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Forensic Science, Medicine and Pathology

Published in:

01-12-2016 | Original Article

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Authors: Joanna Garstang, Catherine Ellis, Frances Griffiths, Peter Sidebotham

Published in: Forensic Science, Medicine and Pathology | Issue 4/2016

Abstract

Background

A comprehensive child death review (CDR) program was introduced in England and Wales in 2008, but as yet data have only been analyzed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for sudden unexpected death in infancy (SUDI) as determined by the new CDR program.

Methods

This was a descriptive outcome study using data from child death overview panel Form C for SUDI cases dying during 2010–2012 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia.

Results

Data were obtained for 65/70 (93 %) SUDI cases. 20/65 (31 %) deaths were initially categorized as due to medical causes; 21/65 (32 %) as SIDS; and 24/65 (37 %) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as “undetermined” had significantly higher total family and environmental risk factor scores (mean 2.6, 95 % CI 2.0–3.3) compared to those classified as SIDS (mean 1.6, 95 % CI 1.2–1.9), or medical causes for death (mean 1.1, 95 % CI 0.8–1.3). 9/20 (47 %) of medical deaths, 19/21 (90 %) SIDS, and 23/24 (96 %) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25 %) of medically explained deaths.

Conclusions

The CDR program results in detailed information about risk factors for SUDI cases but failed to recognize deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as “undetermined deaths” is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future.

Government HM. Working together to safeguard children. Department for Education, editor. London; 2015.

Fleming P, Blair P, Bacon CJ, Berry P. Sudden unexpected deaths in infancy: the CESDI SUDI studies 1993–1996. London: The Stationery Office; 2000.

Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T, et al. Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics. 2004;114(1):234–8.CrossRefPubMed

Fleming P, Blair PS. Sudden infant death syndrome and parental smoking. Early Hum Dev. 2007;83(11):721–5. doi:10.1016/j.earlhumdev.2007.07.011.CrossRefPubMed

Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. Lancet. 2006;367(9507):314–9. doi:10.1016/S0140-6736(06)67968-3.CrossRefPubMed

Fleming PJ, Gilbert R, Azaz Y, Berry PJ, Rudd PT, Stewart A, et al. Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study. BMJ. 1990;301(6743):85–9.CrossRefPubMedPubMedCentral

Brixey SN, Kopp BC, Schlotthauer AE, Collier A, Corden TE. Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting. Inj Prev. 2011;17(Suppl 1):i23–7.CrossRefPubMed

Mitchell E, Krous HF, Byard RW. Pathological findings in overlaying. J Clin Forensic Med. 2002;9(3):133–5.CrossRefPubMed

Becroft DMO, Thompson JMD, Mitchell EA. Nasal and intrapulmonary haemorrhage in sudden infant death syndrome. Arch Dis Child. 2001;85(2):116–20. doi:10.1136/adc.85.2.116.CrossRefPubMedPubMedCentral

10.

Office for National Statistics. Child mortality statistics: childhood, infant and perinatal, 2012. London; 2014.

11.

Sidebotham P, Fleming P. Unexpected death in childhood: a handbook for practitioners. NSPCC wiley series in protecting children: the multi professional approach. Chichester: Wiley; 2007.

12.

Garcia AJ 3rd, Koschnitzky JE, Ramirez JM. The physiological determinants of sudden infant death syndrome. Respir Physiol Neurobiol. 2013;189(2):288–300. doi:10.1016/j.resp.2013.05.032.CrossRefPubMed

13.

Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EM, Fleming P. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ. 2009;339:b3666. doi:10.1136/bmj.b3666bmj.b3666.CrossRefPubMedPubMedCentral

14.

Hutchison BL, Rea C, Stewart AW, Koelmeyer TD, Tipene-Leach DC, Mitchell EA. Sudden unexpected infant death in Auckland: a retrospective case review. Acta Paediatr. 2011;100(8):1108–12.CrossRefPubMed

15.

Schnitzer PG, Covington TM, Kruse RL. Assessment of caregiver responsibility in unintentional child injury deaths: challenges for injury prevention. Inj Prev. 2011;17(Suppl I):i45–54. doi:10.1136/ip.2010.027094.CrossRefPubMed

16.

