Sudden Unexpected Death in Infancy: Advances in Diagnostics and Multidisciplinary Investigation

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 31 January 2027 | Viewed by 693

Editor


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Guest Editor
Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
Interests: sudden unexpected death in infancy (SUDI); sudden infant death syndrome (SIDS); post‑mortem diagnostics; multidisciplinary investigation; medicolegal assessment
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Special Issue Information

Dear Colleagues,

Sudden unexpected death in infancy (SUDI) refers to the sudden and unforeseen death of an infant under one year of age, where the cause is not immediately evident. This category includes both explained deaths and unexplained cases, such as sudden infant death syndrome (SIDS) and fatal sleep accidents. Despite improvements in perinatal care and public health initiatives, SUDI remains a significant contributor to post‑neonatal mortality in high‑income countries and continues to present complex diagnostic and medicolegal challenges. This Special Issue of Diagnostics aims to provide a multidisciplinary platform for advancing the understanding and investigation of SUDI. We invite contributions from fields including pathology, pediatrics, genetics, neuropathology, and forensic medicine. Emphasis is placed on standardized post‑mortem protocols—including complete autopsy, death‑scene investigation, and clinical history review—as well as ancillary diagnostics such as microbiology, toxicology, metabolic screening, and genetic testing. We particularly welcome studies that explore underlying pathogenetic mechanisms, identify novel biomarkers or genetic variants, refine phenotypic classifications, or propose risk‑stratification tools. Submissions may include original research, case series, single‑case reports with innovative diagnostic approaches, and systematic or narrative reviews that synthesize current evidence and identify future research priorities. By bringing together diverse diagnostic perspectives, this Special Issue seeks to enhance the accuracy and consistency of SUDI classification, support evidence‑based prevention and family counseling, and strengthen medicolegal assessments—including the critical differentiation between natural and unnatural causes of death.

Dr. Maria P. Bonasoni
Guest Editor

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Keywords

  • sudden unexpected death in infancy (SUDI)
  • sudden infant death syndrome (SIDS)
  • post‑mortem diagnostics
  • multidisciplinary investigation
  • medicolegal assessment

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Published Papers (1 paper)

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Review

16 pages, 278 KB  
Review
Hidden and Under-Recognized Causes of Sudden Unexpected Death in Infancy (SUDI): A Comprehensive Review of Autopsy Findings
by Jessika Camatti, Anna Laura Santunione, Rossana Cecchi, Erjon Radheshi, Edoardo Carretto and Maria Paola Bonasoni
Diagnostics 2026, 16(11), 1730; https://doi.org/10.3390/diagnostics16111730 - 4 Jun 2026
Viewed by 449
Abstract
Sudden unexpected death in infancy (SUDI) remains a major challenge in pediatric pathology and forensic medicine. Despite advances in diagnostic techniques, many cases are still classified as unexplained and labeled as sudden infant death syndrome (SIDS). Increasing evidence suggests that a proportion of [...] Read more.
Sudden unexpected death in infancy (SUDI) remains a major challenge in pediatric pathology and forensic medicine. Despite advances in diagnostic techniques, many cases are still classified as unexplained and labeled as sudden infant death syndrome (SIDS). Increasing evidence suggests that a proportion of these deaths may be due to “hidden” causes not detectable through routine post-mortem examination. A narrative review of the literature (2000–2026) was conducted using PubMed and Scopus, focusing on under-recognized causes of SUDI and their diagnostic implications. Relevant studies were selected and organized into major pathological and forensic categories. Hidden causes of SUDI include a wide spectrum of conditions. Cardiac disorders—such as myocarditis, cardiomyopathies, and inherited arrhythmogenic syndromes—are frequently implicated and may require molecular autopsy for detection. Infectious diseases, often presenting with minimal or nonspecific findings, represent another important category, particularly viral and bacterial infections. Inborn errors of metabolism, especially fatty acid oxidation defects, may lead to sudden death in the absence of specific autopsy findings, highlighting the role of biochemical analyses. Neuropathological abnormalities involving brainstem regulatory systems may contribute to impaired autonomic control. Environmental, toxicological, and medico-legal factors—including unsafe sleep conditions, toxic exposures, and inflicted injury—must also be considered. SUDI is a multifactorial entity in which many unexplained deaths may be attributable to identifiable but overlooked conditions. A standardized, multidisciplinary approach integrating autopsy, ancillary investigations, and molecular diagnostics is essential to improve diagnostic accuracy and support prevention strategies. Full article
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