Investigation Of Infant Deaths Research Articles

Investigation of infant deaths associated with critical congenital heart diseases; 2018–2021, Türkiye

BackgroundThe aim of this study was to examine the characteristics of infant mortality associated with critical congenital heart disease (CCHD).MethodsIn a cross-sectional study, data for the study were obtained through Death Notification System, Birth Notification System and Turkish Statistical Institute birth statistics.ResultsOf all infant deaths, 9.8% (4083) were associated with CCHD, and the infant mortality rate specific to CCHD was 8.8 per 10,000 live births. CCHD-related infant deaths accounted for 8.0% of all neonatal deaths, while the CCHD specific neonatal death rate was 4.6 per 10,000 live births. Of the deaths 21.7% occurred in the early neonatal, 30.3% in the late neonatal and 48.0% in the post neonatal period. Group 1 diseases accounted for 59.1% (n = 2415) of CCHD related infant deaths, 40.5% (n = 1652) were in Group 2 and 0.4% (n = 16) were in the unspecified group. Hypoplastic left heart syndrome was the most common CCHD among infant deaths (n = 1012; 24.8%). The highest CCHD related mortality rate was found in infants with preterm birth and low birth-weight while multiparity, maternal age ≥ 35 years, twin/triplet pregnancy, male gender, maternal education in secondary school and below, and cesarean delivery were also associated with higher CCHD related infant mortality rate. There was at least one non-cardiac congenital anomaly/genetic disorder in 26.1% of all cases.ConclusionCCHD holds a significant role in neonatal and infant mortality in Türkiye. To mitigate CCHD-related mortality rates, it is crucial to enhance prenatal diagnosis rates and promote widespread screening for neonatal CCHD.

Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs).

To assess sudden unexpected infant death (SUID) investigations for structural inequities by race/ethnicity and geography. The SUID Case Registry compiles data on death investigations. We analyzed cases from 2015 to 2018 (N = 3847) to examine likelihood of an incomplete death investigation, defined as missing autopsy, missing scene investigation, or missing detailed information about where and how the body was found. We also analyzed which specific components of death investigations led to the greatest number of incomplete investigations. Twenty-four percent of SUIDs had incomplete death investigations. Death scenes in rural places had 1.51 times the odds of incomplete death investigations (95% confidence interval [CI], 1.19-1.92) compared with urban areas. Scene investigations led by law enforcement were more likely to result in incomplete death investigations (odds ratio [OR] = 1.49; 95% CI, 1.18-1.88) than those led by medical examiners. American Indian/Alaska Native SUIDs were more likely than other racial groups to have an incomplete investigation (OR = 1.49; 95% CI, 0.92-2.42), more likely to occur in rural places ( P = .055), and more likely to be investigated by law enforcement ( P < .001). If doll reenactments had been performed, 358 additional cases would have had complete investigations, and if SUID investigation forms had been performed, 243 additional cases would have had complete investigations. American Indian/Alaska Native SUIDs were also more likely to be missing specific components of death investigations. To produce equitable public health surveillance data used in prevention efforts, it is crucial to improve SUID investigations, especially in rural areas and among American Indian/Alaska Native babies.

Cardiac Genetic Investigation of Sudden Infant and Early Childhood Death: A Study From Victims to Families.

Background Sudden infant death syndrome (SIDS) is the leading cause of death up to age 1. Sudden unexplained death in childhood (SUDC) is similar but affects mostly toddlers aged 1 to 4. SUDC is rarer than SIDS, and although cardiogenetic testing (molecular autopsy) identifies an underlying cause in a fraction of SIDS, less is known about SUDC. Methods and Results Seventy-seven SIDS and 16 SUDC cases underwent molecular autopsy with 25 definitive-evidence arrhythmia-associated genes. In 18 cases, another 76 genes with varying degrees of evidence were analyzed. Parents were offered cascade screening. Double-blind review of clinical-genetic data established genotype-phenotype correlations. The yield of likely pathogenic variants in the 25 genes was higher in SUDC than in SIDS (18.8% [3/16] versus 2.6% [2/77], respectively; P=0.03), whereas novel/ultra-rare variants of uncertain significance were comparably represented. Rare variants of uncertain significance and likely benign variants were found only in SIDS. In cases with expanded analyses, likely pathogenic/likely benign variants stemmed only from definitive-evidence genes, whereas all other genes contributed only variants of uncertain significance. Among 24 parents screened, variant status and phenotype largely agreed, and 3 cases positively correlated for cardiac channelopathies. Genotype-phenotype correlations significantly aided variant adjudication. Conclusions Genetic yield is higher in SUDC than in SIDS although, in both, it is contributed only by definitive-evidence genes. SIDS/SUDC cascade family screening facilitates establishment or dismissal of a diagnosis through definitive variant adjudication indicating that anonymity is no longer justifiable. Channelopathies may underlie a relevant fraction of SUDC. Binary classifications of genetic causality (pathogenic versus benign) could not always be adequate.

