Accidental Asphyxia Research Articles

Trends in under-five mortality rate in China, 1996–2020: a Joinpoint regression and correlation analysis

ObjectivesTo analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system...

A Case Report of Pediatric Mechanical Asphyxia by a Daycare Center Teacher: Implications for Forensic Pathologists from the Perspectives of the Judicial Verdicts

This study highlights a new case of an infant death caused by mechanical asphyxia, who was found dead after being wrapped and pressed by a daycare center teacher with the body and beddings. Moreover, we present a comparative review of four similar previously reported cases and the implications for forensic pathologists in the management of such cases from the perspectives of judicial verdicts of the cases. The previous report commented that the four cases could be considered as overlaying as a type of accidental asphyxia. However, a contextual comprehensive review including the whole scenarios of the cases and negative postmortem findings concluded that all the cases were explicitly different from overlaying cases. Furthermore, we followed up the judicial processes and verdicts in all five cases, including the present case and the four previously reported cases. In the four cases, the defendants were incarcerated for violation of ‘Act on Special Cases Concerning the Punishment of Child Abuse Crimes.’ The ruling trend revealed that the prison sentence durations had been prolonged from 4 to 19 years. Therefore, for a pediatric death suspecting mechanical asphyxia involving a daycare center, contextual comprehensive approach is essential to determine the cause of death and to provide appropriate medicolegal interpretation.

Analysis of Cases of Infants and Children Asphyxia at Day Care Center: Cases of Asphyxia in the Process of Teachers Putting the Infants and Children to Sleep

In the cases of infants and children, there is a special form of accidental asphyxia that occurs in an unsafe sleeping environment. Rarely, some infants and children unexpectedly die in the day care centers. This also occurs during the process when teachers put the infants and children to sleep. This analysis was performed on national forensic autopsy cases from January 1, 2001, to October 31, 2022. The 97,402 cases were selected to provide their incident overview, the cause of death and the manner of death. The cases of infants and children asphyxia at day care centers were 43 cases (0.04%). The major cause of death was sudden infants and children death syndrome which included the possibility of accidental asphyxia (31 cases). This was followed by chocking (8 cases), complicated asphyxia (2 cases), smothering (1 case), and positional asphyxia (1 case). Two cases were a result of homicide, 10 cases were accidents, and 31 cases had unknown manner of death. There were four cases of asphyxia that occurred in the process of teachers putting infants and children to sleep. In all cases, there were no specific findings in the autopsy and there were CCTV footage including contact with the day care center teacher while taking a nap. Reporting these results provides information and awareness to social members related with infants and children, specially day care centers, and serves as basis for establishing social systems such as mandatory of CCTVs, helping to reduce the occurrence of similar death on infants and children.

A Unique Workplace Death by Mechanical Asphyxia Caused by Waste Materials and Manure

Asphyxia is defined as a condition that occurs when a body does not receive or utilize adequate amounts of oxygen. The term asphyxia includes several types of mechanisms underlying the death related to lack of oxygen. We present a case of work-related accidental asphyxia caused by aspiration of industrial waste materials and manure. The deceased subject was maintaining an agricultural-industrial plant. Toxicological analysis has identified the presence of cocaine. During the autopsy, considerable quantities of waste materials and manure were found in the respiratory and digestive tract of the subject. Work-related Asphyxia is a rare cause of death; the aspiration of materials during work is extremely rare. The scene investigation, the autopsy and the toxicological analyses are fundamental in the reconstruction of the events involved in the occupational deaths.

