Paediatric Forensic Medicine and Pathology, Second Edition
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The possibility that cytokines associated with these foci of inflammation are involved in the fatal episode is purely hypothetical 92 - It should also be noted that such areas of minor chronic inflammation are commonly found in lung sections from a wide range of non-infectious cases, accidents, or homicides Over the years there have been several contentious markers that have been put forward to differentiate SIDS cases from accidental or homicidal suffocation.
It is worthwhile exploring two of these in detail to show that they are no longer considered reliable. First, it was suggested that intra-alveolar hemorrhage indicated airway obstruction from overlaying or smothering If sections have been taken from dependent areas of the lungs there may also be marked congestion with intra-alveolar hemorrhage.
Asphyxial episodes from smothering may show marked congestion with areas of hemorrhage 98 , but these changes are very variable and subject to the influence of a number of other factors Second, the other finding that was used to suggest previous trauma or suffocation was that of hemosiderin within intra-alveolar macrophages - However, intra-alveolar hemosiderin may be found in otherwise unremarkable SIDS cases that have typical clinical, historical, and autopsy features Hemosiderin may also be deposited in the lungs following episodes of aspiration of blood, or as a result of medical conditions with chronic pulmonary congestion such as congestive cardiac failure or mitral valve stenosis.
Various criteria have been proposed to assist in the histologic evaluation of these cases , The autopsy investigation of cases of sudden and unexpected infant deaths should be undertaken in an organized and comprehensive manner according to established protocols.
The investigation of these deaths cannot rely purely on the pathological findings, but must integrate clinical and family histories with death scene findings. The crucial role of infant mortality committees in monitoring these deaths cannot be underestimated. Finally, it must be recognized that the pathological findings in SIDS infants are by its very nature nonspecific and it is vital that not too much emphasis is placed on incidental findings such as low-grade chronic inflammation, intra-alveolar hemorrhage, and hemosiderin deposition.
This licence allows for the copying, distribution, display and performance of this work for non-commercial purposes providing the work is clearly attributed to the copyright holders. Address all inquiries to the Director at the above address. Turn recording back on. National Center for Biotechnology Information , U. Search term. There are no facts, only interpretations. Friedrich Nietzsche Introduction In Chapter 1 the various definitions of sudden infant death syndrome SIDS were discussed, with the one common theme being the lack of diagnostic features.
Death Scene Investigation Although death scene examinations are a requirement of all of the major current definitions of SIDS 21 , 22 , this has not been met with universal acceptance 23 , as was noted in Chapter 1. Table Issues with Shared Sleeping One area that death scene examination has shed some light on is shared or co-sleeping.
Medical History Review As specified in current definitions 20 , 22 , a thorough review of the medical history of the deceased infant is required before the autopsy is commenced, checking for any evidence of potentially lethal medical conditions such as congenital heart disease. Autopsy Findings One of the most useful developments in recent years in the pathological evaluation of unexpected infant and early childhood deaths has been the development and adoption of autopsy protocols 18 , 57 — in particular, the International Standardized Autopsy Protocol ISAP see Table External findings A full external examination of all body surfaces including the anogenital region, nose, and ears should be undertaken as soon as possible after death.
Internal findings The abdominal cavity is normal in appearance with glistening, non-dehydrated organs located in their usual positions.
Paediatric Forensic Medicine and Pathology
Microscopic findings By definition, the histologic findings in SIDS infants are unremarkable, as significant disease would warrant an alternative diagnosis Conclusions The autopsy investigation of cases of sudden and unexpected infant deaths should be undertaken in an organized and comprehensive manner according to established protocols. References 1. Autopsy findings — Sudden infant death syndrome — Epidemiology and etiology.
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In: Encyclopedia of forensic and legal medicine. Oxford: Academic Press, Autopsy findings — Sudden infant death syndrome — Pathological findings and autopsy approach. Sturner WQ. Perspect Pediatric Pathol. Byard RW. Possible mechanisms responsible for the sudden infant death syndrome.
J Paediatr Child Health. Emery JL. A way of looking at the causes of crib death. In: Sudden infant death syndrome. Academic Press: New York, Is sudden infant death syndrome a diagnosis? Or is it just a diagnostic dustbin? Brit Med J. Sudden unexpected death in infancy SUDI : Suggested classification and applications to facilitate research activity.
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Forensic Sci Med Pathol. Sudden death in the young. Forensic pathology of infancy and childhood. New York: Springer Publishers, Prospective study on the prevalence of sudden infant death and possible risk factors in Brussels: Preliminary results Eur J Pediatrics. An analysis of trends in the incidence of sudden infant death in The Netherlands Inaccurate classification of infant deaths in Australia: A persistent and pervasive problem.
Med J Aust. Armstrong KL, Wood D. Can infant death from child abuse be prevented? Fitzgerald K. Problems, progress and possibilities. London: Arnold, How useful is post-mortem examination in sudden infant death syndrome? Pediatr Pathol. Categories of preventable unexpected infant deaths. Arch Dis Child.
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An analysis of the usefulness of specific stages in the pathological investigation of sudden infant death. Am J Forensic Med Pathol. Sudden infant death syndrome. Sudden infant death syndrome and unclassified sudden infant deaths: A definitional and diagnostic approach.
Changing infant death rates: Diagnostic shift, success story, or both? Becroft DMO. An international perspective [letter]. Arch Pediatr Adol Med. Death scene investigation. The pathological approach to sudden infant death — Consensus or confusion? Byard RW, Jensen L. Fatal asphyxial episodes in the very young — Classification and diagnostic issues. Death-scene investigation in sudden infant death.
N Engl J Med. Byard RW, Hilton J. Overlaying, accidental suffocation, and sudden infant death. Hazardous infant and early childhood sleeping environments and death scene examination. J Clin Forensic Med. Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate? J Pediatr. An individual level analysis of five major case-control studies.
BMJ Open. Sudden infant death syndrome and advice for safe sleeping. Is co-sleeping in infancy a desirable or dangerous practice? Should infants and adults sleep in the same bed together? Bed sharing and sudden infant death syndrome [letter]. Sofa sleeping and infant death.
Evolution and infant sleep: An experimental study of infant-parent co-sleeping and its implications for SIDS. Acta Paediatrica. Mother-infant cosleeping: Toward a new scientific beginning. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Resp Rev.