Perinatal mortality profile in municipalities of Piauí’s Coastal Plain

Among the elements that impact Infant Mortality, Perinatal Mortality stands out, which involves deaths that occur during the period that begins at 22 completed weeks (or 154 days) of gestation (fetal period) and ends at 7 completed days after birth, that is, from 0 to 6 days of life (early neonatal period). The objective of this research is to describe the profile of perinatal deaths reported in municipalities of Piauí’s Coastal Plain from 2013 to 2017. This is a retrospective, descriptive study with a quantitative analysis approach, resulting from the Course Completion Work entitled ‘Perinatal mortality profile in municipalities of Piaui’s Coastal Plain’. The sample consisted of death certificates and infant death and fetal death investigation forms of children whose mothers lived in the Coastal Plain, PI, and who had their deaths confirmed in the perinatal period, between January 2013 and December 2017. During the study period, the Perinatal Mortality Rate (PMR) of the Coastal Plain, PI, was 22.97 deaths per 1,000 births, with little variation between 2013 and 2017. Fetal deaths were predominant, comprising 61.9% of the sample. Hospital deaths that occurred in Parnaíba were the most frequent, revealing this to be the reference municipality in the region. This shows the need for greater attention on the part of health professionals and managers to such conditions, in order to improve the quality of care for pregnant women, parturient women, and newborns.

The Science (or Nonscience) of Research Into Sudden Infant Death Syndrome (SIDS).

This Viewpoint paper presents a timely and constructive critique of mainstream SIDS research. It is concerning that twenty-first century medical science has not provided an answer to the tragic enigma of SIDS. The paper helps explain why this is so and illustrates possible shortcomings in the investigation of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID) by mainstream researchers. Mainstream findings are often based on questionable and dogmatic assumptions that return to founding notions such as the Triple Risk Hypothesis and the contention that the mechanisms underlying SIDS/SUID are heterogeneous in nature. The paper illustrates how the pathological findings in SIDS have been under-investigated (or ignored) and that key epidemiological risk factors have slipped from memory. This apparent amnesia has resulted in failure to use these established SIDS facts to substantiate the significance of various neuropathological, neurochemical, or other research findings. These unsupported findings and their derivative hypotheses are therefore ill-founded and lack scientific rigor.ConclusionThe deficits of SIDS “science” revealed in this paper explain why the SIDS enigma has not yet been solved. To make progress in understanding SIDS, it is important that researchers, as scientists, uphold standards of research. Encouragement for new directions of research is offered.

Barriers to consistent and reliable investigation of sudden unexpected infant death: Perspectives from law enforcement.

Despite persistent efforts to advance infant death investigation, most sudden unexpected infant deaths (SUIDs) remain unexplained. Law enforcement officials contribute to SUID investigations throughout the United States, but their impacts on these investigations have not been adequately examined. In this exploratory study, 26 law enforcement officials were interviewed about their experiences and perspectives with SUID investigations. Thematic analysis of qualitative data revealed three specific difficulties law enforcement encounter during SUID investigations: (1) inadequate preparation; (2) overwhelming emotions; and (3) a victim-suspect dilemma. Findings indicate that these barriers may inhibit consistent and reliable investigation of infant death and, therefore, may impede the cause and manner of death determinations. Participants' narratives also offered insights into potential solutions, including expanded SUID training for law enforcement and use of checklists, such as the Sudden Unexpected Infant Death Investigation Reporting Form. The impacts of overwhelming emotions confronted during SUID investigation warrant further study. The victim-suspect dilemma stems from the inability of law enforcement to conclusively eliminate the possibility of homicide. This dilemma may be resolved through a clear distinction between interactions with potential evidence and interactions with the family. Law enforcement must be trained to treat all SUID families in a compassionate and non-accusatory manner, while investigating all SUID with careful attention to detail that is essential in any potential homicide investigation. A consistent, meticulous, and compassionate approach to SUID investigations will improve the reliability of information obtained and offer the best opportunity for providing answers to grieving parents.