Application of Correspondence Analysis in the Analysis of Accidental Death of Chinese Residents

Objective To study the preference relation between residence, sex, age and causes of accidental death of Chinese residents. Methods In this study, 72 residence-sex-age groups and 8 causes of accidental death were qualitatively and quantitatively analyzed by correspondence analysis using the official statistical yearbook issued from 2014 to 2018, and the preference values were calculated. Results Among the 576 pairs of correspondences between the residence-sex-age groups and causes of accidental death, 352 pairs （61.11%） showed a preference relation （preference value>0）. In terms of residence and sex, accidental death preference among Chinese residents was higher in rural areas than in urban areas, and males were higher than females. In terms of the causes of accidental death, the overall risk of accidental mechanical asphyxia and motor vehicle accidents was the highest among all age groups of Chinese residents. In terms of age, with the increase of age, the preference value of accidental death of Chinese residents showed a trend of first increasing and then decreasing. The comparative analysis results of the preference values of various causes of accidental death in different age groups showed that motor vehicle traffic accidents, accidental poisoning, death by crush and electric shock were more likely to occur in the working age group between 20 and 59 years old, accidental fall and fire were more likely to occur in the elderly group over 80 years old, and drowning and accidental mechanical asphyxia were more likely to occur in the minor group between 1 and 19 years old. Conclusion There are different preference relations between residence-sex-age groups and causes of accidental death in China. Therefore, effective control strategies and measures should be formulated for Chinese residents with preference for accidental death.

Classification of sleep-related sudden unexpected death in infancy: A national survey.

To identify how British Child Death Overview Panels (CDOPs) and paediatric pathologists classify cause of death for sleep-related Sudden Unexpected Death in Infancy (SUDI). To determine compliance with national requirements for SUDI investigation. Electronic survey of CDOPs and pathologists using three vignettes of SUDI cases illustrating: accidental asphyxia, typical Sudden Infant Death Syndrome (SIDS) and SIDS with co-sleeping. Thirty-eight (41%) of 92 CDOPs returned questionnaires, and 32 were complete. Thirteen (14%) of 90 pathologists returned complete questionnaires. Thirty-one (97%) CDOPs and 7 (53%) pathologists agreed with the cause of death in the accidental asphyxia case; 24 (75%) CDOPs and 9 (69%) pathologists in the typical SIDS case; and 11 (34%) CDOPs and 1 (8%) pathologist in the co-sleeping SIDS case. Pathologists used the terms SUDI or unascertained as the cause of death for the accidental asphyxia case (46%) and the co-sleeping SIDS case (77%). These terms were used by CDOPs for the typical SIDS case (25%) and the co-sleeping SIDS case (41%). Seventeen (46%) CDOPs reported compliance with guidelines for investigation in more than 75% of cases. There is wide variation in classification of deaths, with only limited agreement between CDOPs and pathologists. The terms SIDS and accidental asphyxia are underused, even in typical cases.

Recurrent sudden unexpected death in infancy: a case series of sibling deaths

ObjectivesTo determine the rate of sudden unexpected death in infancy (SUDI) for infants born after a previous SUDI in the same family, and to establish the causes of death and...

Inconsistent classification of unexplained sudden deaths in infants and children hinders surveillance, prevention and research: recommendations from The 3rd International Congress on Sudden Infant and Child Death

This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26–27, 2018 at the Radcliffe Institute at Harvard University. The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. We describe the diagnostic shift away from SIDS and the practical issues contributing to it. The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers. SIDS was reframed as unexplained sudden death in infancy or SIDS/MH11 to emphasize that either term signifies the lack of explanation following a rigorous investigation. A distinct category for children over the age of 1 was recommended (MH12). Definitions and exclusions were provided for the alternative categories of accidental asphyxia and undetermined. As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. The conclusions will be submitted to the World Health Organization for inclusion in the upcoming ICD-11.

An evaluation of pathologists' application of the diagnostic criteria from the San Diego definition of SIDS and unclassified sudden infant death.

Despite being widely used, few studies have assessed the utility of the San Diego definition of sudden infant death syndrome (SIDS). The purpose of this study was to evaluate pathologists' application of the San Diego definition in all cases of sudden unexpected death in infancy (SUDI) that occurred in Queensland, Australia, between 2010 and 2014. Key coronial documents of 228 cases of SUDI were reviewed independently by three reviewers and classified according to the San Diego definition. Clear guidance regarding the evidentiary threshold for classification and interpretation of the San Diego definition was provided. All reviewers classified cases identically in 202 cases (88.6%). Consensus was achieved on the classification of the remaining 26 deaths following case discussion. After review, 79 cases were classified as SIDS, a one third reduction compared with the original classification, mainly due to a high probability of accidental asphyxia. The number of cases classified as undetermined (USID) almost doubled (75/228, 32.9%), and there was more than a fivefold increase in cases classified as asphyxia (43/228, 18.9%). Natural conditions decreased by approximately one third (21/228, 9.2%). This study demonstrates that with clear guidelines for interpretation, the San Diego definition can be applied reliably, with discrepancies resolved through a process of peer review.

