Diagnosis Of Sudden Infant Death Syndrome Research Articles

Forensic Autopsy Findings in Determination of the Risk Factors of Sudden Infant Death Syndrome

Introduction: Sudden infant death syndrome (SIDS) occurs when a seemingly healthy newborn under the age of one year dies unexpectedly while sleeping. SIDS is often known as crib death because neonates usually die in their cribs. Even after a thorough forensic examination and death site investigation, the general diagnosis of SIDS is made when the cause of infant death cannot be determined. According to the 1969 definition, SIDS is still an excluding diagnosis. Despite the fact that this syndrome has various distinguishing characteristics, such as an age distribution that only affects children under the age of one year and an apparent incidence during sleep, there has been a reluctance to include these characteristics in the classification. The aim of the study was to better understand the risk factors of sudden infant death syndrome (SIDS). Methods: This cross-sectional analytical study was conducted at the Department of Forensic Medicine, Pabna Medical College Hospital, Pabna, from March 2020 to April 2021, and the participants of the study were 25 sudden and unidentified infant death cases at the study hospital whose guardians had given authorization for inclusion in the study. Result: The male: female ratio of the present study was 1.27:1. 60% of the participants had died while at home, and no information regarding the activity of infant at time of death was available for 56% of cases. Initial forensic analysis confirmed SIDS in 76% of the cases. Among the SIDS cases, majority had no observable risk factors, but family history of ailments and habits such as heart disorders, respiratory distress and smoking were determined as possible risk factors. Previous history of SIDS in family was also considered as a risk factor. Conclusion: The location of the infants at the time of death is very important in properly determining cause of death. Better observation of the infants can help in conducting a proper forensic analysis.

Medullary Serotonergic Binding Deficits and Hippocampal Abnormalities in Sudden Infant Death Syndrome: One or Two Entities?

Sudden infant death syndrome (SIDS) is understood as a syndrome that presents with the common phenotype of sudden death but involves heterogenous biological causes. Many pathological findings have been consistently reported in SIDS, notably in areas of the brain known to play a role in autonomic control and arousal. Our laboratory has reported abnormalities in SIDS cases in medullary serotonin (5-HT) receptor 1A and within the dentate gyrus of the hippocampus. Unknown, however, is whether the medullary and hippocampal abnormalities coexist in the same SIDS cases, supporting a biological relationship of one abnormality with the other. In this study, we begin with an analysis of medullary 5-HT1A binding, as determined by receptor ligand autoradiography, in a combined cohort of published and unpublished SIDS (n = 86) and control (n = 22) cases. We report 5-HT1A binding abnormalities consistent with previously reported data, including lower age-adjusted mean binding in SIDS and age vs. diagnosis interactions. Utilizing this combined cohort of cases, we identified 41 SIDS cases with overlapping medullary 5-HT1A binding data and hippocampal assessment and statistically addressed the relationship between abnormalities at each site. Within this SIDS analytic cohort, we defined abnormal (low) medullary 5-HT1A binding as within the lowest quartile of binding adjusted for age and we examined three specific hippocampal findings previously identified as significantly more prevalent in SIDS compared to controls (granular cell bilamination, clusters of immature cells in the subgranular layer, and single ectopic cells in the molecular layer of the dentate gyrus). Our data did not find a strong statistical relationship between low medullary 5-HT1A binding and the presence of any of the hippocampal abnormalities examined. It did, however, identify a subset of SIDS (~25%) with both low medullary 5-HT1A binding and hippocampal abnormalities. The subset of SIDS cases with both low medullary 5-HT1A binding and single ectopic cells in the molecular layer was associated with prenatal smoking (p = 0.02), suggesting a role for the exposure in development of the two abnormalities. Overall, our data present novel information on the relationship between neuropathogical abnormalities in SIDS and support the heterogenous nature and overall complexity of SIDS pathogenesis.

Pathologizing the Unknown: A Sociological Explanation for the (Mis-)Use of Sudden Infant Death Syndrome as a Diagnosis.

