Sudden Infant Death Syndrome versus Child Abuse

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The topic of this discussion is the assessment findings that would distinguish between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse. It is in the realm of forensic nursing to share the responsibility of rendering a medicolegal opinion as to the cause of death.
The interview assessment will need to include the epidemiology trends identified with SIDS. Some of these are: early gestation, low birth weight, mother who used tobacco or recreational drugs during pregnancy. Post birth incidences of thrush, pneumonia, cyanotic spells and vomiting. It will also be important to note last visit to pediatrician and any immunizations received. Current thinking is having one child with SIDS does not predispose future children to SIDS, however, it would be important to know if considering abuse.
The mother needs to be questioned regarding psychiatric disturbances, postpartum depression or history of maltreatment themselves. There is an epidemiology trend indicating that a mother with one of these histories has a tendency to infanticide.
New standards of markers to check in the autopsy have increased as SIDS is studied in greater detail. Some but not all are:
• Develop a timeline for baby illness as it is trended many of these babies who subsequently died had previous hospitalizations for failure to thrive.
• Check for patterns of viral infections as respiratory syncytial virus, cytomegalovirus, Hepatitis.
• Forensic nurse could also have a role in the investigation of the child’s home for environmental risk factors. The crib will need to be assessed for cleanliness, repair, type of pillows, blankets, type of sheets, check stuffed toys for tight seams to hold stuffing, strings of any type the baby could get in the airway or around the neck. The environmental assessed for cleanliness and observe family members interaction with each other.
• Pathology review needs to include assessing the brainstems for glial nodules as there is speculation these may affect cardiorespiratory control.
o Intrathoracic petechia is a controversial marker for SIDS that should be observed for.
o Samples need to be taken of body fluids such as: vitreous humor, CSF, blood, urine and stool. Tissue needs to be taken from the brain, liver, kidney heart, adrenals, pancreas skin, and muscle
o Chemistry panels would be required due to thoughts on metabolic diseases accounting for SIDS in infants with fatty livers.
o Radiology studies would need to complete to rule out past or recent physical abuse with residual injuries to skeletal system.
o
A nurse trained in forensics could serve as a pivotal member of a trauma response team for a infant brought by EMS. The staff all need maintain a supportive approach to parents during the death review process. The forensics training would allow timely gathering of evidence such as bed linens, clothes, and initial reactions from care giver, photograph any contusions or physical signs of maltreatment before the body is taken to the morgue. Photographs could help determine postmortem lividity from bruising or other skin lesions. Reports emphasize the need for evaluation that includes thorough physical examinations, autopsies, and death scene investigation. The information compiled by means of the detailed investigation suggested could provide a greater determination of cause and manner of death. Overall minimize mistakes in determining the cause and manner of death in these tragic cases.

References:

Peterson DR Clinical implications of sudden infant death syndrome epidemiology Pediatrician1988;15:198-203

Reece DR Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision Pediatrics Vol 91 February 1993

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