Trend analysis of mortality rates and causes of death in children under 5 years old in Beijing, China from 1992 to 2015 and forecast of mortality into the future: an entire population-based epidemiological study

ObjectivesTo analyse trends in mortality and causes of death among children aged under 5 years in Beijing, China between 1992 and 2015 and to forecast under-5 mortality rates (U5MRs) for...

A Longitudinal Analysis of the Mortality Spectrum of Children under 5 Years from 1990 to 2015 in Hubei Province of China

OBJECTIVES: This research analyzed trends of the mortality spectrum resulted from dynamics of the health care service for children under 5 years.METHODS: It was sampled 23 surveillance sites to establish a population-based surveillance network for children under 5 years by implementing a multistage randomized, stratified and cluster sampling since 1990 in Hubei province of China.RESULTS: Among children under 5 years, the mortality rates of pneumonia, birth asphyxia, preterm birth/low birth weight and accidental asphyxia declined from 12.9, 6.6, 4.3 and 3.5 in 1990 to 0.9, 0.7, 1.1 and 0.7 per 1,000 live births in 2015 respectively, and manifested a distinguished milestone at which pneumonia and birth asphyxia had been replaced by preterm birth/low birth weight after 2005 (P<0.05). The death proportions of pneumonia and birth asphyxia decreased from 22.2% and 11.4% in 1990 to 10.3% and 7.7% in 2015, while the death proportions of preterm birth/low birth weight and accidental asphyxia increased from 7.4% and 6.0 % in 1990 to 12.9% and 8.6% in 2015 accordingly. The proportions of clinical diagnosis, emergence treatment and death place at the county/district hospitals increased from 9.0%, 27.4% and 28.7% in 1990 to 75.5%, 67.7% and 60.4% in 2015, and had the significant differences between 1990 and 2015 in Hubei province (P<0.01).CONCLUSIONS: It was suggested that the trends of the mortality spectrum were mainly due to the improvement of the health care service for children under 5 years in Hubei province.

Sudden unexplained early neonatal death or collapse: a national surveillance study.

The incidence of sudden unexpected early neonatal death (SUEND) or acute life-threatening events (ALTEs) is reported as 0.05/1,000 to 0.38/1,000 live births. There is currently no national system in Australia for reporting and investigating such cases. A 3-y prospective, national surveillance study, run in collaboration with the Australian Pediatric Surveillance Unit (APSU). Data were provided by pediatricians reporting to APSU; and independently ascertained by the Coroner in two states (NSW and QLD) and the Newborn Early Transport Network in NSW. A detailed deidentified questionnaire was created. In NSW and QLD, the incidence was 0.1 and 0.08/1,000 live births, respectively. Forty-eight definitive cases were identified. Common causes included accidental asphyxia, cardiac disease, persistent pulmonary hypertension of the newborn, and sudden infant death syndrome. Twenty-six babies collapsed on day 1 and 19 were found on the carer's chest. The incidence in NSW and QLD is higher than previously published. The first postnatal day is a vulnerable period for newborns, who require close observation particularly during skin-to-skin contact. Development and implementation of guidelines for safe sleeping in hospital are needed. Collaboration between obstetricians, midwives, and pediatricians is essential to ensure safety of the newborn.

