In Reply In response to Dr Schmidt regarding the JAMA Pediatrics article “The Disappearance of Sudden Infant Death Syndrome: Has the Clock Turned Back?,”1 the purpose of this article was to bring attention to the dismal state of practices dealing with sudden unexpected infant deaths including sudden infant death syndrome (SIDS). It is unfortunate that Dr Schmidt disagrees with several issues raised in my article. For example, he states that “plenty of research is going on, much of it confirming that infants have no pathologic changes,” or that “the research is meaningless and describes findings no one can reproduce.” However, Dr Schmidt fails to consider other possibilities to explain why, in many cases of SIDS, no anatomical cause of death is apparent (which in fact is one of the criteria for SIDS diagnosis). Data suggest that the main abnormality/defect in such cases occurs at a submicroscopic/molecular level, not detectable by tools used in routine forensic practice. Increasing evidence is accumulating indicating that SIDS is not a single disease entity but rather a heterogeneous disorder with up to one-third of SIDS cases owing to genetic/molecular defects including cardiac and other organ channelopathies, defects in genes involved in the neurotransmission, immune/inflammatory response, and metabolic pathways.2 In many of these conditions, no obvious gross or microscopic changes are evident. These facts, together with the lack of appropriate technology, could account for the failure of previous research studies to provide a single “pathognomonic or diagnostic” finding. The San Diego protocol, with the aim to improve the investigation of sudden unexpected infant deaths and SIDS is dismissed as unknown or ignored “because it is an abomination that legitimizes shoddy death scene investigation.” I wish to point out that this protocol was developed by an international panel of SIDS experts composed of pediatric and forensic pathologists including the former President of National Association of Medical Examiners, hardly a group that would advocate shoddy death scene investigation practices.3
Cutz E. The Disappearance of Sudden Infant Death Syndrome—Reply. JAMA Pediatr. 2016;170(10):1026–1027. doi:10.1001/jamapediatrics.2016.1782
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