Sudden infant death syndrome (SIDS) is a diagnosis given to infants who die suddenly and unexpectedly before the age of one. After decades of research into SIDS, little has been conclusively determined regarding the etiology of this phenomenon. While SIDS deaths are in reality undetermined deaths, there is resistance to abandon SIDS and synonymous terminology. This paper identifies the social functions that a diagnosis of SIDS provides both to the families of the deceased, as well as the physicians who treat them. It is suggested that these social functions help to explain why, despite being inaccurate and misleading, SIDS is still widely used today. It is argued, however, that the forensic pathology and medical community as a whole should lead a systematic shift away from the use of SIDS as a diagnosis. Adopting more medically-appropriate terminology would better serve the goals of the medical profession and the families they serve.

Is there a common denominator for Brief Resolved Unexplained Events, Sudden Infant Death Syndrome, and alleged Shaken Baby Syndrome?

We propose the medical hypothesis that a common denominator may be the precursor for Brief Resolved Unexplained Events (BRUE), cases of Sudden Infant Death Syndrome (SIDS) as well as to cases of alleged Shaken Baby Syndrome (SBS) without external signs of trauma. Although previous studies have emphasized differences, we have focused on the overarching common denominators of the three conditions in terms of mechanism theories.In consequence, fatal cases with subdural hemorrhage (SDH) classified as SBS could be classified as high risk BRUE with SDH. Fatal cases without SDH could be classified as SIDS. Non-fatal cases with SDH and retinal hemorrhages (RHs), currently classified as SBS, could be classified as BRUE with SDH and RHs, leaving a fourth group of BRUE without SDH and RHs.While both the BRUE and the SIDS diagnoses have been refined and developed, alleged abusive head trauma (AHT) cases with and without external signs of trauma have been indiscriminately combined. This is analogous to indiscriminately grouping together, e.g., headache due to a brain tumor or headache after head trauma. Alleged AHT cases with external signs of trauma and high velocity impact might be explained by the traditional AHT mechanism theories, whereas the one-third of all alleged AHT cases without external signs of trauma could be explained by the hypoxia cascade theory and/or other non-shaking theories.

How Frequently Does out-of Hospital Sudden Unexpected Infants Death Represent the Sudden Infant Death Syndrome?

Background.19.6 % of all fatal cases among Russian children who died in the first year of life are registered out-of hospital, and they are usually sudden. Out-of-hospital sudden unexpected infant death (OSUID) could be confused with sudden infant death syndrome (SIDS) followed by the wide variation in the diagnostic indicators of the syndrome.The aim of the studyis to reveal the pathological changes in the tissues and organs of 420 cases of OSUID (group 1) compared with 350 cases of death in the hospital (group 2), to estimate the conformity of the final diagnoses and to identify cases of OSUID, which were SIDS.Methods.From 2009 to 2016 pathoanatomical and virological study of the organs of 420 cases of OSUID (group 1) and 350 babies who died in a hospital were carried out.Results.It was established that the age of infants of the 1st group at the time of death in 71 % of cases corresponded to the age of SIDS. In terms of gestational age and body weight at birth babies of the 1st group turned out to be much more prosperous. Signs of rapid onset of death in this group: plethora of internal organs (83.3 %) and petechial hemorrhages (75.5 %) were present significantly more often than in the 2nd. In the 1st group, predominantly light acute respiratory viral infections (ARVI) with minimal pathologic signs and pneumonia were diagnosed, but pneumonia in 33.3 % not detected at autopsy. Purulent tracheobronchitis (0 and 21.4 %), bacterial pneumonia (6.3 and 26.3 %), a large area of lung damage (3.8 and 56.1 %) were detected much less frequently in the 1st group. In 38 % of the 1st group, pneumonia was the only cause of death, and in no case in the 2nd. Pathology of the cardiovascular system (55.2 and 87.7 %), central nervous system (58.6 and 90.9 %);urogenital system (34.8 and 62.9), inflammation of the membranes and brain tissue (21.9 and 70.0 %), signs of past or current intrauterine viral infection (29.5 and 64.0 %) in the 1st group was diagnosed much less frequently than in the 2nd, but congenital syphilis, HIV infection and hepatitis C — 3 times more often (12.9 and 3.7 %). The more frequent pathology of the adrenal glands in the 1st group (66.7 and 34 %) could cause inadequate responses to minimal exposure to external factors, including mild acute respiratory viral infections. The diagnosis of SIDS was made in 3 cases and in 3 more it was questionable. However, the presence of multisystemic pathology excludes the diagnosis of SIDS. The diagnosis of SIDS could be established in 30 cases in cases of slight ARVI without intoxication, shock liver or disseminated intravascular coagulation syndrome.Conclusion.The most cases of sudden death occurred in not obvious life-threatening conditions in socially disadvantaged families in the absence of adequate observation, diagnosis and treatment.

