I 
112TH CONGRESS 
1ST SESSION H. R. 3418 
To amend the Public Health Service Act to improve the health of children 
and reduce the occurrence of sudden unexpected infant death and to 
enhance public health activities related to stillbirth. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 14, 2011 
Mr. PALLONE (for himself and Mr. KING of New York) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve the 
health of children and reduce the occurrence of sudden 
unexpected infant death and to enhance public health 
activities related to stillbirth. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Stillbirth and SUID 
Prevention, Education, and Awareness Act of 2011’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) Every year, there are more than 25,000 
stillbirths in the United States. 
(2) Causes for stillbirth include genetic abnor-
malities, umbilical cord accidents, infections, and 
placental problems. 
(3) A number of risk factors for stillbirth have 
been described in pregnant women such as young or 
advanced maternal age, obesity, smoking, diabetes, 
and hypertension. 
(4) Because of advances in medical care over 
the last 30 years, much more is known about the 
causes of stillbirth. But for as many as 50 percent 
of stillbirths, the cause is never identified. 
(5) Sudden unexpected infant death (SUID) is 
the sudden death of an infant under 1 year of age 
that when first discovered did not have an obvious 
cause. These include those deaths that are later de-
termined to be from explained as well as unexplained 
causes. 
(6) In 2004, approximately 4,600 infants died 
suddenly and unexpectedly of no immediate obvious 
cause. 
(7) Each year approximately 200 deaths of chil-
dren between the ages of 1 and 4 remain unex-
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plained after a thorough case investigation is con-
ducted. 
(8) The Sudden Unexpected Infant Death 
(SUID) rate has been declining significantly since 
the early 1990s. However, research has found that 
some of the decline in SUID since 1999 can be ex-
plained by diagnostic shifts and increasing diagnosis 
specificity. 
(9) Many sudden unexpected infant deaths are 
not investigated and, even when they are, cause-of- 
death data are not collected and reported consist-
ently. 
(10) Inaccurate or inconsistent classification of 
cause and manner of death due to inconsistent data 
collection impedes prevention efforts and complicates 
the ability to understand risk factors related to these 
deaths. 
(11) The National Child Death Review Case 
Reporting System collects comprehensive informa-
tion on the risk factors associated with SUID 
deaths. As of March 2011, 37 of the 49 States con-
ducting child death reviews are voluntarily submit-
ting data to this reporting system. 
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SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART W—SUDDEN UNEXPECTED INFANT DEATH 
AND 
SUDDEN 
UNEXPLAINED 
DEATH 
IN 
CHILDHOOD 
‘‘SEC. 399OO. DEFINITIONS. 
‘‘In this part: 
‘‘(1) ADMINISTRATOR.—The term ‘Adminis-
trator’ means the Administrator of the Health Re-
sources and Services Administration. 
‘‘(2) DIRECTOR.—The term ‘Director’ means 
the Director of the Centers for Disease Control and 
Prevention. 
‘‘(3) STATE.—The term ‘State’ has the mean-
ing given to such term in section 2, except that such 
term includes tribes and tribal organizations (as 
such terms are defined in section 4 of the Indian 
Self-Determination and Education Assistance Act). 
‘‘(4) SUDDEN
UNEXPECTED
INFANT
DEATH; 
SUID.—The terms ‘sudden unexpected infant death’ 
and ‘SUID’ mean the sudden death of an infant 
under 1 year of age that when first discovered did 
not have an obvious cause. Such terms include those 
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deaths that are later determined to be from ex-
plained as well as unexplained causes. 
‘‘(5) SUDDEN UNEXPLAINED DEATH IN CHILD-
HOOD; SUDC.—The terms ‘sudden unexplained death 
in childhood’ and ‘SUDC’ mean the sudden death of 
a child older than 1 year of age which remains unex-
plained after a thorough case investigation that in-
cludes a review of the clinical history and cir-
cumstances of death and performance of a complete 
autopsy with appropriate ancillary testing. 
‘‘SEC. 399OO–1. DEATH SCENE INVESTIGATION AND AU-
TOPSY. 
‘‘(a) INVESTIGATIONS.— 
‘‘(1) GRANTS.—The Secretary, acting through 
the Director, shall award grants to States to enable 
such States to improve the completion of comprehen-
sive death scene investigations for sudden unex-
pected infant death and sudden unexplained death in 
childhood. 
‘‘(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), a State shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
‘‘(3) USE OF FUNDS.— 
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‘‘(A) IN
GENERAL.—A State shall use 
amounts received under a grant under para-
graph (1) to improve the completion of com-
prehensive death scene investigations for sud-
den unexpected infant death and sudden unex-
plained death in childhood, including through 
the awarding of subgrants to local jurisdictions 
to be used to implement standard death scene 
investigation protocols for sudden unexpected 
infant death and sudden unexplained death in 
childhood and conduct comprehensive, stand-
ardized autopsies. 
‘‘(B) 
PROTOCOLS.—A 
standard 
death 
scene protocol implemented under subparagraph 
(A) shall include the obtaining of information 
on current and past medical history of the in-
fant/child, the circumstances surrounding the 
death including any suspicious circumstances, 
the sleep position and sleep environment of the 
infant/child, and whether there were any acci-
dental or environmental factors associated with 
the death. The Director in consultation with 
medical examiners, coroners, death scene inves-
tigators, law enforcement, emergency medical 
technicians and paramedics, public health agen-
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cies, and other individuals or groups determined 
necessary by the Director shall develop a stand-
ard death scene protocol for children from 1 to 
4 years of age, using existing protocols devel-
oped for SUID. 
‘‘(b) AUTOPSIES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director, shall award grants to States 
to enable such States to increase the rate at which 
comprehensive, standardized autopsies are per-
formed for sudden unexpected infant death and sud-
den unexplained death in childhood. 
‘‘(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), a State shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
‘‘(3) COMPREHENSIVE AUTOPSY.—For purposes 
of this subsection, a comprehensive autopsy shall in-
clude a full external and internal examination, in-
cluding microscopic examination, of all major organs 
and 
tissues 
including 
the 
brain, 
complete 
radiographs, vitreous fluid analysis, photo docu-
mentation, selected microbiology when indicated, 
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metabolic testing, and toxicology screening of the in-
fant or child involved. 
‘‘(4) GUIDELINES.—The Director, in consulta-
tion with board certified forensic pathologists, med-
ical examiners, coroners, pediatric pathologists, pedi-
atric cardiologists, pediatric neuropathologists and 
geneticists, and other individuals and groups deter-
mined necessary by the Director shall develop na-
tional guidelines for a standard autopsy protocol for 
sudden unexpected infant death and sudden unex-
plained death in childhood. The Director shall en-
sure that the majority of such consultation is with 
board certified forensic pathologists, medical exam-
iners, and coroners. The Director is encouraged to 
seek additional input from child abuse experts, be-
reavement specialists, parents, and public health 
agencies on nonmedical aspects of the autopsy guide-
lines. In developing such protocol, the Director shall 
consider autopsy protocols used by State and local 
jurisdictions. 
‘‘(c) STUDY ON GENETIC TESTING.—The Director, 
in consultation with medical examiners, coroners, forensic 
pathologists, geneticists, researchers, public health offi-
cials, and other individuals and groups determined nec-
essary by the Director, shall commission a study to deter-
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