Understanding Sudden Unexplained Deaths in Toddlers

Toddlers are more than difficult to understand as they are unable to convey what they want to or tell how they feel. More than 2,900 US children aged younger than 4 years die from unknown causes each year, accounting for more than 219,000 life years lost annually. They are mostly sleep-related and unwitnessed with unremarkable autopsies, limiting our understanding of death mechanisms. Researchers sought to understand potential mechanisms of death by evaluating videos of sudden deaths in toddlers.

A new study in Neurology journal reveals a groundbreaking cause for unexpected toddler death. Brief seizures accompanied by muscle convulsions have been named as a possible reason for the mysterious and tragic deaths — a tragic loss suffered by thousands of families in the United States each year.

Researchers used the registry of 301 sudden unexplained child deaths, a series of 7 consecutively enrolled cases with home video recordings of the child's last sleep period were independently assessed by 8 physicians for video quality, movement, and sound.

Key Findings of the Study

• Four boys and 3 girls (13–27 months at death) with terminal videos shared similar demographic features to the 293 other registry cases without video recordings.
• Five video recordings were continuous and 2 were triggered by sound or motion.
• Two lacked audio. All continuous recordings included a terminal convulsive event lasting 8–50 seconds; 4 children survived for >2.5 minutes postconvulsion.
• Among discontinuous videos, time lapses limited review; 1 suggested a convulsive event.
• Six were prone with face down, and 1 had autopsy evidence of airway obstruction.
• Primary cardiac arrhythmias were not supported; all 7 children had normal cardiac pathology and whole-exome sequencing identified no known cardiac disease variants.

Researchers concluded that "Audio-visual recordings in 7 toddlers with unexplained sudden deaths strongly implicate that deaths were related to convulsive seizures, suggesting that many unexplained sleep-related deaths may result from seizures."

Reference

Laura Gould, Codi-Ann Reid, Alcibiades J. Rodriguez, and Orrin Devinsky, Video Analyses of Sudden Unexplained Deaths in Toddlers, https://doi.org/10.1212/WNL.0000000000208038.