SIDS or Murder?

Abstract

To the Editor. In his commentary in the January 1997 issue of Pediatrics ,1 Dr Bergman stated his concern that the much-publicized conviction of Waneta Hoyt for causing the deaths of her five children, deaths previously attributed to the sudden infant death syndrome (SIDS), might provoke a “return to the aura of suspicion that surrounded SIDS deaths in the past.” We agree, but still believe that information excluding the possibility of child abuse should have been provided for the cases reported in Pediatrics electronic pages of the same month under the title “Environmental Risk Factors Associated with Pediatric Idiopathic Pulmonary Hemorrhage and Hemosiderosis in a Cleveland Community.”2 In that article, Montana and colleagues2 describe the epidemiologic investigation of a cluster of 10 infants who during 1993 to 1994 had illnesses of sudden onset at home with evidence of acute pulmonary hemorrhage that was confirmed by the demonstration of alveolar iron-laden macrophages (siderophages) 3 to 6 weeks later. Five infants had recurrent acute episodes, all after leaving the hospital and some within 48 hours of returning home. One child died. These cases differed from a control series in various respects, but on the basis of exceptionally high incidence of water damage in the case infants' homes it has been suggested in another publication that the fungus Stachybotrys atra might have been responsible.3 A retrospective study by the coroner's office of 172 infant deaths in the same county during approximately the same time period revealed nine infants (5%) with intrapulmonary siderophages indicating previous pulmonary hemorrhage.3 We have recently reported4 the identification of abundant intraalveolar siderophages in the lungs of two pairs of siblings who had previous hospital admissions for apparent life-threatening events (ALTEs) …