Child Protective Services referrals in cases of sudden infant death: a 10-year, population-based analysis in San Diego County, California.

The potential diagnostic significance of prior family referral to Child Protective Services (CPS) in cases of sudden infant death is unknown. Therefore, the authors retrospectively searched for CPS data for the 5-year referral history on all 533 families whose infants died suddenly from Sudden Infant Death Syndrome (SIDS), other natural diseases, accidents, or inflicted injuries and underwent postmortem examination by the medical examiner during a 10-year period. No family had more than one infant death. At least 27% of the families in each group had at least one CPS referral. The data suggest that a family's referral to CPS prior to their sudden death of their infant does not increase the likelihood that it was caused by inflicted injuries, and prior referral should not preclude a diagnosis of SIDS. The authors recommend future prospective studies that include refined exposure histories and that are large enough to have sufficient statistical power to compare family CPS referrals and outcomes in groups of infants who died suddenly with a matched group of living infants.

Serum testosterone and estradiol in sudden infant death.

OBJECTIVE: To test the hypothesis that among infants who die unexpectedly, testosterone and/or estradiol levels are elevated in those diagnosed with SIDS versus those with known causes of death (controls). STUDY DESIGN: Postmortem blood was collected and coded from infant autopsies, and serum was prepared and frozen until assayed for total testosterone and estradiol by fluoroimmunoassay. Subject information was then collected from the medical examiner's report. RESULTS: Testosterone, but not estradiol, was significantly higher in 127 SIDS cases versus 42 controls for both males (4.8 +/- 0.4 vs 2.2 +/- 0.4 nmol, respectively; P < .005) and females (2.4 +/- 0.2 vs 1.6 +/- 0.2 nmol, respectively; P < 0.03). CONCLUSIONS: Higher testosterone levels in infant victims of unexpected, unexplained death may indicate a role for testosterone or related steroids in SIDS. Further research is needed to understand the potential utility of testosterone as an indicator of SIDS risk.

Sudden unexpected death in childhood: a report of 50 cases.

Sudden unexplained death in childhood (SUDC) is rare, with a reported incidence in the United States of 1.5 deaths per 100,000 live births compared with 56 deaths per 100,000 live births for sudden infant death syndrome in 2001. The objectives of this study include a proposal for a general definition for SUDC and presentation of 36 cases of SUDC and 14 cases of sudden unexpected death in childhood. Cases were accrued through referrals or unsolicited via our Web page (http://www.sudc.org ). Our analyses tentatively suggest a SUDC profile characterized by cases being 1 to 3 years in age, predominantly male, and frequently having a personal and family history of seizures that are often associated with a fever. A history of recent minor head trauma is not uncommon. They are usually born at term as singletons and occasionally have a family history of sudden infant death syndrome or SUDC. Most are found prone, often with their face straight down into the sleep surface. Minor findings are commonly seen at postmortem examination but do not explain their deaths. Comprehensive review of the medical history and circumstances of death and performance of a complete postmortem examination including ancillary studies and extensive histologic sampling of the brain are critical in determining the cause of death in these cases of sudden unexpected childhood death. Legislation enabling research and formation of a multicenter research team is recommended to unravel the mystery of SUDC.