Respiratory Arrest in a Late Preterm Infant Presenting for a 2-Week Well-Visit

We read Respiratory Arrest in a Late Preterm Infant Presenting for a 2-Week Well-Visit, by Urbina et al1 with keen interest. We should all feel heartened by the ability to make previously elusive diagnoses in pediatrics, and our growing understanding of human parechovirus (HPeV) infection represents progress against an especially severe infection in young infants. As can often be the case with HPeV, laboratory studies, including cerebrospinal fluid, were normal. In many institutions, HPeV testing is not readily available. We recently published a case report involving an infant whose death in a hospital setting involved HPeV3 infection.2 The cause of death in our case was concluded to be “sudden infant death while bedsharing” and the manner of death “undetermined.” We believe a reflection on the differences between these 2 cases offers lessons about our assumptions in sudden unexpected infant deaths (SUIDs).In our case, as opposed to progressive apnea episodes witnessed by a pediatrician during a well-child care visit, the 11-day-old infant had been admitted to the hospital for sepsis evaluation and empirical antibiotics after presenting with fever and fussiness. Her evaluation was similarly unremarkable. While awaiting discharge, the mother fell asleep with the baby and awakened to discover her infant unresponsive. Resuscitation efforts were not successful. HPeV3 was not identified during the hospitalization or autopsy, but as part of our research when we further evaluated molecular changes related to inflammation detected in the brainstem.It is not difficult to imagine events similar to the Urbina case occurring in the home as parents sleep. Without the benefit of symptoms presenting incidentally during a well-child visit, they would likely be labeled as SUIDs. Many SUID cases, despite the intention of a complete investigation, can only focus on established risk factors as the salient findings, as was the situation for bed-sharing in our case.At some point, the new capabilities illustrated by Urbina et al and elsewhere2–5 will influence our assumptions about SUIDs. We believe that pediatricians have a special responsibility to argue for postmortem assessments beyond routine autopsies and investigations centered on documenting risk factors for SUIDs. Especially in such tragic circumstances, it is the role of pediatricians to advocate for exhaustive efforts to understand the child’s underlying condition and its implications for the health of a family.