Infanticide and Abandonment in the Industrial Metropolis: Gender, Reproduction and Capitalism in Chicago, 1870–1911

ABSTRACTThis article uses an unprecedentedly extensive data set of 1,270 suspicious infant death investigations from Cook County to measure the incidence of infanticide. We contextualize this data with quantitative evidence on abandonment in Chicago, newspaper coverage, and judicial cases. We argue that over the long run, a changing occupational structure, with wage‐earning women leaving domestic service and entering clerical work, was crucial in decreasing both infanticide and abandonment. From being a prominent part of fertility control for poor women in the 1870s, by the 1910s infanticide and abandonment had become rare. However, in the short term, inflation increased the incidence of both infanticide and abandonment from 1904 to 1908. We argue that agency at the most intimate levels must be understood within broader structures. Bourgeois proprietors ran households that employed an extensive staff of domestic servants for cooking, cleaning, child rearing, and for facilitating visiting among elite families. With the rise of new kind of capitalist elite alongside the rise of the corporation, servants and urban networks of visiting were no longer central to elite social reproduction by the early twentieth century. The reconstruction of capitalism transformed work within homes and firms, thereby mitigating the conditions that made infanticide common in the nineteenth century.

Infant deaths due to preventable causes in the Far West Health Region of Santa Catarina

The discussion and scientific production on preventable infant deaths has attracted attention due to the intrinsicassociation with the quality of health services and social determinants. Its analysis, within the scope of SUS, supportsthe management and planning of health promotion and prevention interventions aimed at children. Thus, the presentstudy aimed to analyze the occurrence of infant deaths from preventable causes in the Health Region of the Far West ofSanta Catarina. Data collection was carried out between the months of July and December 2019, in secondary sources,in the death certificates, live birth certificates, and infant death investigation forms for the period from 01/01/2018to 12/31/2018. The information obtained was analyzed using descriptive statistics. The instrument for the analysis ofpreventability was the Brazilian List of causes of preventable deaths by interventions of the Unified Health System. Froma total of 3,046 births, verified in the analyzed period, there were 62 deaths, among which were 25 fetal deaths (40.32%) and 37 infant deaths (59.67%). With an Infant Mortality Rate estimated at 12.14%, there was a predominance of fetal(40.32%) and early neonatal (29.03%) deaths. As for preventability, 40 (64%) deaths were classified as preventable, 14(23%) were not preventable, and 8 (13%) had ill-defined causes. The causes that can be reduced by adequate care forwomen during pregnancy stood out as the main component in infant mortality. Our results demonstrate that there isa compromise in the quality of prenatal and neonatal care and demonstrate the importance of directing attention andinvestments to improve this care.

Tendências recentes dos óbitos fetais por malformações congênitas: um estudo descritivo

Este artigo se baseia em um estudo de série temporal sobre os óbitos fetais por malformações congênitas no estado do Maranhão relativo ao período de 2006 a 2016. Foram construídos indicadores epidemiológicos para estimar o risco de morte fetal e sua tendência ao longo da série estudada. Os dados são provenientes do Departamento de Informática do SUS e sua análise realizada por modelos de regressão linear. Foram registrados 17.843 óbitos fetais no período abordado pelo estudo, 528 dos quais decorrentes de malformações congênitas (2,96%). Observou-se uma tendência significativa de aumento do coeficiente de mortalidade fetal geral, correspondente a 6,99% (β1=0,17; p=0,004) e do específico por malformações congênitas, equivalente a 5,13% (β1=0,01; p=0,04). Os resultados deste estudo corroboram a tendência histórica dos serviços de saúde negligenciarem os óbitos fetais. É importante destacar que parte destes óbitos são preveníveis e potencialmente evitáveis. Desse modo, a implementação dos comitês de investigação de óbitos fetais e infantis e a sua vigilância adequada poderiam melhorar a assistência prestada tanto no pré-natal quanto no parto.