Sidebotham P, Blair PS, Evason-Coombe C, Edmond M, Heckstall-Smith E, Fleming P. Responding to unexpected infant deaths: experience in one English region. Arch Dis Child. 2010;95(4):291–5. doi:10.1136/adc.2009.167619.PubMed

17.

Li L, Fowler D, Liu L, Ripple MG, Lambros Z, Smialek JE. Investigation of sudden infant deaths in the State of Maryland (1990–2000). Forensic Sci Int. 2005;148(2–3):85–92. doi:10.1016/j.forsciint.2004.01.021.CrossRefPubMed

18.

Meersman SC, Schaberg MJ. Rhode Island child death review: sudden infant death and sudden unexpected infant deaths, 2008–2009. Med Health Rhode Island. 2010;93(7):219–21.

19.

Office for National Statistics. Mortality statistics: deaths registered in England and Wales (Series DR), 2014. London: UK Statistics Authority; 2015.

20.

Taylor BJ, Garstang J, Engelberts A, Obonai T, Cote A, Freemantle J, et al. International comparison of sudden unexpected death in infancy rates using a newly proposed set of cause-of-death codes. Arch Dis Child. 2015;. doi:10.1136/archdischild-2015-308239.

21.

Hayman RM, McDonald G, Baker NJ, Mitchell EA, Dalziel SR. Infant suffocation in place of sleep: New Zealand national data 2002–2009. Arch Dis Child. 2015;100(7):610–4. doi:10.1136/archdischild-2014-306961.CrossRefPubMed

22.

Gould SJ, Weber MA, Sebire NJ. Variation and uncertainties in the classification of sudden unexpected infant deaths among paediatric pathologists in the UK: findings of a National Delphi Study. J Clin Pathol. 2010;63(9):796–9. doi:10.1136/jcp.2010.079715.CrossRefPubMed

23.

Garstang J, Ellis C, Sidebotham P. An evidence-based guide to the investigation of sudden unexpected death in infancy. Forensic Sci Med Pathol. 2015;11(3):345–57. doi:10.1007/s12024-015-9680-x.CrossRefPubMed

24.

Volpe LE, Ball HL. Infant sleep-related deaths: why do parents take risks? Arch Dis Child. 2015;100(7):603–4. doi:10.1136/archdischild-2014-307745.CrossRefPubMed

25.

The Lullaby Trust. Safer sleep for babies. A guide for parents. In: Trust TL, editor. London; 2013.

26.

Gilbert RE, Fleming PJ, Azaz Y, Rudd PT. Signs of illness preceding sudden unexpected death in infants. BMJ. 1990;300(6734):1237–9.CrossRefPubMedPubMedCentral

27.

Leach CE, Blair PS, Fleming PJ, Smith IJ, Platt MW, Berry PJ, et al. Epidemiology of SIDS and explained sudden infant deaths. CESDI SUDI research group. Pediatrics. 1999;104(4):e43.CrossRefPubMed

28.

Carpenter RG, Irgens LM, Blair PS, England PD, Fleming P, Huber J, et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 2004;363(9404):185–91.CrossRefPubMed

29.

Bacon C. Recurrence of sudden infant death syndrome. Pediatrics. 2008;122(4):869–70.CrossRefPubMed

30.

Mitchell EA, Thompson JM, Stewart AW, Webster ML, Taylor BJ, Hassall IB, et al. Postnatal depression and SIDS: a prospective study. J Paediatr Child Health. 1992;28(Suppl 1):S13–6.CrossRefPubMed

31.

Carpenter R, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, Smuk M, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies. BMJ Open. 2013;3(5). doi:10.1136/bmjopen-2012-002299.

32.

Spencer N, Logan S. Sudden unexpected death in infancy and socioeconomic status: a systematic review. J Epidemiol Community Health. 2004;58(5):366–73.CrossRefPubMedPubMedCentral

Title: Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy
Authors: Joanna Garstang
Catherine Ellis
Frances Griffiths
Peter Sidebotham
Publication date: 01-12-2016
Publisher: Springer US
Published in: Forensic Science, Medicine and Pathology / Issue 4/2016
Print ISSN: 1547-769X
Electronic ISSN: 1556-2891
DOI: https://doi.org/10.1007/s12024-016-9802-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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