Forensics - Pediatric Deaths

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Forensics

Pediatric Deaths

Author: Lindsey Harle, M.D. (see Reviewers page)
Revised: 9 August 2012, last major update July 2012
Copyright: (c) 2012, PathologyOutlines.com, Inc.

Sudden Unexplained Infant Death (SUID)
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● Term currently favored by many forensic pathologists/pediatricians to replace Sudden Infant Death Syndrome (SIDS)
● Defined as sudden, unexpected death of an otherwise healthy infant, less than 1 year of age, in which scene investigation, clinical history, and complete postmortem evaluation fail to determine a cause of death
●Diagnosis of exclusion, and likely represents a group of as yet unidentifiable natural causes of sudden death (i.e. congenital cardiac arrhythmia, occult infection, etc)
● Risk factors: prematurity, male gender, poor socioeconomic status, colder climate, maternal smoking or illicit drug, young maternal age (less than 20 years old)
● Death usually occurs during sleep
● No specific autopsy findings; may see thymic/pleural/epicardial petechiae, pulmonary congestion, sparse pulmonary inflammation
● Natural causes of death that may at first appear to be SUID: myocarditis, respiratory infection, cardiac channelopathies, meningitis, gastroenteritis, inborn errors of metabolism
● Accidental causes of death that may at first appear to be SUID: asphyxia (overlay in shared bed or poor bedding material), poisoning

Homicide of infants and children
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● Neonaticide: the deliberate killing of an infant
     • Mother is most common perpetrator
     • Usually death via asphyxia (e.g. smothering) or environmental exposure (due to abandonment)
     • With newborns, mother may claim child was stillborn; air in lungs indicates child was breathing prior to death
          • Hydrostatic test: lungs are placed in a container of water; if they float, they are presumably filled with air, suggesting the child was breathing prior to death
          • False positive hydrostatic test with attempted resuscitation or decomposition; false negatives can also occur
● Child homicide
     • In first year of life, most homicidal deaths are due to head trauma
     • In second year of life, head trauma and abdominal trauma are both common
     • Battered child syndrome: multiple bruises, abrasions and boney fractures of various ages; this category also included neglected children suffering from malnutrition
     • Other causes of death include thermal injury due to scalding, smothering (autopsy usually negative)
     • Shaken baby syndrome: controversial cause of death due to violent shaking of infant with subdural or subarachnoid hemorrhage and retinal hemorrhages
          • Many believe shaking alone cannot produce significant injuries and death, and most of these infants actually suffered from blunt force trauma

End of Forensics > Pediatric Deaths

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