Virchows Archiv A

, Volume 346, Issue 4, pp 287–301 | Cite as

Sudden unexpected unexplained death in infants

A comparative clinicopathologic study
  • Jurgen Ludwig
  • John P. FitzgibbonsJr.
  • Fred T. Nobrega
Article

Summary

Gross and histologic findings at autopsy in 32 cases of sudden unexpected unexplained death (SUUD) in infants were compared with autopsy findings in (1) 7 cases in which alarming clinical symptoms had been observed but no cause of death was found pathologically (morphologically unexplained death, MUD) and (2) 74 cases in which the cause of death was clearly established [8 cases of sudden unexpected explained death (SUED) and 66 control cases]. Laryngotracheitis was found most often in SUUD cases but did not differ histologically from the upper respiratory infections in the other categories. Other infections in SUUD which may be considered primary were bronchitis, focal pancreatitis, and mild pyelonephritis. Similar lesions were also found in control cases in which death was due to unrelated causes. The history in some SUUD and MUD cases and the morphologic changes in the spleen, thyroid gland, and adrenal gland indicated that unexpected unexplained death may occur at any time during the course of an upper respiratory or other type of infection. Our findings suggest that 2 factors have to combine to initiate the lethal episode: (1) an infection, usually of the upper respiratory tract, and (2) a predisposing condition or a trigger mechanism such as irritating skin lesions, trauma, or pain. The final common pathway appeared to be independent of the underlying disease. The characteristic findings of the terminal episode — hemorrhagic pulmonary edema and petechial hemorrhages — may also be part of a known fatal disease such as encephalitis or sepsis.

Keywords

Pancreatitis Encephalitis Pulmonary Edema Bronchitis Pyelonephritis 

Plötzlicher, unerwarteter und ungeklärter Tod im Säuglingsalter

Eine vergleichende klinisch-pathologische Studie

Zusammenfassung

Makroskopische und mikroskopische Autopsiebefunde von 32 plötzlichen, unerwarteten und ungeklärten Todesfällen im Säuglingsalter (SUUD, „Krippentod“). werden verglichen mit 1. 7 Fällen, bei denen sich morphologisch keine Todesursache fand, obwohl alarmierende klinische Symptome beobachtet worden waren (MUD, morphologisch ungeklärter Tod) und 2. 74 Fällen, bei denen die Todesursache autoptisch gesichert war [8 Kinder dieser Gruppe waren plötzlich und unerwartet gestorben (SUED), und 66 Kinder mit schweren klinischen Symptomen dienten als Kontrollen].

Laryngotracheitis war am häufigsten bei Krippentod (SUUD). Histologisch fanden sich keine Unterschiede zu den Infektionen der oberen Atemwege in den anderen Gruppen. Bronchitis, herdförmige Pankreatitis und geringgradige Pyelonephritis kamen ebenfalls als Primärinfektionen in Frage. Ähnliche Befunde wurden jedoch auch in Kontrollfällen mit anderer Todesursache erhoben.

Der Krippentod (SUUD) kann wahrscheinlich zu jeder beliebigen Zeit im Ablauf einer Infektion, besonders der oberen Atemwege, auftreten. Dafürd srechen die klinischen Vorgeschichten einiger Krippentodesfälle (SUUD) sowie einiger Fälle von morphologisch ungeklärtem Tod (MUD) und außerdem morphologische Veränderungen in der Milz, der Schilddrüse und der Nebennierenrinde.

Nach unseren Befunden müssen 2 Faktoren zusammentreffen, um den Krippentod auszulösen: 1. eine Infektion, gewöhnlich der oberen Atemwege, und 2. eine Disposition, z. B. als Folge einer Frühgeburt, oder Auslösemechanismen wie irritierende Hautschäden, Trauma oder Schmerz. Der Todesmechanismus scheint unabhängig von der auslösenden Krankheit zu sein. Die typischen Befunde des Endstadiums, hämorrhagisches Lungenödem und petechiale Schleimhautblutungen, finden sich auch bei tödlichen Krankheiten bekannter Ursache, wie Encephalitis oder Sepsis.

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Copyright information

© Springer-Verlag 1969

Authors and Affiliations

  • Jurgen Ludwig
    • 1
  • John P. FitzgibbonsJr.
    • 2
  • Fred T. Nobrega
    • 2
  1. 1.Mayo Clinic and Mayo Foundation: Section of Experimental and Anatomic PathologyUSA
  2. 2.Mayo Graduate School of MedicineUniversity of MinnesotaRochester

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