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Claudet I, de Visme S, Duthoit G, Barnet L, Marchand-Tonel C, Chever M, Daussac E, Bréhin C, Levieux K. Prevalence of positive toxicology analysis from the French national registry for sudden unexpected infant death (Tox-MIN). Clin Toxicol (Phila) 2021; 60:38-45. [PMID: 34080518 DOI: 10.1080/15563650.2021.1933005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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.
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Affiliation(s)
- Isabelle Claudet
- The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France.,UMR 1295, Inserm, Paul Sabatier University, UPS, Toulouse, France
| | | | - Gilles Duthoit
- The Pediatric Mobile Care Unit (SMUR), Children's hospital, Toulouse CHU, France
| | - Lucile Barnet
- The Pediatric Mobile Care Unit (SMUR), Children's hospital, Toulouse CHU, France
| | - Claire Marchand-Tonel
- Director of the Health Division, IFRASS, Toulouse, France.,The LISST laboratory, Jean-Jaurès University, UT2J, Toulouse II, France
| | - Martin Chever
- The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France
| | - Elisabeth Daussac
- The Pediatric Mobile Care Unit (SMUR), Children's hospital, Toulouse CHU, France
| | - Camille Bréhin
- The Pediatric Emergency Department, Children's Hospital, Toulouse University Hospital (CHU), France.,UMR 1416, Inserm, IRSD, Toulouse, France
| | - Karine Levieux
- The Pediatric Emergency Unit, Children's Hospital, Nantes CHU, France
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Tuchtan L, Delteil C, Levrat F, Bacquet J, Garcia P, Fayol L, Gorincour G, Zandotti C, Girard N, Drancourt M, Léonetti G, Piercecchi Marti MD, Bartoli C. Sudden unexpected infant death characteristics in the French region of West Provence-Alpes-Côte d'Azur. Paediatr Int Child Health 2019; 39:104-110. [PMID: 30382004 DOI: 10.1080/20469047.2018.1533734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Although the incidence of sudden unexpected infant death (SUID) has decreased since the 'Back to Sleep' campaign in English-speaking countries and other preventive campaigns, the circumstances of such deaths remain unclear. Aim: To analyse infant deaths recorded at the referral centre for sudden infant death of the West Provence-Alpes-Côte d'Azur region of France (West PACA) and the forensic medicine department of Marseille University Hospital. Methods: Information on all SUID cases from 2000 to 2017 was extracted from the referral centre for sudden infant deaths in West PACA and the forensic medicine department of Marseille. Results: The study included 130 infants over the 17 years with a very similar distribution. There was a marked male preponderance, with 61.6% of boys whatever the age at death (sex ratio 1.6). Half of the deaths occurred in the first 6 months of life and the majority (61%) of infants died during autumn and winter. Nearly one-third (33.2%) had presented with minor infections and 21% had been seen by a doctor or had been admitted to hospital. Most deaths (86.4%) occurred during sleep (night or day). Nearly half of the infants (47.7%) were discovered in a prone position. A large majority of parents (90.7%) agreed to a post-mortem examination. Only 6.2% of deaths led to legal proceedings. Nearly 16.9% remained unexplained after compiling all the data included in the protocol and 9.2% remained unexplained because of incomplete investigation, including refusal of post-mortem examination. Abuse was involved in 2.3% of cases. Conclusions: Asymptomatic infectious conditions were associated with a high proportion of SUID cases. Non-supine sleep positions were still practised. There is a need to increase SUID prevention campaigns. Abbreviations: HAS, Haute Autorité de Santé: French National Health Authority; NICHD, National Institute of Child Health and Human Development; PACA, Provence-Alpes-Côte d'Azur region of France; SUID, sudden unexpected infant death; SIDS, sudden infant death syndrome; CépiDc, Centre d'Epidémiologie sur les Causes Médicales de Décès/Center for Epidemiology on the Medical Causes of Death.
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Affiliation(s)
- Lucile Tuchtan
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Clémence Delteil
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Flore Levrat
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France
| | - Juliette Bacquet
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Patricia Garcia
- c Service de Néonatologie , APHM, Hôpital de la Conception , Marseille , France
| | - Laurence Fayol
- c Service de Néonatologie , APHM, Hôpital de la Conception , Marseille , France
| | - Guillaume Gorincour
- d Département d'Imagerie Médicale , APHM, Hôpital de la Timone , Marseille , France
| | - Christine Zandotti
- e Département de Microbiologie , APHM, Hôpital de la Timone , Marseille , France
| | - Nadine Girard
- d Département d'Imagerie Médicale , APHM, Hôpital de la Timone , Marseille , France
| | - Michel Drancourt
- e Département de Microbiologie , APHM, Hôpital de la Timone , Marseille , France
| | - Georges Léonetti
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Marie Dominique Piercecchi Marti
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Christophe Bartoli
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
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