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Published in: Forensic Science, Medicine and Pathology 4/2008

01-12-2008 | Original Paper

Intrathoracic petechiae in SIDS: a retrospective population-based 15-year study

Authors: Henry F. Krous, Elisabeth A. Haas, Amy E. Chadwick, Homeyra Masoumi, Christina Stanley

Published in: Forensic Science, Medicine and Pathology | Issue 4/2008

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Abstract

Intrathoracic petechiae (IP), the most common gross finding in sudden infant death syndrome (SIDS) cases at autopsy, suggest upper airway obstruction (UAO) occurs during the terminal event. If true, IP would be expected more frequently among SIDS cases found face down compared to other face positions. We compare the rates of IP in SIDS cases found face down versus other face positions. A retrospective 15-year review of IP among all cases of SIDS occurring from 1991 through 2005 accessioned by the San Diego County Medical Examiner’s Office was conducted. The presence or absence of IP was based on both gross and microscopic observations of the thoracic organs. The severity of thymic petechiae was scored semiquantitatively from microscopic observations. There were 489 SIDS cases during the study period. Sixteen of these were excluded because their deaths had been delayed by initially successful cardiopulmonary resuscitation. Among the remaining 473 SIDS cases, face position when found was specifically described for 332 (70%). Of 122 cases found face down, 112 (92%) had IP, compared to 85% (179) of 210 infants found with the face up or to the side (P = 0.06). The groups were not different with respect to age or gender, but the racial distribution was significantly different (P = 0.004). African-American infants comprised 28% of the found face down group compared to only 12% of the face up or side group. Our data do not support a role for external UAO caused by face positioning directly into the sleep surface in SIDS, but are consistent with internal UAO associated with apnea or gasping before dying of SIDS.
Literature
1.
go back to reference Krous HF, Beckwith JB, Byard RW, et al. Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics. 2004;114:234–8.PubMedCrossRef Krous HF, Beckwith JB, Byard RW, et al. Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics. 2004;114:234–8.PubMedCrossRef
2.
go back to reference Farber JP, Catron AC, Krous HF. Pulmonary petechiae: ventilatory-circulatory interactions. Pediatr Res. 1983;17:230–3.PubMedCrossRef Farber JP, Catron AC, Krous HF. Pulmonary petechiae: ventilatory-circulatory interactions. Pediatr Res. 1983;17:230–3.PubMedCrossRef
3.
go back to reference Beckwith JB. Intrathoracic petechial hemorrhages: a clue to the mechanism of death in sudden infant death syndrome? Ann NY Acad Sci. 1988;533:37–47.PubMedCrossRef Beckwith JB. Intrathoracic petechial hemorrhages: a clue to the mechanism of death in sudden infant death syndrome? Ann NY Acad Sci. 1988;533:37–47.PubMedCrossRef
4.
go back to reference Krous HF. The microscopic distribution of intrathoracic petechiae in sudden infant death syndrome. Arch Pathol Lab Med. 1984;108:77–9.PubMed Krous HF. The microscopic distribution of intrathoracic petechiae in sudden infant death syndrome. Arch Pathol Lab Med. 1984;108:77–9.PubMed
5.
go back to reference Krous HF, Jordan J. A necropsy study of distribution of petechiae in non-sudden infant death syndrome. Arch Pathol Lab Med. 1984;108:75–6.PubMed Krous HF, Jordan J. A necropsy study of distribution of petechiae in non-sudden infant death syndrome. Arch Pathol Lab Med. 1984;108:75–6.PubMed
6.
go back to reference Siebert JR, Haas JE. Enlargement of the tongue in sudden infant death syndrome. Pediatr Pathol. 1991;11:813–26.PubMedCrossRef Siebert JR, Haas JE. Enlargement of the tongue in sudden infant death syndrome. Pediatr Pathol. 1991;11:813–26.PubMedCrossRef
7.
go back to reference Thach BT, Davies AM, Koenig JS. Pathophysiology of sudden upper airway obstruction in sleeping infants and its relevance for SIDS. Ann NY Acad Sci. 1988;533:314–28.PubMedCrossRef Thach BT, Davies AM, Koenig JS. Pathophysiology of sudden upper airway obstruction in sleeping infants and its relevance for SIDS. Ann NY Acad Sci. 1988;533:314–28.PubMedCrossRef
8.
go back to reference Mitchell EA, Brunt JM, Everard C. Reduction in mortality from sudden infant death syndrome in New Zealand: 1986–92. Arch Dis Child. 1994;70:291–4.PubMed Mitchell EA, Brunt JM, Everard C. Reduction in mortality from sudden infant death syndrome in New Zealand: 1986–92. Arch Dis Child. 1994;70:291–4.PubMed
9.
