SIDS

Question 1

what are the causes of unexpected infant death

Answer 1

natural disease
accidents 
homicides 
SIDS 
undetermined

Question 2

What is the definition of SIDS

Answer 2

sudden death of an infant under 1
remains unexplained after investigation + autopsy + exam of death scene + review of clinical history (1984)
+ association with sleep
+ replace death scene with circumstances of death

Question 3

characteristics of SIDS infancts

Answer 3

0.1-4/1000 live births 
low socio 
male 
premature 
low birth g
winter

Question 4

characteristics of SIDS mums

Answer 4

single 
smoker
high parity 
short inter-pregnancy intervals 
infection in pregnancy

Question 5

theories of SIDS

Answer 5

respiratory 
cardiac 
infectious 
biochemical 
occult
mixture of causes, different for each infant

Question 5

theories of SIDS

Answer 5

respiratory 
cardiac 
infectious 
biochemical 
occult
mixture of causes, different for each infant

Question 6

past mistakes about SIDS

Answer 6

using anaesthetisd adult male rat as a model for SIDS

Question 7

risk factors for SIDS

Answer 7

prone sleeping
cigarette smoke exposure
covering the head
overheating when prone

Question 8

current problems with SIDS

Answer 8

3/4 infants dying of SIDS still placed to sleep prone

2/3 parents still smoke

Question 9

relationship between immunisation and SIDS

Answer 9

tennessee 1979 = 4 infants died after immunisation

possible relationship?

Question 10

Cosleeping

Answer 10

some infants will die in parental bed
large, intoxicated parents with soft mattress and heavy coverings
some babies are more vulnerable than others

Question 11

investigation in unexptected infant death: mistakes

Answer 11

closed mind = ‘obvious SIDS’, ‘typical drowning’

Question 12

process for unexpected infant death in SA

Answer 12

death -> ambo -> uniformed cops -> CIB contacted -> forensic response + other officers attend

Question 13

role of pathologist in infant death

Answer 13

contacted by police
attend if suss circumstances
or examine body as soon as arrives at mortuary

Question 14

initial exam

Answer 14

external for injuries - ears, mouth genitals

sent for skeletal survey at childrens hospital

Question 15

info about death scene

Answer 15

who was there
what happened 
corroborating stories 
does if feel ok
bedding arrangements 
bloody fluid 
intoxication (alcohol)

Question 16

what comprises a dangerous cot

Answer 16

gaps
projections
loose sides
poorly fitting mattresses => hanging + wedging

Question 17

importance of past history

Answer 17

previous deaths
domestic violence
involvement of child protection services

Question 18

what are the requirements for a pathologist

Answer 18

accurate description of previous 24 hours

details of clinical procedures + med history before autopsy

Question 19

what are other contacts that are useful

Answer 19

cps for expertise and knowledge

discuss problems before they arise

Question 20

describe additional healp

Answer 20

crimes scene - physical evidence officers for photos and videos
used to have family violence unit officers

Question 21

describe some problem areas

Answer 21

country cases - under resourced, far from forensics centre, contact pathologist asap

Question 22

why is SID complicated

Answer 22

weird disease
inherited problems
development and growth issues
complex dissection

Question 23

describe infant autopsies

Answer 23

extensive
full external and internal examination
soft tissue, neck, spinal, optic dissection

Question 24

describe autopsy photographs

Answer 24

negative as well as positive findings | try asses case on photos alone

Question 25

what are typical autopsy findings

Answer 25

nothing on outside are internal organs shiny and rightly placed are they rib fractures or haemorrhage how is brain

Question 26

what are the special examinations

Answer 26

``` skin dissections fractured bones + eyeballs for histology brain + cord for neuropathology eyes + lungs stained for irons microbio for blood, lungs, spleen, heart csf toxicology = blood, urine, liver electrolytes - vitreous metabolic - blood, urine, vitreous ```

Question 27

describe toxicology

Answer 27

which drugs at scene/suspected

Question 28

what are the warning signs

Answer 28

unexplained bruises in other infants + parents facial petechiae inconsistent stories from carers drug impaired carers

Question 29

advantages of protocols

Answer 29

uniform approach | identical scene evaluations + autopsy work-ups

Question 30

what should we be ware of

Answer 30

just because a baby dies in a cot, doesn't mean it was cot death >30% SIDS cases are actually something else autopsy should be mandatory

Question 31

what are likely problems with SIDS

Answer 31

difficulty with autonomic nervous control poor arousal responses inadequate response to infection and other stresses

Question 32

what's the triple risk model

Answer 32

predisposed infant vulnerable period external stresses

Question 33

sids is a...

Answer 33

heterogeneous entity with characteristic epidemiological and clinical features diverse aetiological pathways

Question 34

disease that can contribute/act as sids

Answer 34

``` meningococcus myocarditis epiglottitis HCM aortic stenosis aberrant coronary pulmonary thromboembolism micrognathia tongue cyst cystic fibrosis haemorrhage ```

Question 35

describe some hematological conditions

Answer 35

sickle cell disease | hemophilia