Medical, Forensic and Social Quandaries of Sudden Infant Death Syndrome Today

Sudden Infant Death Syndrome (SIDS) is described as the sudden, unexplained death (with no attributable cause, during sleep) of a seemingly healthy child before reaching the first year of life. Statistically, SIDS is recognized today as a leading cause of death in infants aged 1 to 12 months. In the present article the authors have analyzed known risk factors, classifications and current standards of forensic investigation while highlighting the necessity of detailed clinical history, autopsy, scene of death examination and lab findings (radiology, metabolic anomalies, infectious diseases and toxicology) in SIDS diagnosis. For an infant death to be considered SIDS, all other possible causes of death must be first excluded, the diagnosis requiring detailed collection and analysis of antemortem patient data and a complete autopsy. Although the forensic methods of today are more exact, the distinction between SIDS and other causes of death (e.g. unintentional asphyxiation, infanticide) remains very difficult in some cases.

Sudden Unexpected Infant Death Certification in New York City: Intra-Agency Guideline Compliance and Variables that May Influence Death Certification.

Differences in certification of similar sudden infant deaths exists among forensic pathologists. This study sought to measure adherence to intra-agency guidelines for infant death certification in one jurisdiction and describe variables that may be associated with the differentiation of sudden infant death syndrome (SIDS), asphyxia, and undetermined death certifications. A retrospective study of deaths at the New York City Office of Chief Medical Examiner identified 427 sudden infant deaths with investigation and autopsy whose cause of death was ruled SIDS, asphyxia, or undetermined. Cases were reviewed for number and types of risk factors for asphyxia, demonstrable evidence of asphyxia, potential competing causes of death, and a doll reenactment. Descriptive and statistical analysis was performed. Of 427 deaths, the causes of 100 deaths (23.4%) were ruled asphyxia; 43 (10.0%) SIDS; and 284 (66.5%) undetermined. Forensic pathologists conformed to agency guidelines in 406 deaths (95.1%). Three or more risk factors for asphyxia were found in 328 deaths (76.8%). Demonstrable evidence of asphyxia (40.7%) was most associated with a certification of asphyxia. A potential competing cause of death (20%) was most associated with undetermined. A doll reenactment had little association with certification type. Guidelines in one agency were effective at limiting incorrect SIDS diagnoses. The interpretation of risk factors can be subjective. Diagnostic overlap occurred in deaths certified differently as SIDS, asphyxia, and undetermined, despite similar findings. Elimination of SIDS as a certification option and better guidelines that help differentiate asphyxia and undetermined deaths are recommended for improved infant death certification.

The Diagnostic Shift of SIDS to Undetermined: Are There Unintended Consequences?

Over the last two decades, a diagnostic shift in regards to the certification of sudden deaths in infancy has emerged with reassignment of deaths previously certified as sudden infant death syndrome (SIDS) to a trend utilizing the classification of undetermined or asphyxia. The consequences of this shift outside the medicolegal death investigation (MDI) community is unknown. We surveyed US organizations working in the field of sudden infant death as well as bereaved parents to understand their perceptions of the current diagnostic trends. Two online anonymous surveys were utilized. Sixty-seven organizations and 55 parents with an infant death diagnosis of SIDS, sudden unexplained infant death (SUID), undetermined, or asphyxia participated. Just over 50% (34/67) of the organizations perceived the shift had an effect on their organization including barriers to bereavement support and education. Forty percent (22/55) of parent respondents stated they did not understand the final diagnosis of their infant's death. The highest frequency of themes elicited from parents were frustration that the diagnosis (regardless of terminology) did not fully explain the death, detrimental mental health effects, and negative perceptions towards the medical and public health communities. However, parents of children whose death was classified as SIDS were spared from negative perceptions towards the medical field, described the least amount of confusion, and reported the most instances of positives effects. Legal implications, perceived social stigmas, and research obstacles were also described. Recommendations from this study include the integration of collaborative efforts to combat sudden infant death with all stakeholders, in and outside of MDI, to achieve better understanding and eradication of these tragedies, improved public education, and effective care of all bereaved.

