Intrathorakale und subkonjunktivale Petechien bei Säuglingstodesfällen

Abstract

Generalised and intrathoracic petechiae (IP) and those restricted to the head occur in a large number of diseases and traumas. IP however are detected in cases of sudden infant death considerably more frequently than for other causes of infant death. They are not associated with gender in cases of sudden infant death, they are not dependent upon hypostatis, are not caused by attempts at resuscitation, have a typical frequency of occurrence and density, and they are a useful diagnostic criterion. The fact that they are missing in some cases of SIDS supports the hypothesis of a non-uniform pathogenesis. According to data from animal studies, they seem to develop as a result of increased breathing intensity with protracted hypoxia and an intact blood circulation. Promoting factors are infections, an increased concentration of catecholamines and a negative intrathoracic pressure. Only few investigations have investigated the frequency of occurrence of subconjunctival petechiae (SP) in infants. Results show that SP are atypical for SIDS, and they should always give cause for a more detailed examination, particularly when they appear in a high density. In contrast to cases of strangulation, where apart from a few exceptions SP can be detected, they are not found in the majority of cases of smothering by soft materials. Key words Sudden infant death syndrome (SIDS) · Intrathoracic petechiae · Subconjunctival petechiae · Hypoxia · StrangulationSchlüsselwörter Plötzlicher Kindstod · Intrathorakale Petechien · Subkonjunktivale Petechien · Hypoxie · Strangulation Einleitung Einer der ersten Autoren, der intrathorakale Petechien bei plötzlich verstorbenen Kindern beschrieb, war Fearn [18]. Die Bedeutung und die Entstehung der intrathorakalen Petechien wird jedoch bis heute unterschiedlich beurteilt. Eine Gruppe von Autoren hält sie für unbedeutende, eventuell erst postmortal entstehende Veränderungen, die keine weiteren Rückschlüsse erlauben [24,50,64,77], andere Autoren -vor allem diejenigen, die sich mit dem plötzlichen Kindstod befassen -lassen ihnen hingegen W. J. KleemannIntrathorakale und subkonjunktivale Petechien bei Säuglingstodesfällen

Sudden infant death—focus subject of medico-legal research

“…The degree of the gastric filling in SID considering a limiting of the time of death as well as the aspiration in view of an aspiration of milk have been investigated extensively [2,47]. If there are external findings and there is also the fact of autoptically typical equivalents for mechanical suffocation which can often be seen in cases of SID occurring as petechiae in pleura, pericardium and capsule of the thymus [23,29,30,45,67], it is easy that this wrong diagnosis is made.…”

Sudden infant death: Results from forensic medicine

“…Adjustierte* Odds-Ratios und 95% Konfidenzintervalle (95 % KI) fitr das Risiko eines pl6tzlichen Siiuglingsmdcs und die Kfrperposition[16].Tabelle 2. Zustand der Kinder bei der Auffmdung (n = 140;[12]). …”