Prevalence of positive toxicology analysis from the French national registry for sudden unexpected infant death (Tox-MIN)

Abstract

Background

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.

Objectives

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.

Design and methods

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.

Results

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+ (n = 19 [53%], e.g., resuscitation drugs, regular treatments) and unexpected (UTox+) (n = 17 [47%]) toxics. The unexpected toxics were opioids (n = 8), cannabis (n = 4), cocaine (n = 3), cotinine (n = 2), carbon monoxide (n = 2), caffeine (n = 2), alcohol (n = 1) and GHB (n = 1). UTox + infants had a different seasonal distribution (p = .03), a higher incidence of inappropriate sleeping position and bedding at the time of death (respectively OR 3.8, p = .037 – OR 5.4, p = .026); inadequate body hygiene (OR 10.6, p = .0005), a younger maternal age (p = .045) and a higher rate of maternal drug abuse (OR 21.9, p = .0008).

Conclusion

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.

Keywords:

• Sudden unexpected infant death
• French national registry
• toxicological analysis
• child abuse

Author contributions

Isabelle Claudet: Prof. Claudet developed the project and the study design, analyzed the results, interpreted data and drafted the initial manuscript.

Gilles Duthoit, Lucile Barnet, Martin Chever, Elisabeth Daussac, Claire Marchand-Tonel: Drs. Gilles Duthoit, Lucile Barnet, Martin Chever, and Elisabeth Daussac, and Mrs. Marchand-Tonel participated in designing the study, and critically reviewed and revised the manuscript.

Sophie de Visme & Karine Levieux: Mrs. Sophie de Visme and Dr Karine Levieux participated in the development of the project and in interpretation and

Camille Bréhin: Dr. Camille Bréhin participated in the analysis of the results, interpreted data, and critically reviewed and revised the manuscript.

All the authors listed contributed to data collection and substantially participated in data analysis. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).