Published online by Cambridge University Press: 20 July 2018
This chapter on sudden unexpected death in infancy (SUDI) (both explained and unexplained) outlines the background to gaps in practice, advances in our understanding of SUDI, non-compliant aspects of prevention, and needs and education of parents and health providers. From this outline the fourth section on future directions is developed.
SUDI is defined as the death of an infant aged less than 12 months that is sudden and unexpected “in which there is death (or collapse leading to death), which would not have been reasonably expected to occur 24 hours previously and in whom no preexisting medical cause of death is apparent. It includes those deaths for which a cause is ultimately found (explained SUDI) and those that remain unexplained following investigation” (1).
Gaps in Practice
The future of SUDI research remains dependent on accurate investigation and classification of death. This is frequently suboptimal. This section will discuss models of best practice, delineation of a standardized process of investigation, application of standardized percentile charts to SUDI from birth to 1 year, and a proposed simple classification that addresses potential asphyxia.
Models of best practice
Various models of SUDI investigation with clear objectives and best practice standards have been defined. Garstang et al. (2015) have categorized the different models of SUDI investigation as coroner- or medical-examiner-led investigation, healthcare-led investigation, police-led investigation, and the joint-agency approach (2). All but policeled investigations have the potential to meet international minimum standards of SUDI investigation. The objectives outlined by Garstang et al. include:
• to identify, as far as is possible, any recognizable cause of death including accidental asphyxia, suspicious deaths, medical deaths, and sudden infant death syndrome (SIDS) where diagnostic criteria have been met
• to identify any factors contributing to the death, including factors in the physical or social environment, parental care, and service provision or need
• to support the family through a sensitive, respectful approach that allows them to grieve and recognizes their need for information
• to learn lessons for the prevention of future child deaths
• to ensure that all statutory requirements in relation to the death are fulfilled and that the public interest is served through the appropriate administration of justice and protection of children.