Mechanical asphyxia due to biological agents. Case report and literature review

A 54-year-old man, working as a shepherd, was found dead in a valley, at the bottom of a natural pit, by the family members. The pit had very steep walls, was 3,5 meters deep and had a diameter of about 10 meters. The investigators stated that most probably, some sheep fell into the pit, the shepherd lowered himself there in order to bring them out, but unfortunately the rest of the sheep followed him into the pit, thus collapsing over him and preventing him to get out. At the scene of investigation there were found 75 dead sheep, covering the dead body and surrounding him. A medico-legal autopsy was performed, followed by histological and forensic toxicology analysis. Autopsy revealed advanced putrefaction, a vital sternal fracture and generalized atherosclerosis. The toxicological exam showed an alcohol blood concentration of 2,80 g/l. Therefore, taking into account the onsite scene investigation, the autopsy findings and the ancillary examinations, the death was considered violent, produced by an accidental traumatic asphyxia due to biological agents (sheep), this being a unique case in the activity of the Department of Legal Medicine.

G421 The current causes and risk factors for sudi

Aims Since 2008, in England, all unexpected child deaths undergo a multi-agency investigation with the aim of determining the complete cause of death; followed by review by local Child Death Overview Panels (CDOP). These new processes have yet to be evaluated. This study aims to determine the effectiveness of the multi-agency investigation and CDOP processes in ascertaining causes of death and risk factors following Sudden Unexpected Death in Infancy (SUDI) and to describe the profile of causes and risk factors. Methods We obtained the dates of birth and death of all SUDI cases from one English region, dying between 1 September 2010 and 31 August 2012. We contacted all 10 CDOP for copies of individual case reviews completed using the standard CDOP Form C. We extracted the age, cause of death and presence of modifiable factors for each case from the Form C and created a total family and environmental risk factor score by totalling the risk factors. Results Data were obtained for 65/70 (93%) SUDI cases. 20/65 (31%) deaths were due to medical causes; 21/65 (32%) due to SIDS and 24/65 (37%) classified as unascertained deaths. Reanalysis of case data suggested that 9 deaths were probably due to accidental asphyxia, with 6 of these involving parents co-sleeping with their infant after consuming excessive alcohol. Unascertained deaths had significantly higher total family and environmental risk factor scores (mean 2.6, 95% CI 2.0–3.3) compared to SIDS (mean 1.6, 95% CI 1.2–1.9), or medical causes for death (mean 1.1, 95% CI 0.8–1.3). 9/20 (47%) of medical deaths. 19/21 (90%) SIDS and 23/24 (96%) unascertained deaths were considered to be preventable. There were inadequacies in medical provision identified in 5/20 (25%) of medically explained deaths. Conclusions The new multi-agency child death processes are effective at determining cause of death and risk factors for SUDI but potential asphyxia deaths may not be recognised. Most deaths labelled as unascertained fulfilled diagnostic criteria for SIDS. Many SUDI occurred in families with mental illness, drug or alcohol misuse and chaotic lifestyles and most in unsafe sleep-environments.

Traumatic asphyxial deaths

Asphyxial deaths are commonly encountered in forensic practice; however deaths due to traumatic asphyxia are uncommon. Traumatic asphyxia is a type of asphyxia where death results from mechanical compression of the chest and/or abdomen. Four cases of accidental traumatic asphyxia in pre-adolescent and adolescent age group are reported and discussed.

Suicide in children and adolescents: A case report of the possible suicide of a 7 year old girl and presentation of data from a forensic autopsy material in Norway

Abstract The present paper reports a 7 year old girl’s death by hanging. The forensic investigation disclosed death most likely to be self-inflicted, either an act of suicide, subsidiary a case of accidental asphyxia from a child’s play. A review of forensic autopsy records from southeast Norway during the years 1984-2012 was performed. Totally 116 deaths among children and adolescents < 18 years of age were classified as either suicide or as “undetermined - suicide likely” subsequent to post-mortem examination. The most common suicidal methods were hanging (46%), the use of firearms (24%), jumping in front of a train (11%) and drug intake / intoxication (8%). Though rarely observed in children < 12 years of age, suicide is a common cause of sudden death in adolescents, and there is evidence that the extent of the problem is unceasing. The paper highlights the value of forensic medical examination and crime scene reenactment in the evaluation of the manner of death in obscure cases.

English

Accidental hangings have far common characteristics that cause death in unsuspecting victim’s. It is a rare medico-legal aspect of death, raising difficulties of differential diagnosis with the suicide hanging and even with other causes of death. This study presents four observations of accidental hanging which occurred to three children and an adult, in strange circumstances sometimes. The medico-legal diagnosis was only possible with the autopsy and the study of the circumstances and the scene of death. Key words: Hanging, accidental asphyxia, death.