Exploratory Brain Metabolomics: Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) is the sudden, unexplained passing of an infant during sleep within the first year of life. The diagnosis of SIDS is one of exclusion, with no plausible explanation following autopsy and investigation of the death scene. Most of our present understanding of SIDS comes from epidemiological studies, and much is less known about molecular etiology. One candidate mechanism is that abnormalities in brainstem biochemistry cause altered neural control of breathing, leading to rousing defect and apparent SIDS. The objective of this study was to identify novel brain biochemicals associated with SIDS. Postmortem human infant brain tissue specimens from 28 decedents underwent comprehensive metabolomic profiling (SIDS, n=15; non‐SIDS, n=13). A total of 87 brain specimens were collected from 4 different regions of the brain associated with learning and memory, including the auditory cortex (AC, n=11), frontal cortex (FC, n=27), hippocampus (HC, n=22), and occipital cortex (OC, n=27). The contributions of both SIDS status and age to differential abundance of biochemicals were determined using Wilcoxon rank sum and Spearman correlation tests. A total of 247 known biochemicals were detected. Between SIDS and non‐SIDS specimens, 2 biochemicals in the AC, 12 in the FC, 9 in the HC and 10 in the OC were detected at significantly different levels (p<0.05). The most striking metabolomic pattern in SIDS vs. non‐SIDS specimens was attributed to changes in the urea cycle. Urea levels were 34% and 45% lower in the OC and HC, respectively, from SIDS brains, suggesting hyperammonemia. Also related to urea cycle, SIDS specimens showed changes in spermidine (−29% in OC), citrulline (+94% in HC), aspartate (+49% in FC and +35% in HC), arginine (+17% in FC) and 4‐guanidobutanoate (+31% in HC), relative to non‐SIDS specimens. Carbohydrate metabolism was altered, as glucose, fructose and sorbitol levels trended downward in all 4 SIDS brain specimens. Changes in both fructose (−70% in OC) and sorbitol (−59% in FC) achieved significance. Protein metabolism was also altered. The tryptophan metabolite kynurenine and the valine metabolite α‐hydoxyisovalerate were 37% and 74% lower in SIDS OC, while cysteine (+2.1‐fold) and cysteine‐glutathione disulfide (+2.2‐fold) increased in SIDS FC. Pseudouridine was ~30% decreased in each of FC, HC and OC from SIDS brains, suggesting differences in tRNA metabolism. Additionally, correlation analysis of biochemical levels vs. age of infant showed remarkable differences between SIDS and non‐SIDS. For example, non‐SIDS HC and OC age correlated with 7 and 22 biochemicals, respectively, while SIDS HC and OC age correlated with 29 and 49 biochemicals. In sum, we have identified several new candidate brain biochemicals and pathways, such as the urea cycle, associated with SIDS.Support or Funding InformationFunding for this study was provided by Abbott Nutrition.

On the Question of the Diagnosis of Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) is one of the leading causes of postneonatal mortality of infants in most developed countries. This paper presents data on terminology and on the study of SIDS in developed countries, and also examines problems of SIDS diagnostic in Russia in comparison with the results of own researches, analyzes risk factors, which are universal as for SIDS, and also for perinatal and infant death in general. The large variability of SIDS diagnosis in Russia suggests that this diagnosis often does not comply with international standard: post-mortem examination of community-acquired sudden death cases is often carried out by a forensic expert, but not by a children's pathologist, and they do not use virological and microbiological methods of investigation. In some cases, there is no infant's record or case record from children's polyclinic.

