Morentin Benito, Suárez-Mier Maria Paz, Aguilera Beatriz
Section of Pathology, Institute of Forensic Medicine, Bilbao, Basque Country, Spain.
Forensic Sci Int. 2003 Aug 27;135(3):213-7. doi: 10.1016/s0379-0738(03)00212-3.
Sudden unexplained death (SUD) on children and young people is unusual, although the real magnitude is unknown. The clinical and physiopathological characteristics are poorly defined. The aim of this work is to analyse the epidemiological, clinical and pathological characteristics of SUD on children and young people. In this population observational study, all sudden non-violent deaths between 1 and 35 years occurred in Bizkaia (north Spain) from 1991 to 1998 were investigated, analysing those diagnosed as SUD. Pathological records, circumstances of death and autopsy findings were obtained. Out of 107 cases of sudden death (SD), 19 were SUD. The mortality rate of SUD was 0.43/100,000 persons per year. Five had pathological antecedents: syncopal episodes in three cases and tachycardia and ventricular extrasystoles one each. The initial symptom was sudden collapse (N=13). In four cases, a precipitating factor was identified (two physical exercise and two emotional stress). Six cases died during sleep. Minimal pathological findings in coronary arteries, myocardium or conduction system was found in nine cases. Heart weight increased (under interval of confidence of 95%) was present in 12 cases. In conclusion, the SUD is very infrequent in children and young people. However, it has great clinical significance because it affects people in good health and occurs without warning symptoms. Some of these cases can be due to cardiac arrhythmias. In deaths in bed there is a high frequency of SUD. In the future, it may be possible that abnormalities at a molecular level will be detected in some of the cases identified today as SUD.
儿童和青少年的不明原因猝死（SUD）较为罕见，尽管实际发生率尚不清楚。其临床和生理病理特征尚不明确。本研究旨在分析儿童和青少年不明原因猝死的流行病学、临床和病理特征。在这项人群观察性研究中，对1991年至1998年发生在西班牙北部比斯开省的所有1至35岁非暴力性猝死病例进行了调查，分析那些被诊断为不明原因猝死的病例。获取了病理记录、死亡情况和尸检结果。在107例猝死病例中，19例为不明原因猝死。不明原因猝死的死亡率为每年0.43/10万人口。5例有病理前驱症状：3例有晕厥发作，1例有心动过速，1例有室性早搏。初始症状为突然倒地（n = 13）。4例发现有诱发因素（2例为体育锻炼，2例为情绪应激）。6例在睡眠中死亡。9例在冠状动脉、心肌或传导系统中发现最小病理改变。12例心脏重量增加（在95%置信区间内）。总之，儿童和青少年不明原因猝死非常罕见。然而，它具有重要的临床意义，因为它影响健康人群且无预警症状。其中一些病例可能是由于心律失常。在床上死亡的病例中不明原因猝死的发生率较高。未来，可能会在一些目前被诊断为不明原因猝死的病例中检测到分子水平的异常。
