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Sudden perinatal death, which includes antepartum death (from 22 completed weeks of gestation), intrapartum death and early neonatal death (occurring within seven completed days of life), and sudden infant death syndrome (SIDS), represents one of the major sociomedical and scientific problems still lacking a solution in today's medicine.1 However, little effort is being made to find a cause of these deaths, as there is no standard method of performing an autopsy in these victims, and no database exists from which researchers can draw autopsy results. Therefore, the need to submit the young victims to necropsy procedures through a standardized protocol is unanimously recognized, and the chance of preventing perinatal unexpected death and SIDS relies mainly on a better knowledge of the underlying alterations of organs and etiopathogenetic mechanisms. Similarly, for diagnostic purposes, an accurate and careful examination of the circumstantial, environmental, and familial situation within which the death occurred is extremely important.
All the information related to victims of sudden and unexplained fetal death and SIDS will soon be made available in Italy through a specific data bank established under the Law 31/2006 “Regulations for Diagnostic Post Mortem Investigation in Victims of Sudden Infant Death Syndrome (SIDS) and Unexpected Fetal Death.”2 This law mandates that infants who die suddenly within one year of life, and fetuses that die after 22 weeks of gestation without any apparent cause, must be rapidly submitted—with the consent of both parents—to diagnostic postmortem investigation.3 Information about the pregnancy, fetal development and delivery, and, in the case of SIDS, the environmental and familial situation in which the death occurred—in addition to information related to risk factors—must be collected by the obstetrician-gynecologist, neonatologist, pediatrician, and pathologist involved in the case and recorded in the registry of the data bank. In addition, to facilitate the collection and analysis of the data, this data bank will allow the Lino Rossi Research Center in collaboration with the Epidemiology Center of the Italian National Health Institute to update the population through public education and prevention programs aimed at decreasing the incidence of stillbirth and SIDS.
In addition to collecting clinical data about the mother, father, fetal/infant victim, and the death scene (in the case of SIDS), the Italian database (http://users.unimi.it/centrolinorossi) allows the researchers of the Lino Rossi Research Center to evaluate the findings of the in-depth autopsy, particularly as they relate to neuropathological study. A careful neuropathological examination is also one of the main goals of the International Stillbirth Alliance of Harvard University (http://www.stillbirthalliance.org), a recently established organization devoted to understanding the causes and prevention of stillbirth. At present, the Italian Data Bank of Stillbirth vs. SIDS is being administered by the Health Government of the Lombardy Region and experimented with in five regional hospitals. In the near future, it will be expanded nationwide. A first analysis of the recorded data will be presented in 2010.
This program finds encouragement from the analogous registry, introduced in the United States by President Barack Obama, which recently presented a bill to enhance public health activities related to stillbirth and SIDS.4