Protocols, practices, and needs for investigating sudden unexpected infant deaths.

Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine scene re-creation with a doll was 30% in small, 64% in medium, and 59% in large offices. Seventy percent of MECs reported infant death investigation training needs. Increased training and use of standardized practices may improve SUID cause-of-death certification, allowing us to better understand SUID.

Working Together to Understand Why Infants Die: A Qualitative Study of Professionals' Experiences of Joint Agency Investigation of Sudden Unexpected Death in Infancy

A comprehensive Child Death Review programme commenced in England in 2008; police, healthcare and social care professionals now work together, using a joint agency approach (JAA) to investigate unexpected child deaths. The aim of this paper is to explore professionals' experiences of the JAA investigation of sudden unexpected death in infancy (SUDI). This was part of a mixed‐methods study evaluating the JAA investigation of SUDI. Professionals participated in qualitative interviews and case notes were scrutinised. Data were analysed using a framework approach. A total of 23 of a possible 113 eligible SUDI cases were recruited. Twenty‐six professionals involved in investigating 12 of the 23 SUDI cases were interviewed giving theoretical saturation of data. The overarching theme was the conflict between the need to investigate deaths while remaining sensitive to families. Other themes were working together, supporting parents, and the benefits and difficulties of joint working practices. All professionals were positive about the JAA, especially joint police and paediatric interviews and home visits. The difficulties included non‐engagement by social care and poor liaison with coroners. The JAA seems to be a thorough investigative process but could be improved by closer joint agency working and information sharing, and more support and training for professionals. © 2018 John Wiley &amp; Sons, Ltd.Key Practitioner Messages Joint agency investigation of unexpected infant deaths enables a detailed understanding of the causes of death and the provision of support to families. Joint home visits by police and paediatricians following unexpected infant deaths provide more detailed information and can be more sensitive to families than police death scene examination alone. Prompt information sharing across all agencies is a key part of effective investigation of unexpected infant deaths. ‘Explore[s] professionals' experiences of the joint agency approach investigation of sudden unexpected death in infancy’

Investigation of Infant Deaths and Causes of the Year 2016 in Bingöl Province

Giriş: Toplumsal gelişmişlik ile bebek ölümleri arasında birneden sonuç ilişkisi vardır, gelişmişlik arttıkça bebek ölümleriazalmaktadır. Bu çalışma ili Bingöl ilindeki 2016 yılında meydanagelen bebek ölümlerinin hızları, nedenleri ve ilişkili olabilecekfaktörlerin incelenmesi amaçlanmıştır.Metot: Çalışma 2016 yılında Bingöl ilinde meydana gelen 99bebek ölümünün tamamının dosyalar üzerinde incelemesi ileyapılmıştır. Bebek ölümleri ile ilgili bilgiler dosya taraması ileelde edilmiştir. Verilerin analizinde SPSS 22 kullanılmıştır.Verilerin analizinde Ki-kare testi, kullanılmıştır. p&amp;lt;0.05 anlamlıolarak kabul edilmiştir.Bulgular: Bingöl ili 2016 yılında toplam 5485 canlı doğumolmuştur ve 99 bebek ölümü meydana gelmiştir. Bebek ölümhızı binde 18’dir, ölümlerin çoğu erken neonatal dönemdemeydana gelmiştir. Prematürite ve konjenital anomaliler en sıkölüm nedenleridir. Ölen bebeklerin annelerinde eğitim seviyesidüşük, akraba evliliğinin yaygın olduğu görülmüştür.Sonuç: Kadınların eğitim seviyesi yükseltilmeli, gebeliköncesinde aile danışmanlığı hizmetleri etkin biçimde verilmeli,antenatal bakım ve izlemlerin sayısı artırılmalı, postnatal dönembakım hizmetleri geliştirilmelidir.

Evaluation of the adequacy of information from research on infant mortality in Recife, Pernambuco, Brazil.

