Pathology of death in childhood

Question 1

What is SUDI and what are the different types?

Answer 1

SUDI = Sudden Unexpected Death in Infancy = the unexpected death of a child <1 year

1. Baby is found dead in cot
2. Baby dies in carers arms
3. Rapid death due to recognised illness

Question 2

When is SIDS most common?

Answer 2

Between 4-20 weeks

Common in the winter

Question 3

What is the triple risk hypothesis?

Answer 3

1. Critical developmental period:
   - development immaturity
   - rapid changes between 2-4 months
2. Vulnerable infant
   - Males (60%)
   - Abnormality of serotonergic network
   - Slower response to changes (increased HR + breathing)
   - Alterations in heart ion channels
3. External stressor
   - minor URTI
   - prone position
   - co-sleeping
   - overheating
   - hypothermia

Question 4

In SUDI what might the autopsy find? (external, internal, microscopic)

Answer 4

External: body apparently well developed + well nourished

Internal: 
- large thymus with petechiae
   (will have a 'starry sky' pattern --> white = macrophages eating up lymphocytes)
- petechiae in pleura 
- epicardial petechiae 
- full expansion of the lungs 
- liquid heart blood 

Microscopic:

• pulmonary congestion + oedema
• mild inflammation of URTI
• focal fibrinoid necrosis of vocal cords
• persistent haemopoiesis in liver

Question 5

What could be the potential cause(s) of death if a baby is found dead in a cot?

Answer 5

1. SIDs
2. CHD (acute myocarditis; fibromuscular dysplasia in CAs)
3. Respiratory infections
4. septicaemia
5. unsuspected liver tumour

Question 6

What could be the potential cause(s) of death if a baby dies in carer’s arms?

Answer 6

SIDS

Question 7

What illnesses could cause rapid death of a neonate?

Answer 7

1. Respiratory infections (severe bronchopneumonia)
2. CNS infections (meningitis; Waterhouse-Friderischen; Disseminated intravascular coagulation)
3. Gastroenteritis
4. CNS haemorrhage