Poza indeksem podatności metabolicznej: proponowana metoda uwzględniająca właściwości próbek do badania kandydujących podatności niemetabolicznych w przypadkach SIDS/SUID bez wyjaśnienia

Purpose: Some sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID) cases remain unexplained after medicolegal investigation. The Metabolic Vulnerability Index (MVI) was proposed as a specimen-aware framework in which the total score summarizes measured multidomain findings and archetype classification organizes patterns of domain involvement. This review proposes a post-MVI framework for organizing candidate non-metabolic vulnerabilities after Stage 1 MVI classification. Methods: Literature on molecular autopsy, cardiac conduction-system pathology, concealed cardiomyopathy, epilepsy/SUDEP, autonomic or respiratory developmental disorders, and postmortem specimen constraints was synthesized into a staged eligibility framework, tiered escalation pathway, and pilot-implementation elements. Results: The framework distinguishes MVI-positive, confirmed low-MVI, and specimen-limited evaluations before routing eligible cases into a tiered pathway. Tier 1 prioritizes targeted cardiac channelopathy testing because of DNA robustness, family actionability, and relevance to autopsy-negative sudden death. Conditional Tier 2 addresses cardiac, neurologic, autonomic/respiratory-control, and structural mechanisms when supported by history, autopsy context, specimen readiness, or predefined triggers. Tier 3 is reserved for unresolved cases when research-level genomic expansion or specialized assessment is feasible and authorized. Stage 1 classification preserves indeterminate or not-evaluable results rather than treating missing findings as normal and separates exposure-context abstraction from score-eligible analytic findings and research-only measurements. Conclusions: The staged MVI/post-MVI model organizes unexplained SIDS/SUID cases into specimen-aware research profiles that integrate abnormal domain patterns, domain evaluability, exposure context, and post-MVI findings. These profiles can generate testable hypotheses about the biologic or physiologic pathways underlying candidate vulnerability. Pilot studies can establish the feasibility and reproducibility of domain collection; subsequent adequately powered studies can determine whether recurring patterns distinguish biologically meaningful subgroups within heterogeneous SIDS/SUID. The resulting classifications remain research constructs and do not constitute diagnoses or individual cause-of-death determinations.