Sudden death in infants

Abstract

An analysis has been made as tothe causes of death in 1,267 infants and young children 4 years and under, reported to the office of the Chief Medical Examiner in Richmond over an eighteen-month period from Jan. 1, 1952, to July 1, 1953. In the same period there were about 5,400 deaths in the entire State. This study, then, represents about 23 per cent of the total deaths for the same age group. The greatest number of deaths occurred in the group classified as “unknown natural” (729 cases). Onehundred and four of these cases were autopsied and twenty-seven cases were found to fit into a pattern variously classified as interstitial pneumonitis or overwhelming infection. A closer analysis has been made of these twenty-seven cases plus five additional cases from my own series. A classic symptomatology for these deaths can be given, namely, a child, usually under 6 months, in previous good health, who is found dead in bed. Given that history, it is possible to state what will be the usual autopsy findings. In addition, it was pointed out that many of the unautopsied cases of natural or accidental deaths variously diagnosed as pneumonia, upper respiratory infection, asphyxia, and aspiration of vomitus give the above history and undoubtedly are cases of the same process. The various factors known to date concerning these deaths have been briefly discussed. It is pointed out that in my opinion, and in the opinion of others in the State who have had an opportunity to see or review these cases, that a satistactory explanation as to the cause of death has not been given. Finally it is suggested that it is better to sign these children out as cases of “unknown natural” when other known factors can be eliminated than it is to state that these children die from suffocation, prematurity, asphyxia, aspiration of vomitus, or even interstitial pneumonitis. This is important for two suggested reasons. A diagnosis of suffocation carries a psychological impact which may give a family a guilt feeling of neglect lasting a lifetime. It is felt that it is better to make a diagnosis of “unknown natural” in these children, for it suggests that we do not actually know what has killed them. From this it is hoped will come a further search for the fundamental process which is occurring and which kills these infants with such rapidity that it is both startling and distressing. An analysis has been made as tothe causes of death in 1,267 infants and young children 4 years and under, reported to the office of the Chief Medical Examiner in Richmond over an eighteen-month period from Jan. 1, 1952, to July 1, 1953. In the same period there were about 5,400 deaths in the entire State. This study, then, represents about 23 per cent of the total deaths for the same age group. The greatest number of deaths occurred in the group classified as “unknown natural” (729 cases). Onehundred and four of these cases were autopsied and twenty-seven cases were found to fit into a pattern variously classified as interstitial pneumonitis or overwhelming infection. A closer analysis has been made of these twenty-seven cases plus five additional cases from my own series. A classic symptomatology for these deaths can be given, namely, a child, usually under 6 months, in previous good health, who is found dead in bed. Given that history, it is possible to state what will be the usual autopsy findings. In addition, it was pointed out that many of the unautopsied cases of natural or accidental deaths variously diagnosed as pneumonia, upper respiratory infection, asphyxia, and aspiration of vomitus give the above history and undoubtedly are cases of the same process. The various factors known to date concerning these deaths have been briefly discussed. It is pointed out that in my opinion, and in the opinion of others in the State who have had an opportunity to see or review these cases, that a satistactory explanation as to the cause of death has not been given. Finally it is suggested that it is better to sign these children out as cases of “unknown natural” when other known factors can be eliminated than it is to state that these children die from suffocation, prematurity, asphyxia, aspiration of vomitus, or even interstitial pneumonitis. This is important for two suggested reasons. A diagnosis of suffocation carries a psychological impact which may give a family a guilt feeling of neglect lasting a lifetime. It is felt that it is better to make a diagnosis of “unknown natural” in these children, for it suggests that we do not actually know what has killed them. From this it is hoped will come a further search for the fundamental process which is occurring and which kills these infants with such rapidity that it is both startling and distressing.