Early sudden unexpected death in infancy (ESUDI) – three case reports and review of the literature



Ursula Kiechl-Kohlendorfer, Department of Pediatrics, Division of Neonatology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Tel: 0043 512 504 27309 | Fax: 0043 512 504 27308 | Email: Ursula.Kohlendorfer@i-med.ac.at



Early sudden unexpected death in infancy (ESUDI) is a rare cause of death occurring in newborns during the first hours of life. Our aim was to find additional data for the identification of risk factors and establishment of prevention strategies.


We describe three cases of ESUDI and give an overview of the literature.


ESUDI was observed in term babies with normal birth weight after good postnatal adaptation within the first four hours of life. Maternal age was between 29 and 36 years, mothers were primiparous and of normal weight. All three events occurred during unobserved early skin-to-skin contact. Autopsy and post-mortem metabolic screening revealed no cause of death. A search of the MEDLINE and Web of Science (Thomson Reuters) databases brought to light 132 cases of ESUDI reported in the literature from 1985 to 2012. Concurrent with our observations, first parity and unobserved early skin-to-skin contact seem to be prime predictors of ESUDI. Other pre-described risk factors such as mode of delivery, birth weight, mother's age and body mass index were not seen in our patients.


Close observation during the first hours of life is essential and can be life-saving, especially during early skin-to-skin contact.