go back to reference Taylor JA, Krieger JW, Reay DT, Davis RL, Harruff R, Cheney LK. Prone sleep position and the sudden infant death syndrome in King County, Washington: a case-control study. J Pediatr. 1996;128:626–30.PubMedCrossRef Taylor JA, Krieger JW, Reay DT, Davis RL, Harruff R, Cheney LK. Prone sleep position and the sudden infant death syndrome in King County, Washington: a case-control study. J Pediatr. 1996;128:626–30.PubMedCrossRef
10.
go back to reference Hauck FR, Herman SM, Donovan M, et al. Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics. 2003;111:1207–14.PubMed Hauck FR, Herman SM, Donovan M, et al. Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics. 2003;111:1207–14.PubMed
11.
12.
go back to reference Krous HF, Nadeau JM, Silva PD, Blackbourne BD. Intrathoracic petechiae in sudden infant death syndrome: relationship to face position when found. Pediatr Dev Pathol. 2001;4:160–6.PubMedCrossRef Krous HF, Nadeau JM, Silva PD, Blackbourne BD. Intrathoracic petechiae in sudden infant death syndrome: relationship to face position when found. Pediatr Dev Pathol. 2001;4:160–6.PubMedCrossRef
13.
go back to reference Kemp JS, Thach BT. Rebreathing of exhaled air. In: Byard RW, Krous HF, editors. Sudden infant death syndrome: problems, progress & possibilities. London: Arnold; 2001. Kemp JS, Thach BT. Rebreathing of exhaled air. In: Byard RW, Krous HF, editors. Sudden infant death syndrome: problems, progress & possibilities. London: Arnold; 2001.
14.
go back to reference Waters KA, Gonzalez A, Jean C, Morielli A, Brouillette RT. Face-straight-down and face-near-straight-down positions in healthy, prone-sleeping infants. J Pediatr. 1996;128:616–25.PubMedCrossRef Waters KA, Gonzalez A, Jean C, Morielli A, Brouillette RT. Face-straight-down and face-near-straight-down positions in healthy, prone-sleeping infants. J Pediatr. 1996;128:616–25.PubMedCrossRef
15.
go back to reference Adelson L, Kinney E. Sudden and unexpected death in infancy and childhood. Pediatrics. 1956;17:663–99.PubMed Adelson L, Kinney E. Sudden and unexpected death in infancy and childhood. Pediatrics. 1956;17:663–99.PubMed
16.
go back to reference Bergman AB, Ray CG, Pomeroy MA, Wahl PW, Beckwith JB. Studies of the sudden infant death syndrome in King County, Washington. 3. Epidemiology. Pediatrics. 1972;49:860–70.PubMed Bergman AB, Ray CG, Pomeroy MA, Wahl PW, Beckwith JB. Studies of the sudden infant death syndrome in King County, Washington. 3. Epidemiology. Pediatrics. 1972;49:860–70.PubMed
17.
go back to reference Carpenter RG, Shaddick CW. Role of infection, suffocation, and bottle feeding in cot death: an analysis of some factors in the histories of 110 cases and their controls. Br J Prev Soc Med. 1965;19:1–7.PubMed Carpenter RG, Shaddick CW. Role of infection, suffocation, and bottle feeding in cot death: an analysis of some factors in the histories of 110 cases and their controls. Br J Prev Soc Med. 1965;19:1–7.PubMed
18.
go back to reference Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Jones ME, McCall MJ. Thermal environment and sudden infant death syndrome: case-control study. Br Med J. 1992;304:277–82.CrossRef Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Jones ME, McCall MJ. Thermal environment and sudden infant death syndrome: case-control study. Br Med J. 1992;304:277–82.CrossRef
19.
go back to reference Scheers NJ, Dayton CM, Kemp JS. Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States. Arch Pediatr Adolesc Med. 1998;152:540–7.PubMed Scheers NJ, Dayton CM, Kemp JS. Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States. Arch Pediatr Adolesc Med. 1998;152:540–7.PubMed
20.
go back to reference L’Hoir MP, Engelberts AC, van Well GT, et al. Risk and preventive factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr. 1998;157:681–8.PubMedCrossRef L’Hoir MP, Engelberts AC, van Well GT, et al. Risk and preventive factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr. 1998;157:681–8.PubMedCrossRef
21.
go back to reference Krous H. Instruction and reference manual for the International Standardized Autopsy Protocol for Sudden Unexpected Infant Death. J SIDS Infant Mortal. 1996;1:203–46. Krous H. Instruction and reference manual for the International Standardized Autopsy Protocol for Sudden Unexpected Infant Death. J SIDS Infant Mortal. 1996;1:203–46.
22.
go back to reference Iyasu S, Rowley D, Hanzlick R. Guidelines for death scene investigation of sudden, unexplained infant deaths: recommendations of the Interagency Panel on Sudden Infant Death Syndrome. MMWR Morb Mortal Wkly Rep. 1996;45:1–6. Iyasu S, Rowley D, Hanzlick R. Guidelines for death scene investigation of sudden, unexplained infant deaths: recommendations of the Interagency Panel on Sudden Infant Death Syndrome. MMWR Morb Mortal Wkly Rep. 1996;45:1–6.
