An Illustrative Review of Positional Asphyxiation in Infants Secured Upright in Car Seats

Margaret L Alston,Yvonne Bronner,Ariel Hunt,Uzma Binte Haidary,Malliga Jambulingam,David Thomas

doi:10.33790/jphip1100186

Abstract

Sudden Unexpected Infant Death (SUID) includes the full spectrum of all causes of infant death, which include “Determined” causes [e.g. Sudden Infant Death Syndrome (SIDS) at 42% and Accidental Suffocation and Strangulation at 24%], as well as “Undetermined” causes at 34% [1]. Literature is replete with studies that address the risk factors associated with SIDS, accounting for at least 42% of infant mortality,[1] but scarcely do published reports address risk factors associated with Positional Asphyxia (PA).This illustrative narrative addresses the 2.8 – 3.0% (98-105) healthy infants who have no pre-existing medical conditions, including prematurity, who die from SUID primarily in car seats, and whose suspected cause of death is PA. Webster’s Dictionary defines PA as, “A condition of deficient oxygen supply to the body which occurs when a person’s physical position prevents adequate breathing.” This tragic phenomenon is suspected when the autopsy of an infant reveals no discovery of a traumatic injury, when there is no pre-existing medical pathology, and when the cause of death is determined to be “Undetermined or Unknown.”

Highlights

Sudden Unexpected Infant Death (SUID) includes the full spectrum of all causes of infant death, which include “Determined” causes [e.g. Sudden Infant Death Syndrome (SIDS) at 42% and Accidental Suffocation and Strangulation at 24%], as well as “Undetermined” causes at 34% [1]
Literature is replete with studies that address the risk factors associated with SIDS, accounting for at least 42% of infant mortality,[1] but scarcely do published reports address risk factors associated with Positional Asphyxia (PA)
Developmental and position-based evidence reveals that the immature conditions of the cervical spine shape; muscular weakness about the neck and upper back; cellular properties, location, and shape of the upper airway all together contribute to the vulnerability for upper airway occlusion in especially young infants when the head falls forward and the neck is maintained in flexion

Summary

Introduction

Sudden Unexpected Infant Death (SUID) includes the full spectrum of all causes of infant death, which include “Determined” causes [e.g. Sudden Infant Death Syndrome (SIDS) at 42% and Accidental Suffocation and Strangulation at 24%], as well as “Undetermined” causes at 34% [1]. Literature is replete with studies that address the risk factors associated with SIDS, accounting for at least 42% of infant mortality,[1] but scarcely do published reports address risk factors associated with Positional Asphyxia (PA) This illustrative narrative addresses the 2.8 – 3.0% (98-105) healthy infants who have no pre-existing medical conditions, including prematurity, who die from SUID primarily in car seats, and whose suspected cause of death is PA. Webster’s Dictionary defines PA as, “A condition of deficient oxygen supply to the body which occurs when a person’s physical position prevents adequate breathing.” This tragic phenomenon is suspected when the autopsy of an infant reveals no discovery of a traumatic injury, when there is no pre-existing medical pathology, and when the cause of death is determined to be “Undetermined or Unknown.”. The phenomenon of PA applies more to young infants -- less than 4 months, a critical developmental period with respect to the morphology of the spine, head and neck alignment, upper back strengthening, and notable upper airway vulnerability

Methods

Results

Conclusion