This study is an evaluation of infant death research in Recife, Pernambuco (PE). It is a cross-sectional study with 120 variables grouped into six dimensions (prenatal, birth, child care, family characteristics, occurrence of death, and conclusion and recommendations), weighted by consensus technique. The research was classifiedas adequate, partially adequate or inadequate according to a composite indicator assessment (ICA). There was dissension on 11 variables (9 in prenatal dimension, one in labor and birth, and 1 in the conclusions and recommendations). Of the 568 deaths studied, 56.2% have adequate research. The occurrence of death was the best-evaluated dimension and prenatal the poorest. The preparation of the ICA enables professionals and managers of child health policies to identify bottlenecks in the investigation of infant deaths for better targeting of actions, and contributing to the discussion about surveillance in other cities and states.

Medicolegal Death Investigation of Sudden Unexpected Infant Deaths.

This review article describes the role of the medicolegal death investigator and medical examiner or coroner (MEC) in the investigations of a sudden unexpected infant death (SUID) beginning with an introduction into the case types that should be investigated and how infant deaths fit into that legal framework. The article also provides an overview of the history of the Centers for Disease Control and Prevention SUID investigation guidelines and process. The article concludes with a description of how the MEC correlates the scene investigation with autopsy findings, as well as the role of the MEC in cause of death determinations. There is also a brief discussion on how infant mortality data are captured and subsequently used to decrease infant mortality. [Pediatr Ann. 2017;46(8):e297-e302.].

Rigour and Rapport: a qualitative study of parents\u2019 and professionals\u2019 experiences of joint agency infant death investigation

BackgroundIn many countries there are now detailed Child Death Review (CDR) processes following unexpected child deaths. CDR can lead to a fuller understanding of the causes for each child’s death but this potentially intrusive process may increase the distress of bereaved families. In England, a joint agency approach (JAA) is used where police, healthcare and social services investigate sudden child deaths together and a key part of this is the joint home visit (JHV) where specialist police and paediatricians visit the home with the parents to view the scene of death. This study aimed to learn of bereaved parents’ experiences of JAA investigation following Sudden Unexpected Death in Infancy (SUDI).MethodsThis was a qualitative study of joint agency investigation of SUDI by specialist police, healthcare and social services including case note analysis, parental questionnaires, and in-depth interviews with parents and professionals. Families were recruited at the conclusion of the JAA. Data were analysed using a Framework Approach.Results21/113 eligible families and 26 professionals participated giving theoretical saturation of data. There was an inherent conflict for professionals trying to both investigate deaths thoroughly as well as support families. Bereaved parents appreciated the JAA especially for the information it provided about the cause of death but were frustrated with long delays waiting to obtain this. Many parents wanted more emotional support to be routinely provided. Most parents found the JHV helpful but a small minority of mothers found this intensely distressing. In comparison to JHVs, when police visited death scenes without paediatricians, information was missed and parents found these visits more upsetting. There were issues with uniformed non-specialist police traumatising parents by starting criminal investigations and preventing parents from accessing their home or collecting vital possessions.ConclusionsOverall most parents feel supported by professionals during the JAA; however there is scope for improvement. Paediatricians should ensure that parents are kept updated with the progress of the investigations. Some parents require more emotional support and professionals should assist them in accessing this.

Death Scene Investigation and Autopsy Practices in Sudden Unexpected Infant Deaths

To describe and compare sudden unexpected infant death (SUID) investigations among states participating in the SUID Case Registry from 2010 through2012. We analyzed observational data from 770 SUID cases identified and entered into the National Child Death Review Case Reporting System. We examined data on autopsy and death scene investigation (DSI) components, including key information about the infant sleep environment. We calculated the percentage of components that were complete, incomplete, and missing/unknown. Most cases (98%) had a DSI. The DSI components most frequently reported as done were the narrative description of the circumstances (90%; range, 85%-99%), and witness interviews (88%, range, 85%-98%). Critical information about 10 infant sleep environment components was available for 85% of cases for all states combined. All 770 cases had an autopsy performed. The autopsy components most frequently reported as done were histology, microbiology, and other pathology (98%; range, 94%-100%) and toxicology (97%; range, 94%-100%). This study serves as a baseline to understand the scope of infant death investigations in selected states. Standardized and comprehensive DSI and autopsy practices across jurisdictions and states may increase knowledge about SUID etiology and also lead to an improved understanding of the cause-specific SUID risk and protective factors. Additionally, these results demonstrate practices in the field showing what is feasible in these select states. We encourage pediatricians, forensic pathologists, and other medicolegal experts to use these findings to inform system changes and improvements in DSI and autopsy practices and SUID prevention efforts.