23.
go back to reference Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. J Am Med Assoc. 1998;280:329–35.CrossRef Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. J Am Med Assoc. 1998;280:329–35.CrossRef
24.
go back to reference Gibson E, Dembofsky CA, Rubin S, Greenspan JS. Infant sleep position practices 2 years into the “back to sleep” campaign. Clin Pediatr (Phila). 2000;39:285–9. Gibson E, Dembofsky CA, Rubin S, Greenspan JS. Infant sleep position practices 2 years into the “back to sleep” campaign. Clin Pediatr (Phila). 2000;39:285–9.
25.
go back to reference Unger B, Kemp JS, Wilkins D, et al. Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics. 2003;111:E127–31.PubMedCrossRef Unger B, Kemp JS, Wilkins D, et al. Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics. 2003;111:E127–31.PubMedCrossRef
26.
go back to reference Fleming PJ, Blair PS, Bacon C, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993–5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential enquiry into stillbirths and deaths regional coordinators and researchers. Br Med J. 1996;313:191–5. Fleming PJ, Blair PS, Bacon C, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993–5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential enquiry into stillbirths and deaths regional coordinators and researchers. Br Med J. 1996;313:191–5.
27.
go back to reference Mitchell EA, Ford RP, Taylor BJ, et al. Further evidence supporting a causal relationship between prone sleeping position and SIDS. J Paediatr Child Health. 1992;28 Suppl 1:S9–12.PubMedCrossRef Mitchell EA, Ford RP, Taylor BJ, et al. Further evidence supporting a causal relationship between prone sleeping position and SIDS. J Paediatr Child Health. 1992;28 Suppl 1:S9–12.PubMedCrossRef
28.
go back to reference Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Wang YG. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med. 1993;329:377–82.PubMedCrossRef Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Wang YG. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med. 1993;329:377–82.PubMedCrossRef
29.
go back to reference Tonkin S. Sudden infant death syndrome: hypothesis of causation. Pediatrics. 1975;55:650–61.PubMed Tonkin S. Sudden infant death syndrome: hypothesis of causation. Pediatrics. 1975;55:650–61.PubMed
30.
go back to reference Beckwith JB. Observations on the pathologic anatomy of SIDS. In: Bergman AB, Beckwith JB, Ray CG, editors. Proceedings of the second international conference on the causes of sudden death in infants. Seattle: University of Washington Press; 1970. p. 83–107. Beckwith JB. Observations on the pathologic anatomy of SIDS. In: Bergman AB, Beckwith JB, Ray CG, editors. Proceedings of the second international conference on the causes of sudden death in infants. Seattle: University of Washington Press; 1970. p. 83–107.
31.
go back to reference Guilleminault C, Ariagno RL, Forno LS, Nagel L, Baldwin R, Owen M. Obstructive sleep apnea and near miss for SIDS: I. Report of an infant with sudden death. Pediatrics. 1979;63:837–43.PubMed Guilleminault C, Ariagno RL, Forno LS, Nagel L, Baldwin R, Owen M. Obstructive sleep apnea and near miss for SIDS: I. Report of an infant with sudden death. Pediatrics. 1979;63:837–43.PubMed
32.
go back to reference Poets CF, Meny RG, Chobanian MR, Bonofiglo RE. Gasping and other cardiorespiratory patterns during sudden infant deaths. Pediatr Res. 1999;45:350–4.PubMedCrossRef Poets CF, Meny RG, Chobanian MR, Bonofiglo RE. Gasping and other cardiorespiratory patterns during sudden infant deaths. Pediatr Res. 1999;45:350–4.PubMedCrossRef
33.
go back to reference Krous HF, Haas EA, Chadwick AE, Masoumi H, Mhoyan A, Stanley C. Delayed death in sudden infant death syndrome: a San Diego SIDS/SUDC Research Project 15-year population-based report. Forensic Sci Int. 2007. Krous HF, Haas EA, Chadwick AE, Masoumi H, Mhoyan A, Stanley C. Delayed death in sudden infant death syndrome: a San Diego SIDS/SUDC Research Project 15-year population-based report. Forensic Sci Int. 2007.
Metadata
Title
Intrathoracic petechiae in SIDS: a retrospective population-based 15-year study
Authors
Henry F. Krous
Elisabeth A. Haas
Amy E. Chadwick
Homeyra Masoumi
Christina Stanley
Publication date
01-12-2008
Publisher
Humana Press Inc
Published in
Forensic Science, Medicine and Pathology / Issue 4/2008
Print ISSN: 1547-769X
Electronic ISSN: 1556-2891
DOI
https://doi.org/10.1007/s12024-008-9054-8

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