Sudden Unexplained Infant Death Investigation Reporting Form

The following information is collected on the Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF):

1. Investigation Data

   This section is completed by the person (e.g., coroner, death scene investigator, law enforcement official, medical examiner) who interviews the witness.
   • Primary residence. Address where the infant was living when he or she died.
   • Incident address. Address where the infant died or where the final injury occurred.
   • Witness. Person who knows some or all of the circumstances surrounding the infant’s death. This may be the person who 1) last placed the infant in or near the area where he or she was found not breathing or breathing with distress, 2) last observed the infant alive, or 3) found the infant not breathing or breathing with distress.

2. Witness Interview

   This section is completed by the person who interviews the witness.
   • Usual caregiver. The person who took care of the infant more than 50% of the time.
   • Last placed. The last time the infant was put down to sleep or rest (e.g., in a crib).
   • Last known alive (LKA). The last time the infant was observed alive (e.g., time when a parent heard the infant cry).
   • Found. The act of finding the infant not breathing or breathing with distress.
   • Positional support. Item such as a wedge or pillow used to keep an infant on their side or back while sleeping.
   • Wedging. Being caught in a narrow space that causes interference with chest wall movements and normal breathing (e.g., infant wedged between mattress and bed frame).

3. Infant’s Medical History

   This section is completed by the person investigating the infant’s death. This information may be obtained from the infant’s health care provider, medical record, or caregiver.
   • Metabolic disorder. A disease that affects a person’s ability to use or metabolize food (e.g., Medium chain acyl-CoA dehydrogenase (MCAD) deficiency).
   • Birth defect. A physical or functional abnormality that the infant had at birth (e.g., spina bifida, congenital heart defect, Down's syndrome).
   • Newborn screen. Tests done at birth to detect certain metabolic disorders.

4. Infant Dietary History

   This section is completed by the person investigating the infant’s death. The information should be obtained from the person who last fed the infant. If that person is not the person who usually fed the infant, also interview the infant’s usual feeder.

5. Pregnancy History

   This section is completed by the person who interviews the biological or birth mother or someone who knows her history well (e.g., her health care provider, partner, or mother).  

6. Incident Scene Investigation

   This section is completed by the person investigating the infant’s death.  

7. Investigation Summary

   Investigators use this section to describe any concerns they have that are not documented in the preceding sections of the form. Investigators may use the check boxes to indicate when tasks, such as doll reenactment, are completed.
   

8. Investigation Diagrams

   Scene Diagram. The investigator indicates the following on the scene diagram:

   • North direction.
   • Windows and doors.
   • Wall lengths and ceiling height.
   • Location of furniture, including infant’s bed or sleep surface.
   • Location of infant’s body when found.
   • Position of other people or animals found near the infant.
   • Location of heating and cooling devices and other objects in room.
   
   

   Body Diagram. The investigator indicates the following on the body diagram:

   • Discoloration around face, nose, or mouth.
   • Secretions (drainage or discharge from anywhere on the body).
   • Skin discoloration (livor mortis).
   • Pressure mark areas (pale areas, blanching).
   • Rash or petechiae (small, red blood spots on skin, on membranes, or in eyes).
   • Marks on body (scratches or bruises).
   • Location of medical devices (e.g., breathing tube, gastrostomy feeding tube).
   • Body temperature.

9. Summary for Pathologist

   This section summarizes all the information collected during the witness interview and during the investigation at the incident or death scene. This section should be completed last by the person investigating the infant’s death.
   • Asphyxia. Condition of severely deficient supply of oxygen to the body that can rapidly lead to unconsciousness and death (e.g., compression of infant’s chest because he was wedged into a narrow space or had a person laying on him).
   • Overlying. Situation in which someone or something is placed on or over the infant.
   • Hyperthermia. Life-threatening condition in which the core body temperature is above 40°C (104°F).
   • Hypothermia. Life-threatening condition in which the core body temperature falls below 35°C (95°F).

Using the SUIDI Additional Investigative Forms

Additional investigative forms can be used by death scene investigators to collect information about the circumstances surrounding a sudden unexplained infant death and to document personal contacts and collection of evidence. While these forms can be used in addition to the SUIDI Reporting Form to collect important investigative information, this information is not thought to be essential prior to autopsy.

These forms are designed as a questionnaire. The death scene investigator can read the questions to the person they are interviewing. Most questions can be answered by placing an “x” in the corresponding checkbox or filling in the blank provided. Each of these forms can be used alone, or if desired by the local jurisdiction, they can be used with the SUIDI Reporting Form.