Similarities and Differences in the Epidemiology of Pyloric Stenosis and SIDS

Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses about a shared etiology. We carried out a population-based study to highlight similarities and differences between IHPS and SIDS. We used vital statistics and hospitalization data on all live births in Washington State, USA (1987-2009). Changes in IHPS and SIDS rates over time were quantified using rate ratios with 95% confidence intervals (CI). The duration between birth and diagnosis of IHPS or SIDS was examined as a function of gestational age at birth. Logistic regression analysis was used to identify risk factors and quantify adjusted temporal trends (2000-2008). Although both IHPS and SIDS rates declined significantly between 1987 and 2008, the patterns and magnitude of the declines (40 and 74%, respectively) were different. IHPS and SIDS shared risk factors such as maternal smoking and single parent status but other factors showed qualitatively or and quantitatively different associations. Primiparity was a risk factor for IHPS [odds ratio (OR) 1.24, 95% CI 1.09-1.41], and a protective factor for SIDS (OR 0.44, 95% CI 0.36-0.55), while male sex had a stronger association with IHPS (OR 4.51, 95% CI 3.85-5.28 vs 1.36, 95% CI 1.13-1.64). Both IHPS and SIDS showed significant inverse associations between gestational age at birth and chronologic age at diagnosis/death. IHPS and SIDS share some epidemiologic features and risk factors but other risk factors have qualitatively or quantitatively different effects and recent temporal trends in the two diseases are dissimilar.

Morphological and immunohistochemical features of the lung tissue in Sudden Infant Death Syndrome (SIDS)

Morphological and immunohistochemical features of the lung tissue from 50 corpses of infants aged 1 month to 1 year were studied to determine their place in the structure of causes of death. Immunohistochemistry revealed decreased expression of surfactant protein B in most cases of sudden infant death syndrome (SIDS), which is probably due to qualitative changes in pulmonary surfactant. The data obtaine d suggest that the comprehensive studies of lung tissue of infants may contribute to clarifying the degree of risk and more accurately determining the causes of death in some cases of sudden infant death. This will help reduce the risk of diagnostic errors, i.e., hypo- or overdiagnosis SIDS and is of practical importance for forensic examination. This is especially true for those cases that require the need for differential diagnosis of SIDS with different types of pneumonia or mechanical asphyxia. Further investigations in this area should focus on the study of the molecular and genetic mechanisms of synthesis and transport of surfactant proteins, and to develop simple inexpensive methods for detection of the lungs surfactant deficiency in infants.

Application of a classification system focusing on potential asphyxia for cases of sudden unexpected infant death

Current classification schemes for sudden unexpected infant death (SUID) may not be optimal for capturing scene events that potentially predispose to asphyxia. (1) To compare causes of death in a group of SUID cases assigned by multiple reviewers using our recently published classification scheme for SUID that is based on asphyxial risk at the death scene, and (2) To compare these newly assigned causes of death to that originally assigned by the medical examiners of record who performed the autopsies. Five reviewers independently assigned causes of death for 117 cases of SUID, including 83 originally diagnosed as sudden infant death syndrome (SIDS), accessioned into the San Diego SIDS/SUDC Research Project from the San Diego County Medical Examiner's Office. The diagnostic categories are: A: SIDS; B: Unexplained-Potentially Asphyxia; C: Unexplained-Other Potential Causes of Death; D: Unclassified-Other; E: Unclassified; and F: Known Cause of Death. The reviewers collectively opined that conditions at the death scene contributed to or caused death in 32-50% of all of the 117 cases as well as in 40-59% of the 83 originally diagnosed SIDS cases. Another cause of death was considered plausible in 2-12% of the SIDS cases. Application of this new classification system resulted in 55-69% decrease in SIDS diagnoses. Asphyxia as a potential contributor to, or as the specific cause of death, appears to exist in a large percentage of cases designated as SIDS using other classification schemes. When certifiers use a classification system that focuses upon potential asphyxia in determining the cause of death the incidence of SIDS dramatically declines.

Perfil epidemiológico e estratégias para o diagnóstico de SMSL em um país em desenvolvimento

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children’s health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Hepatic Hemangioendothelioma Presenting as Sudden Unexpected Death in Infancy: A Case Report

The classification of an unexpected infant death as sudden infant death syndrome (SIDS) depends upon a complete autopsy, death scene investigation, and review of medical history to exclude known causes of death. Death from occult neoplastic disease in infancy is extremely rare but is within the broad differential diagnosis of SIDS. We report the sudden and unexpected death of a 1-month-old infant from a hepatic (infantile) hemangioendothelioma. The physiologic mechanism of death was likely cardiac failure induced by the circulatory demands of this large vascular tumor and respiratory compromise from diaphragmatic thoracic incursion. The clinical progression and pathology of these relatively common tumors of infant livers are extremely variable. This case dramatically illustrates the potential for fatal outcome of this tumor, as well as the need for autopsy to determine the cause of sudden and unexpected death in an infant.

