BACKGROUND. Sudden and unexpected death is well known to occur in infants, and although sudden deaths are less frequent after the first
birthday, they still account for a significant proportion of childhood deaths. In 2009, 1.9% of the total deaths in the USA were childhood
deaths. In South Africa (SA) this proportion was much higher at 11.85%. According to the law, sudden and unexpected deaths are generally
investigated as unnatural deaths. Establishing an exact underlying anatomical cause of death will depend on available resources and can be
difficult in a substantial proportion of cases.
METHODS. A retrospective descriptive case audit was conducted at the Pretoria Medico-Legal Laboratory (PMLL), SA, from 1 January 2007
through to 31 December 2011. All children aged 1 - 18 years who died suddenly and unexpectedly were included.
RESULTS. Ninety-eight cases were identified, which constituted nearly 1% of total admissions to the PMLL. The majority of the deaths
were of children aged 1 - 5 years, and the male/female ratio was 1.04:1. In the largest proportion of cases (n=28, 28.6%), the medicolegal
investigation, including autopsy and ancillary investigations, did not establish an underlying anatomical cause of death. In the cases where
a cause of death was established, pneumonia was the most common diagnosis (n=22, 22.4%).
CONCLUSIONS. The fact that the cause of the largest proportion of deaths could not be ascertained emphasises the need for consideration of
additional investigative techniques, such as molecular/genetic screening, which have provided an underlying cause of death in a significant
number of cases in other countries. There is a lack of published research on the causes and incidence of sudden unexpected deaths in
children in SA, and further research in this area is needed.