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Histological examination in sudden unexpected death in infancy: evidence base for histological sampling
  1. M A Weber,
  2. J W Pryce,
  3. M T Ashworth,
  4. M Malone,
  5. N J Sebire
  1. Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK and UCL Institute of Child Health, London, UK
  1. Correspondence to Professor Neil J Sebire, Department of Paediatric Pathology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK; sebirn{at}


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 the frequency with which histological examination of visceral organs determines cause of death and examines associations between clinical, macroscopic and microscopic findings.

Methods Retrospective review of 546 SUDI autopsies performed for a 10-year period (1996–2005) at a single centre. The proportion of cases in which non-neuropathological histological examination directly determined the cause of death was identified, and clinical, macroscopic and histological findings at autopsy were compared.

Results Of 510 SUDIs included, 166 cases were explained SUDI, and of these, 54% (89/166) were identified solely on microscopic examination, based on histology of the lungs in 71 (43%), heart in 13 (8%), liver in 4 (2%) and kidneys in 1 (<1%). The proportions of macroscopically normal organs with significant histological findings were 26% lungs, 2% heart and 1% each of liver and kidneys, but none of spleen, thymus, pancreas or adrenals. Macroscopically abnormal organs were more likely to yield significant histological features. Symptoms preceding death were more common in cases with significant histological findings in lungs, heart, liver and adrenals.

Conclusion A non-neuropathological cause of death in explained SUDI can be established from histological examination of lungs, heart, liver and kidneys. Significant histological abnormalities may be detected in selected organs with macroscopically normal appearances. Routine histological sampling of other organs in the absence of specific clinical history or macroscopic abnormalities has a low yield for establishing cause of death.

  • SUDI
  • sudden unexpected death
  • infancy
  • autopsy
  • histology
  • SIDS
  • autopsy pathology
  • paediatric pathology
  • histopathology
  • placenta
  • trophoblastic disease
  • neuroblastoma
  • neoplasms

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  • The sponsor had no role in the study design; collection, analysis and interpretation of data; writing of the report or the decision to submit the paper for publication.

  • Funding The study was supported by a project grant from the Foundation for the Study of Infant Deaths (grant number 1RTZ).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the local research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.