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A practical classification schema incorporating consideration of possible asphyxia in cases of sudden unexpected infant death

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Abstract

Although the rate of the sudden infant death syndrome (SIDS) has decreased over the last two decades, medical examiners and coroners are increasingly unwilling to use the SIDS diagnosis, particularly when there is an unsafe sleeping environment that might pose a risk for asphyxia. In order to reliably classify the infant deaths studied in a research setting in the mixed ancestory population in Cape Town, South Africa, we tested a classification system devised by us that incorporates the uncertainty of asphyxial risks at an infant death scene. We classified sudden infant deaths as: A) SIDS (where only a trivial potential for an overt asphyxial event existed); B) Unclassified—Possibly Asphyxial-Related (when any potential for an asphyxial death existed); C) Unclassified—Non-Asphyxial-Related (e.g., hyperthermia); D) Unclassified—No autopsy and/or death scene investigation; and E) Known Cause of Death. Ten infant deaths were classified according to the proposed schema as: SIDS, n = 2; Unclassified—Possibly Asphyxial-Related, n = 4; and Known Cause, n = 4. A conventional schema categorized the deaths as 6 cases, SIDS, and 4 cases, Known Cause, indicating that 4/6 (67%) of deaths previously classified as SIDS are considered related importantly to asphyxia and warrant their own subgroup. This new classification schema applies a simpler, more qualitative approach to asphyxial risk in infant deaths. It also allows us to test hypotheses about the role of asphyxia in sudden infant deaths, such as in brainstem defects in a range of asphyxial challenges.

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Acknowledgments

We appreciate the help of Mr. Richard A. Belliveau in manuscript preparation. Drs. Eugene E. Nattie and Henry F. Krous provided critical reviews.

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Authors and Affiliations

  1. University of South Dakota Sanford School of Medicine, 2441 Stanton Drive, Sioux Falls, SD, 57103, USA

    Brad B. Randall

  2. Division of Forensic Medicine and Pathology, University of Stellenbosch, National Forensic Pathology Service, Stellenbosch, South Africa

    Sabbir A. Wadee & Johan J. Dempers

  3. School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA

    Mary Ann Sens

  4. Department of Pathology, Harvard Medical School, Boston, MA, USA

    Hannah C. Kinney & Rebecca D. Folkerth

  5. University of Stellenbosch, Tygerberg, South Africa

    Hein J. Odendaal

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  1. Brad B. Randall
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  2. Sabbir A. Wadee
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  4. Hannah C. Kinney
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  5. Rebecca D. Folkerth
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  7. Johan J. Dempers
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Correspondence to Brad B. Randall.

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Randall, B.B., Wadee, S.A., Sens, M.A. et al. A practical classification schema incorporating consideration of possible asphyxia in cases of sudden unexpected infant death. Forensic Sci Med Pathol 5, 254–260 (2009). https://doi.org/10.1007/s12024-009-9083-y

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  • DOI: https://doi.org/10.1007/s12024-009-9083-y

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