The Death-Scene Investigation

The death-scene investigation is an important and increasingly recognized step in the process of diagnosing Sudden Infant Death Syndrome (SIDS). According to current definitions, information from death-scene investigations is required when SIDS diagnoses are made. Due to differences in national jurisdictions, however, there are differences in the methods used and the professions involved in routinely performed death-scene investigations. Therefore any international comparability of death-scene data is limited. Only a few epidemiological studies have used thorough death-scene investigations in a systematic way, including a standardized, objective observation of the scene in cases and reference data from the general population. These studies gave close insights into the circumstances of infant death, but their complex protocols are mostly not feasible for routine use. For that purpose, manageable death-scene investigation protocols need to be distilled from the ones used in complex studies, taking into account their results. Whilst protocols for post-mortem examinations and definitions for SIDS have been largely standardized and agreed internationally, this step is still missing for death-scene investigations. If routinely obtained death-scene data were standardized and, thus, comparable, this would have a potential of generating new hypotheses that eventually lead to a better understanding of the underlying mechanisms and to more effective measures of prevention. Keywords: SIDS, infant, death, scene, investigation

A practical classification schema incorporating consideration of possible asphyxia in cases of sudden unexpected infant death

Although the rate of the sudden infant death syndrome (SIDS) has decreased over the last two decades, medical examiners and coroners are increasingly unwilling to use the SIDS diagnosis, particularly when there is an unsafe sleeping environment that might pose a risk for asphyxia. In order to reliably classify the infant deaths studied in a research setting in the mixed ancestory population in Cape Town, South Africa, we tested a classification system devised by us that incorporates the uncertainty of asphyxial risks at an infant death scene. We classified sudden infant deaths as: A) SIDS (where only a trivial potential for an overt asphyxial event existed); B) Unclassified-Possibly Asphyxial-Related (when any potential for an asphyxial death existed); C) Unclassified-Non-Asphyxial-Related (e.g., hyperthermia); D) Unclassified-No autopsy and/or death scene investigation; and E) Known Cause of Death. Ten infant deaths were classified according to the proposed schema as: SIDS, n = 2; Unclassified-Possibly Asphyxial-Related, n = 4; and Known Cause, n = 4. A conventional schema categorized the deaths as 6 cases, SIDS, and 4 cases, Known Cause, indicating that 4/6 (67%) of deaths previously classified as SIDS are considered related importantly to asphyxia and warrant their own subgroup. This new classification schema applies a simpler, more qualitative approach to asphyxial risk in infant deaths. It also allows us to test hypotheses about the role of asphyxia in sudden infant deaths, such as in brainstem defects in a range of asphyxial challenges.

Evaluating the SIDS diagnosis process utilized by coroners in Mississippi

To assess the consistency of Mississippi coroners' practices in identifying Sudden Infant Death Syndrome (SIDS) cases, coroners were surveyed about diagnostic protocols. Findings were compared with published Centers for Disease Control guidelines and Mississippi law. One-third of coroners report they sometimes or never perform investigations at the place of infant death. The agency responsible for transferring the infant and the turn-around time for autopsy reports also varies. This study demonstrates inconsistency in SIDS diagnostic protocols among Mississippi coroners.

