Key result
Infant myocarditis in SUDI requires strict diagnostic criteria to address medico-legal liability.
Why the study?
Sudden infant death causes often remain unclear in 75 % of cases, prompting a need to analyze available data on SUDI associated with myocarditis and its medico-legal implications.
Systematic Review (n=31)
A definitive diagnosis of myocarditis in SUDI requires meeting all necessary criteria and the involvement of expert pediatric pathologists to standardize analytical methods and guide examinations.
Strict criteria required for myocarditis diagnosis in SUDI; supports expert pathologist inclusion in multidisciplinary forensic teams.
Sudden infant deaths should be recognized as a public health concern, and understanding their underlying causes is crucial to elucidate this still poorly understood phenomenon. Despite efforts and standardized diagnostic protocols including autopsies and laboratory tests, the causes of sudden infant death often remain unclear in the 75 % of the cases. The aim of this review is to analyze the available data on SUDI associated with myocarditis, offering forensic pathologists a comprehensive overview of this topic, with a particular focus not only on pathophysiological and clinical implications but also on medico-legal aspects. This systematic review included articles concerning SUDI related to myocarditis, in particular etiopathogenesis, diagnosis, consequences and medico-legal implications. The research was carried out on articles written in English published between January 1990 and December 2024. A total of 557 studies were found through the electronic search and 11 studies were included after cross-referenced research on the references of the examined full-text articles. A total of 31 studies were included in this systematic review. The study showed that a definitive diagnosis of myocarditis should only be established when all necessary criteria have been met, given the potential liability implications of asserting a specific cause of death in an infant condition that remains the subject of ongoing debate and research. To optimize this process, the inclusion of expert pediatric pathologists in multidisciplinary teams is strongly recommended to standardize analytical methods and guide autopsy, histological, and genetic examinations based on the unique characteristics of the pediatric population.
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Giovannini et al. (2025) conducted a systematic review in Sudden unexpected death in infancy (SUDI) and myocarditis (n=31). Myocarditis was evaluated on SUDI related to myocarditis (etiopathogenesis, diagnosis, consequences and medico-legal implications). Myocarditis as a cause of sudden unexpected death in infancy was evaluated across 31 studies, highlighting the need for strict diagnostic criteria to address medico-legal liability.
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