Guilia Ottaviani: Crib Death. Sudden Unexplained Death of Infants: The Pathologist’s Viewpoint

Abstract

For decades, crib death or SIDS, the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history has been one of the main topics of scientific research and routine work in forensic pathology all over the world. The tragedy that parents face when SIDS occurs is one aspect. The main focus for us as forensic pathologists in such cases is to exclude any other causes of death and especially to rule out homicide. This book is based on the author’s PhD dissertation from the University of Milan. Over the last years, Dr. Ottaviani has published a presentable number of scientific papers concerning mainly the cardiac conduction system and the central nervous system in infants and especially in those who have died of SIDS. Dr. Ottavani is a well-recognized researcher in the field of SIDS in clinical pathology and her monograph presents a systematic summary of the investigations carried out and results achieved by her study group. The book is good to read from both an intellectual as well as a scientific point of view. However, the forensic pathologist, probably in contrast to the clinical pathologist who is not so focused as those dealing with cases that occasionally end in a court rooms as previously concealed homicides, misses those aspects dealing with situations when a suspected SIDS case turns out as infanticide. It has been proposed that as many as approximately 10% of deaths attributed to SIDS are actually infanticide, mainly by smothering (leaving no signs of trauma and unremarkable autopsy findings). The inspection of the death scene by the forensic pathologist who performs the autopsy of the infant may be crucial for the later conclusion whether death by suffocation (may this be accidental or intentional by a third party) has to be considered or not. These are the only aspects that one who is involved in forensic death investigation misses when reading this book. Nevertheless, the Ottavaviani book is a good supplement to all the SIDS books currently available.