Listed below is the name and purpose of each investigative form and definitions of terms not commonly recognized.

1. Body Diagram
   This diagram is a larger version of the diagram included in the SUIDI Reporting Form. It can be used in place of the smaller version. The diagram can be used to note bruises, discoloration, and other observations such as the following:
   • Discoloration around face, nose, or mouth.
   • Secretions (e.g., drainage or discharge from anywhere on the body).
   • Skin discoloration (e.g., livor mortis).
   • Pressure mark areas (e.g., pale areas, blanching).
   • Rash or petechiae (e.g., small, red blood spots on skin, on membranes, or in eyes).
   • Marks on body (e.g., scratches or bruises).
   • Location of medical devices (e.g., breathing tube, gastrostomy feeding tube).
   • Body temperature.
2. EMS Interview
   The investigator uses this form to gather information from emergency medical service (EMS) personnel who responded to the scene. It can be used to augment the EMS run sheet if the sheet is not available.
3. Hospital Interview
   The investigator uses this form to gather information from the hospital emergency department personnel who treated the infant. This form can be used to augment the hospital records. The form can be used to interview hospital personnel if the medical records are not available.
4. Immunization Record
   The investigator uses this form to document all immunizations the infant received since birth. The investigator can get this information from the parent or caregiver’s immunization records or from medical records at the infant’s clinic. To date, there is no evidence supporting an association between immunizations and SIDS.
5. Infant Exposure History
   The investigator uses this form to identify all persons who were in contact with the infant in the 24 hours before the infant’s death. This form may be used to document day care contacts or people attending large family or community gatherings.
6. Informant Contact
   The investigator uses this form to track contact information for each person interviewed.
7. Law Enforcement Interview
   The investigator uses this form to gather information from law enforcement personnel who responded to the scene. This information can be collected from interviews with law enforcement personnel and by reviewing law enforcement reports.
8. Materials Collection Log
   The investigator uses this form to keep a detailed, descriptive list of all items recovered from the incident or death scene.
9. Nonprofessional Responder Interview
   The investigator uses this form to gather information from the first nonprofessional (e.g., caregiver, neighbor) who responded to the infant at the scene.
10. Parental Information
    The investigator uses this form to gather contact information about the infant’s mother, father, and other primary caregivers.
11. Primary Residence Investigation
    The investigator uses this form to describe the infant’s primary residence if the incident or death did NOT occur at the primary residence.
12. Scene Diagram
    The investigator uses this form to diagram multiple scenes or when a larger diagram is needed to document the scene. This form is used to document the immediate area surrounding the infant when the infant was discovered dead, unresponsive, or in distress. The investigator uses the form to record observations, such as the following:
    • North direction.
    • Windows and doors.
    • Wall lengths and ceiling height.
    • Location of furniture, including infant’s bed or sleep surface.
    • Location of infant’s body when found.
    • Position of other people or animals found near the infant.
    • Location of heating and cooling devices and other objects in room.

Download the Sudden Unexplained Infant Death Investigation Reporting Form and the Additional Investigative Forms.

Sudden Unexplained Infant Death Investigation Reporting Form—Electronic Version

In response to numerous requests, the CDC’s SUID Initiative has created an electronic version of the Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) in Microsoft Access. This application is available for download to your computer and is modifiable based upon your jurisdictional needs.

The Sudden Unexplained Infant Death Investigation Reporting Form—Electronic Version (SUIDIRF—EV) application was designed to assist investigative agencies to better understand the circumstances and factors contributing to unexplained deaths in infants. The electronic version of the SUIDIRF allows for increased ease of use so users will not have to enter data more than once, and readable reports can be printed right from the database. The electronic application runs using the Access program on the Windows Operating System, allowing most offices to easily install, use and even modify the forms in Access with the assistance of your IT department or programmer. Individual agencies and jurisdictions can use the application to report and track information. The application can also be used to better understand the characteristics of SUID deaths in their local area so that statistical reports can be easily created and disseminated.

The electronic version contains the primary SUIDIRF as well as ten additional investigative forms. Each form has been designed based on the needs of the different agencies collecting this information.

Download the Sudden Unexplained Infant Death Investigation Reporting Form—Electronic Version (SUIDIRF—EV), SUIDIRF-EV user guide, and installation instructions.