Infant Death Scene Investigation and the Assessment of Potential Risk Factors for Asphyxia: A Review of 209 Sudden Unexpected Infant Deaths

Pasquale-Styles, Melissa A.; Tackitt, Patricia L.; Schmidt, Carl J.

doi:10.1111/j.1556-4029.2007.00477.x

Cited by 86 publications

(73 citation statements)

References 22 publications

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“…Research have shown conclusively that death scene investigation may assist in identifying underlying risk factors for SIDS and can also identify cases of wedging or accidental suffocation/strangulation which cannot be proved at post mortem examination [8,14]. This is important even if the infant was removed from the scene of death and resuscitated or rushed to hospital, as is often the case.…”

Section: Discussionmentioning

confidence: 99%

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The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we—and where are we going?

Toit-Prinsloo

Dempers

Wadee

et al. 2010

Forensic Sci Med Pathol

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Abstract:Purposes: Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants under one year of age in many countries. Unfortunately, a paucity of published research data exists in South Africa, with regard to the incidence of and investigation into the circumstances surrounding Sudden Unexplained Deaths in Infants (SUDI) and/or SIDS. Currently, even though most academic centers conform to a protocol consistent with internationally accepted standards, there exists no nationally accepted infant death investigation protocol in South Africa. It is the aim of this study to review the current practice of infant death investigation in two representative but geographically and demographically distinct centers. Methods:Retrospective case audit over a five-year period (2000 to 2004) was conducted at two large medico-legal mortuaries in Pretoria (Gauteng) and Tygerberg (Cape Town). Case files on all infants younger than one year of age were reviewed. The outcome measures included number of deaths, demographic details and the nature and final outcome of the post mortem examinations.Results: A total of 512 cases were identified as possible SIDS cases and of these, 171 was classified as SIDS. The study showed marked inter-case and inter-divisional variation in terms of the investigation of infant deaths at the two institutions. Conclusions:It is envisaged that this study will focus attention on the current lack of usable data regarding sudden/unexplained/unexpected infant deaths in South Africa, and aid in the formulation and implementation of a practical (yet internationally accountable) infant death investigation protocol, which could facilitate comparisons with other countries and initiate further structured research in this field.

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Section: Discussionmentioning

confidence: 99%

“…The value of death scene investigation is important in determining risk factors for SIDS [7,8]. Death scene investigation may also elucidate the mechanism of death in some instances, which includes accidental suffocation and wedging [14].…”

Section: Introductionmentioning

confidence: 99%

The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we—and where are we going?

Toit-Prinsloo

Dempers

Wadee

et al. 2010

Forensic Sci Med Pathol

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“…Sleeping on the side with one' s face against the back cushions of the sofa or against another person can result in suffocation. 27 Past analyses have found that infant deaths on sofas are usually asphyxia deaths from entrapment between a person and the sofa cushions, overlay by another person, or wedging against the sofa cushions. 18,28,29 Indeed, the cause of death for infants on sofas in this sample was most frequently classified as ASSB rather than SIDS.…”

Section: Discussionmentioning

confidence: 99%

Sofas and Infant Mortality

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Sleeping on a sofa increases the risk of sudden and unexpected infant death.WHAT THIS STUDY ADDS: Infant deaths on sofas are associated with nonsupine placement, being found in side position, surface sharing, changing sleep location, and experiencing prenatal tobacco exposure. These results may help explain why sofa sleeping is hazardous for infants. abstract OBJECTIVE: Sleeping on sofas increases the risk of sudden infant death syndrome and other sleep-related deaths. We sought to describe factors associated with infant deaths on sofas. METHODS:We analyzed data for infant deaths on sofas from 24 states in 2004 to 2012 in the National Center for the Review and Prevention of Child Deaths Case Reporting System database. Demographic and environmental data for deaths on sofas were compared with data for sleep-related infant deaths in other locations, using bivariate and multivariable, multinomial logistic regression analyses. RESULTS:A total of 1024 deaths on sofas made up 12.9% of sleeprelated infant deaths. They were more likely than deaths in other locations to be classified as accidental suffocation or strangulation (adjusted odds ratio [aOR] 1.9; 95% confidence interval [CI], 1.6-2.3) or ill-defined cause of death (aOR 1.2; 95% CI, 1.0-1.5). Infants who died on sofas were less likely to be Hispanic (aOR 0.7; 95% CI, 0.6-0.9) compared with non-Hispanic white infants or to have objects in the environment (aOR 0.6; 95% CI, 0.5-0.7) and more likely to be sharing the surface with another person (aOR 2.4; 95% CI, 1.9-3.0), to be found on the side (aOR 1.9; 95% CI, 1.4-2.4), to be found in a new sleep location (aOR 6.5; 95% CI, 5.2-8.2), and to have had prenatal smoke exposure (aOR 1.4; 95% CI, 1.2-1.6). Data on recent parental alcohol and drug consumption were not available. CONCLUSIONS:The sofa is an extremely hazardous sleep surface for infants. Deaths on sofas are associated with surface sharing, being found on the side, changing sleep location, and experiencing prenatal tobacco exposure, which are all risk factors for sudden infant death syndrome and sleep-related deaths.

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“…Shapiro-Mendoza et al, 3 in a more recent study using a combination of data similar to the data sources in our study, including medical examiner, law enforcement, and hospital records, revealed that 47.9% of deaths were attributed by the medical examiner to ASSB. 4 Even the article cited by Dr Cutz (Pasquale-Styles et al 5 ) revealed that "if the witnessed overlays, entrapments, strangulations and infants found with their noses and mouths blocked and/ or their heads covered represent asphyxia deaths, then a minimum of 108 (51.7%) in this study died of asphyxia" and "this would represent a conservative estimate of asphyxia deaths, as it does not take into account infants who died in high-risk sleep situations." 5 Dr Cutz also found implausible the proposed mechanism of suffocation of the older age group, stating that "actual scene reconstruction studies are often inconclusive" and citing Pasquale-Styles et al 5 We disagree with this conclusion; again, Pasquale-Styles et al 5 found that over half of the infant deaths in that study demonstrated a clear asphyxia mechanism.…”

mentioning

confidence: 99%

“…4 Even the article cited by Dr Cutz (Pasquale-Styles et al 5 ) revealed that "if the witnessed overlays, entrapments, strangulations and infants found with their noses and mouths blocked and/ or their heads covered represent asphyxia deaths, then a minimum of 108 (51.7%) in this study died of asphyxia" and "this would represent a conservative estimate of asphyxia deaths, as it does not take into account infants who died in high-risk sleep situations." 5 Dr Cutz also found implausible the proposed mechanism of suffocation of the older age group, stating that "actual scene reconstruction studies are often inconclusive" and citing Pasquale-Styles et al 5 We disagree with this conclusion; again, Pasquale-Styles et al 5 found that over half of the infant deaths in that study demonstrated a clear asphyxia mechanism. 5 Finally, Dr Cutz expressed concern that our study and other recent studies "create the impression that the cause of sudden unexpected infant death including sudden infant death syndrome (SIDS) has now been identified and a simple solution exists to prevent such death," thereby implying that further research into molecular and genetic etiologies to sleep-related infant deaths is unnecessary.…”

mentioning

confidence: 99%