Deadly Robbery - A Case Report

Here we report about a male corpse aged 32 years, which was actually brought to the mortuary as death due to accidental traumatic asphyxia. Asphyxia was the definitive mode of death in this case, but trauma was not the cause for the asphyxia instead, by the presence of electrical injury. The different types of lesions were caused due to struggle to get down together with the electrocution. Of all the lesions diagnosed at post mortem examination, one needs a special mention, the subarachnoid hemorrhage, which resulted due to electrocution. Based on postmortem finding, the time since death was given as 12 -24 hours prior to the post mortem examination and the Cause of death was given as ELECTROCUTION.

Efficacy analysis of surgical ligation in very low birth weight infant with hemodynamic significant patent ductus arteriosus

Objective To evaluate the efficacy of surgical ligation in very low birth weight infant(VLBWI) with hemodynamic significant patent ductus arteriosus (hsPDA), and further investigate the indication, timing and safety of surgical intervention of VLBWI with hsPDA. Methods Retrospective analysis was performed for the medical records of 11 cases of VLBWI with hsPDA confirmed by echocardiography who received operation between January 2006 and December 2010 in Guangdong General Hospital.The indications of PDA ligation were patients with invalid medical treatment combined with different kinds of complication of hsPDA. Results All infants' median gestational age was 29 weeks (26-32 weeks), mean birth weight was (1166.8±283.9) g, and the hsPDA diameter ranged from 2.0-5.5 mm.The most common complication of operation was ventilator-associated pneumonia.The operation mortality was 0, the mean hospital stay was (67.1±36.1) days, and duration of oxygen dependence was (60.9±28.0) days.Total duration of mechanical ventilation dependence was (33.6±13.2) days.After ligation, duration of mechanical ventilation dependence was (11.4±6.9) days, which was significantly shorter than before ligation[(22.9±9.3) days](P<0.05). The incidence of apnea, broncho pulmonary dysplasia, metabolic acidosis, septicemia, retinopathy of prematurity, necrotizing enterocolitis, intraventricular haemorrhage and pulmonary hemorrhage were 81.8%, 63.6%, 45.5%, 36.4%, 36.4%, 27.3%, 27.3% and 18.2% respectively.Followed up to 44 months after surgery, there was only 1 infant who died of accidental asphyxia, so total survival rate was 90.9%. Conclusion Surgical ligation was an effective therapy of VLBWI with hsPDA, as it can lessen the duration of mechanical ventilation dependence, treatment cost and decrease the mortality. Key words: Patent ductus arteriosus; Very low birth weight infant; Surgical ligation; Echocardiography; Complication

Routine Metabolic Testing is Not Warranted in Unexpected Infant Death Investigations

Inborn errors of metabolism (IEM) only rarely cause sudden unexpected infant death. Yet, postmortem metabolic screening is often ordered reflexively during infant death investigations, even in the absence of historical, clinical or autopsy findings suggestive of IEM. This retrospective descriptive study examines the impact of metabolic screening of infants who die suddenly in a medical examiner's jurisdiction. The study population included 135 cases, one of which was certified as death due to IEM with historical and pathologic findings suggestive of IEM and an abnormal postmortem screening study, one which was certified as death due to IEM with historical and pathologic findings suggestive of IEM and a negative postmortem screening study, and one which was certified as undetermined with pathologic features of IEM and a negative postmortem screening study, but also with features suggestive of accidental asphyxia. Nine cases had abnormal postmortem screens that were deemed to represent false positives. During the entire nine-year study of these 135 cases, the utilization of screening tests in cases without historical or autopsy features of IEM did not detect any unsuspected cases. IEM may rarely cause unexpected infant death, and it can be suggested by historical and autopsy findings. Thus, within the appropriate investigative and autopsy context, judicious use of metabolic screening tests is warranted. Caution is advised when interpreting negative screening studies with suggestive historical and/or autopsy findings as the success of testing decreases with increasing postmortem interval.