&lt;b&gt;Gestational risks determinants of mothers of newborns in neonatal death

Describes the socio-economic, reproductive and obstetric characteristics of mothers of newborn children that had neonatal death in Londrina, Parana State, Brazil. The quantitative descriptive retrospective research is based on data retrieved from the declaration of live birth, death certificate and infant death investigation form, between 2000 and 2009. During a period of 10 years, 537 newborn children died; 50.5% of mothers were nulliparous; 60.0% were between 12 and 27 years old; 30.8% had less than seven years of schooling; 55.2% had an income of more than two minimum wages. Over 90.0% of mothers had previous history of infant death prior to pregnancy. Further, 91.4% attended prenatal courses and all of them showed some type of disease during pregnancy which, in most cases, led to the death of the newborn child in the early neonatal period ( p <0.05). Most maternal characteristics investigated could be detected early and controlled in prenatal care.

G459(P) Improving the investigation of unexpected infant deaths

Aims Since 2008, in England, all unexpected infant deaths must be investigated jointly by police, health and social services. This study aims to learn of bereaved parents’ and professionals’ experiences of this joint agency approach (JAA) as well as assess the effectiveness of the JAA in determining causes and risk factors for deaths and use this knowledge to improve professional practice. Methods A mixed methods study of JAA investigation of SUDI cases in one English region; involving case note analysis, questionnaires and in–depth interviews with bereaved parents and the relevant professionals. A descriptive study of outcomes of JAA SUDI investigation using Child Death Overview Panel (CDOP) data. Results 23/111 families were recruited giving theoretical saturation. The median time between infants’ deaths and parental study participation was 33 weeks; data collection took place between 2011–3. 25 professionals were interviewed. CDOP Form Cs were obtained for 65/70 (93%) SUDI cases dying during 2010–2. Non–specialist police often arrived at the parents’ home along with the ambulance; increasing parental distress. Parents felt that the JAA provided information about why their baby died but offered minimal emotional support. The joint home visit by police and paediatrician is a key investigative process and most parents found this helpful. Final case discussions were used to discuss relevant risk factors but not to determine the cause of death; in nearly all cases the final cause of death relied on post–mortem examination alone ignoring findings of death scene examinations. Many deaths fitted the diagnostic criteria for SIDS but despite this were labelled as unascertained. Social care were only involved in 13/23 JAA investigations, in two cases without involvement there were safeguarding concerns. Some Coroners were reluctant to share post–mortem examination reports with paediatricians preventing effective JAA investigations. Conclusion Ideally, SUDI investigations should be carried out only by specialist clinicians who do this work frequently and the JAA fully integrated with social care and Coroners’ investigations. There needs to be a clearer system for classifying unexplained SUDI. Police should reconsider their immediate response to SUDI; parents would like more follow–up and bereavement support from professionals.

A Simple, Effective, and Inexpensive Method for Backlighting Retinal Hemorrhages

Adequate photographic documentation of important autopsy findings, both positive and negative, is vital for serving as a record of the pathologist's examination, as well as for a tool in the courtroom, for consultations, or for educational endeavors. Examination of the eye, especially the retina, is an important part of the investigation of suspicious infant deaths; however, obtaining good photographs can be difficult due to many factors. The method described herein allows for the development of a cost-effective, technically simple, and mobile way to take outstanding photographs of the retina.

Investigation of Sudden Unexpected Infant Deaths

The investigation of infant death is complex and requires synergy between multiple agencies including law enforcement, Child Protective Services, medicolegal death investigators, and forensic pathologists. Prior to the forensic pediatric autopsy, the death investigator must identify the types of death scenes involved (e.g., hospital, residence, daycare) and document the details of the scene. Interviews must be conducted with the caregivers and other family members (including doll reenactments), law enforcement, pediatricians, and emergency medical personnel. The forensic pathologist must be able to conduct a comprehensive pediatric forensic autopsy and be aware of the specific challenges related to cases of sudden unexpected infant deaths. This article provides an overview of infant death investigation, discussing the roles and responsibilities of the medicolegal death investigator and the forensic pathologist.