{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:08:26Z","timestamp":1791648506626,"version":"4.3.4"},"reference-count":77,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Sudden unexpected death in infancy (SUDI) remains a major challenge in pediatric pathology and forensic medicine. Despite advances in diagnostic techniques, many cases are still classified as unexplained and labeled as sudden infant death syndrome (SIDS). Increasing evidence suggests that a proportion of these deaths may be due to \u201chidden\u201d causes not detectable through routine post-mortem examination. A narrative review of the literature (2000\u20132026) was conducted using PubMed and Scopus, focusing on under-recognized causes of SUDI and their diagnostic implications. Relevant studies were selected and organized into major pathological and forensic categories. Hidden causes of SUDI include a wide spectrum of conditions. Cardiac disorders\u2014such as myocarditis, cardiomyopathies, and inherited arrhythmogenic syndromes\u2014are frequently implicated and may require molecular autopsy for detection. Infectious diseases, often presenting with minimal or nonspecific findings, represent another important category, particularly viral and bacterial infections. Inborn errors of metabolism, especially fatty acid oxidation defects, may lead to sudden death in the absence of specific autopsy findings, highlighting the role of biochemical analyses. Neuropathological abnormalities involving brainstem regulatory systems may contribute to impaired autonomic control. Environmental, toxicological, and medico-legal factors\u2014including unsafe sleep conditions, toxic exposures, and inflicted injury\u2014must also be considered. SUDI is a multifactorial entity in which many unexplained deaths may be attributable to identifiable but overlooked conditions. A standardized, multidisciplinary approach integrating autopsy, ancillary investigations, and molecular diagnostics is essential to improve diagnostic accuracy and support prevention strategies.<\/jats:p>","DOI":"10.3390\/diagnostics16111730","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:52:30Z","timestamp":1780573950000},"page":"1730","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hidden and Under-Recognized Causes of Sudden Unexpected Death in Infancy (SUDI): A Comprehensive Review of Autopsy Findings"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8449-1803","authenticated-orcid":false,"given":"Jessika","family":"Camatti","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, Via Universit\u00e0 12, 43121 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-1895","authenticated-orcid":false,"given":"Anna Laura","family":"Santunione","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Metabolic and Neural Sciences, Unit of Legal Medicine, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-7212","authenticated-orcid":false,"given":"Rossana","family":"Cecchi","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Metabolic and Neural Sciences, Unit of Legal Medicine, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2064-6523","authenticated-orcid":false,"given":"Erjon","family":"Radheshi","sequence":"additional","affiliation":[{"name":"Unit of Legal Medicine and Bioethics, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Carretto","sequence":"additional","affiliation":[{"name":"Local Health Authority \u2018Papa Giovanni XXIII\u2019, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4889-1944","authenticated-orcid":false,"given":"Maria Paola","family":"Bonasoni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy"},{"name":"Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2022057990","DOI":"10.1542\/peds.2022-057990","article-title":"Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. 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