a significant risk factor, most developed countries implemented back-to-sleep campaigns [11]. SIDS-classified death rates started to decline after 1990, as did non-SIDS-classified postneonatal mortality rates, and continued to decline until 2001 [11]. Much of this decline was initially attributed