Use of a Fan During Sleep and the Risk of Sudden Infant Death Syndrome

To examine the relation between room ventilation during sleep and risk of sudden infant death syndrome (SIDS). Population-based case-control study. Eleven California counties. Mothers of 185 infants with a confirmed SIDS diagnosis and 312 randomly selected infants matched on county of residence, maternal race/ethnicity, and age. Intervention Fan use and open window during sleep. Main Outcome Measure Risk of SIDS. Fan use during sleep was associated with a 72% reduction in SIDS risk (adjusted odds ratio [AOR], 0.28; 95% confidence interval [CI], 0.10-0.77). The reduction in SIDS risk seemed more pronounced in adverse sleep environments. For example, fan use in warmer room temperatures was associated with a greater reduction in SIDS risk (AOR, 0.06; 95% CI, 0.01-0.52) compared with cooler room temperatures (0.77; 0.22-2.73). Similarly, the reduction associated with fan use was greater in infants placed in the prone or side sleep position (AOR, 0.14; 95% CI, 0.03-0.55) vs supine (0.84; 0.21-3.39). Fan use was associated with a greater reduction in SIDS risk in infants who shared a bed with an individual other than their parents (AOR, 0.15; 95% CI, 0.01-1.85) vs with a parent (0.40; 0.03-4.68). Finally, fan use was associated with reduced SIDS risk in infants not using pacifiers (AOR, 0.22; 95% CI, 0.07-0.69) but not in pacifier users (1.99; 0.16-24.4). Some differences in the effect of fan use on SIDS risk did not reach statistical significance. Fan use may be an effective intervention for further decreasing SIDS risk in infants in adverse sleep environments.

Cribs for Kids: Risk and Reduction of Sudden Infant Death Syndrome and Accidental Suffocation

The Cribs for Kids campaign, created in 1998 by a nonprofit voluntary health organization, S. I.D.S. of Pennsylvania, is an innovative program whose aim is to combat infant mortality resulting from sudden infant death syndrome (SIDS) and accidental suffocation in Allegheny County, Pennsylvania. This program was first of its kind in country to include an evaluation component and is germane to social work practice with maternal child health and mental health professionals. This article delineates application of a low-cost but ultimately beneficial intervention to lower risk of SIDS or accidental suffocation by providing education and a safe sleeping environment for infants. SIDS IN THE UNITED STATES SIDS is a frightening phenomenon that has plagued parents for thousands of years. The definition of SIDS is the sudden death of an infant under one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of death scene, and review of clinical history (Willinger, James, & Catz, 1991, pp. 677-678). SIDS strikes an infant during sleep without warning and remains leading cause of postneonatal infant mortality for infants ages one month to one year in Western countries. Neither parents nor physicians can accurately predict which infants will succumb to SIDS, and in United States nearly 3,000 infants die from SIDS each year (National SIDS/Infant Death Resource Center [NSIDRC], 2004b). Despite widespread risk reduction education from Back to Sleep campaign, initiated in 1994 by a coalition of National Institute of Child Health and Human Development (NICHD), Maternal and Child Health Bureau, American Academy of Pediatrics (AAP), SIDS Alliance, and Association of SIDS and Infant Mortality Programs, it remains an alarming social work and public health dilemma that crosses all ethnic, race, and socioeconomic populations (NSIDRC, 2004a). A SIDS diagnosis is made after death, only after all other possible causes have been eliminated. In fact, researchers and medical practitioners are not certain what causes SIDS, although they believe it to involve a dynamic interaction of several factors (NICHD, 2000b). An infant is at increased risk of SIDS if he or she experiences an unstable period of homeostatic control (that is, an inability of infant's body to maintain equilibrium in physiological systems) during sleep combined with triggering factors such as prone sleep position, bed sharing, soft bedding, maternal smoking, viral infections, and premature birth (Filiano & Kinney, 1994). An infant may be born with an underlying vulnerability that increases risk of SIDS (Panigraphy et al., 2000). After American Academy of Pediatrics changed its recommendation of infant sleep position in 1992 (AAP, 1992) there was a 53 percent decrease in number of SIDS deaths in United States by 2001 (Matthews, Menacker, & MacDorman, 2003) .This suggests that prone sleep position for infants as a risk factor for SIDS can be reduced by using a firm, flat mattress; eliminating fluffy bedding from infant's sleep environment; maintaining a smoke-free environment for infant; and avoiding overheating (NICHD, 2001). The Consumer Product Safety Commission (CPSC), AAP, and NICHD responded to these statistics by recommending that all infants younger than 12 months be put to sleep in a crib with no soft bedding on top of or under baby (CPSC, 1999). On October 10, 2005, AAP Task Force on Sudden Infant Death Syndrome issued a revised policy statement on SIDS and reiterated their policy recommendation of back sleep position on a firm mattress with no soft bedding in crib. The task force further recommended that infant sleep in same room as mother to facilitate breastfeeding, but on a separate sleep surface, such as a crib, bassinet, or cradle that meets CPSC standards for safety. …