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Role of routine neuropathological examination for determining cause of death in sudden unexpected deaths in infancy (SUDI)
  1. J W Pryce1,
  2. S M L Paine2,
  3. M A Weber1,
  4. B Harding3,
  5. T S Jacques2,
  6. N J Sebire1
  1. 1Department of Paediatric Pathology, Great Ormond Street Hospital, London, UK
  2. 2Neural Development Unit, Institute of Child Health, London, UK
  3. 3The Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  1. Correspondence to Professor N J Sebire, Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London WC1N 3JH, UK; sebirn{at}


Background Current guidelines for the investigation of sudden unexpected death in infancy (SUDI) include full neuropathological examination with recommendations for brain fixation for 1–2 weeks. Little evidence is available regarding the yield of such examination in determining cause of death in clinical practice. This study examines the frequency of neuropathological findings determining cause of death at postmortem examination in SUDI in relation to clinical and macroscopic features.

Methods All postmortem examinations performed for the indication of SUDI at a single specialist centre over a 14-year period were reviewed, including clinical history, macroscopic and neuropathological findings.

Results 6% of postmortem examinations performed for cases of SUDI demonstrated a neuropathological cause of death; in almost all (>90%) the clinical history and/or macroscopic examination suggested the cause of death. In 2% of all cases the cause of death was determined by histological neuropathological examination, but there were no cases in which histological neuropathological examination of a macroscopically normal brain revealed the cause of death in the absence of a ‘neurological history’. Macroscopic brain abnormalities and the presence of a ‘neurological history’ were significantly more likely to yield histological brain abnormalities (11-fold and fourfold, respectively).

Conclusions Histological neuropathological examination rarely determines the cause of death in SUDI in the absence of macroscopic abnormalities or neurological clinical history. A macroscopically abnormal brain and the presence of a clinical history of possible neurological disease or of inflicted injury are significantly more likely to be associated with significant histological brain abnormalities.

  • SUDI
  • neuropathology
  • registration
  • death
  • infant
  • brain
  • histopathology
  • paediatric pathology
  • autopsy pathology
  • SIDS
  • placenta
  • trophoblastic disease
  • neuroblastoma
  • neoplasms
  • paediatric pathology

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  • Funding JWP is funded by a grant awarded by SPARKS charity. SPARKS had no involvement in the collection, analysis or interpretation of data, in the writing of this paper, or in the decision to submit the paper for publication.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Great Ormond Street Hospital local ethical committee.

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