The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France.
UMR 1295, Inserm, Paul Sabatier University, UPS, Toulouse, France.
Clin Toxicol (Phila). 2022 Jan;60(1):38-45. doi: 10.1080/15563650.2021.1933005. Epub 2021 Jun 3.
Sudden unexpected infant death (SUID) remains the leading cause of postnatal mortality in many countries. French and international guidelines recommend a thorough examination with toxicology studies.
The main objective was to determine the prevalence of toxic detection and positive analyses. The secondary objectives were to describe the different toxics and compare children with positive (Tox+) and negative results (Tox-) with other SUID risk factors.
We used the data registered from May 2015 to December 2018 by the French national SUID registry (OMIN). It collects data for all SUID cases admitted to any of the 35 participating French SUID referral centers.
Of the 624 SUID cases registered in the OMIN, a post-mortem toxicological analysis was performed in 398 infants. Thirty-six patients (9%) were positives for expected (Etox+ ( = 19 [53%], e.g., resuscitation drugs, regular treatments) and unexpected (UTox+) ( = 17 [47%]) toxics. The unexpected toxics were opioids ( = 8), cannabis ( = 4), cocaine ( = 3), cotinine ( = 2), carbon monoxide ( = 2), caffeine ( = 2), alcohol ( = 1) and GHB ( = 1). UTox + infants had a different seasonal distribution ( = .03), a higher incidence of inappropriate sleeping position and bedding at the time of death (respectively OR 3.8, = .037 - OR 5.4, = .026); inadequate body hygiene (OR 10.6, = .0005), a younger maternal age ( = .045) and a higher rate of maternal drug abuse (OR 21.9, = .0008).
The high rate of positive results warrants routine toxicology testing. The imputability of identified molecules is complicated by the presence of other known risk factors for SUID.
在许多国家，婴儿猝死仍然是导致产后死亡的主要原因。法国和国际指南建议进行全面检查并进行毒理学研究。
主要目的是确定毒物检测和阳性分析的发生率。次要目的是描述不同毒物，并比较阳性（Tox+）和阴性结果（Tox-）的儿童与其他婴儿猝死综合征（SUID）危险因素的差异。
我们使用了法国国家 SUID 登记处（OMIN）于 2015 年 5 月至 2018 年 12 月期间登记的数据。该登记处收集了所有纳入的 35 个法国 SUID 转诊中心的 SUID 病例的数据。
在 OMIN 登记的 624 例 SUID 病例中，对 398 例婴儿进行了死后毒理学分析。36 例患者（9%）毒物检测阳性，包括预期毒物（Etox+（19 例[53%]，例如复苏药物、常规治疗）和意外毒物（UTox+（17 例[47%]）。意外毒物包括阿片类药物（8 例）、大麻（4 例）、可卡因（3 例）、可替宁（2 例）、一氧化碳（2 例）、咖啡因（2 例）、酒精（1 例）和 GHB（1 例）。UTox+婴儿的季节性分布不同（P=0.03），死亡时不适当的睡眠姿势和床上用品的发生率更高（OR 3.8，P=0.037-OR 5.4，P=0.026）；身体卫生状况不佳（OR 10.6，P=0.0005）、产妇年龄较小（P=0.045）和产妇药物滥用率较高（OR 21.9，P=0.0008）。
高阳性率需要常规毒物检测。由于存在其他已知的 SUID 危险因素，因此鉴定出的分子的可归因性较为复杂。
