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Biomedical subjects

A N Stanton

Publications and source records attributed to A N Stanton.

16 recordsLinked to original sources
PubMed2003

Sudden unexpected death in infancy associated with maltreatment: evidence from long term follow up of siblings.

AIMS: To identify any association between sudden unexpected death in infancy (SUDI) and maltreatment within local families. METHODS: Retrospective enquiry and subsequent follow up of all siblings and later births within the families. Full investigation of the circumstances of all unexpected deaths. SETTING: Scarborough and Bridlington Health Districts and Trusts, North and East Yorkshire. SUBJECTS: All local families losing a baby from SUDI, 1982-96. Follow up to end of 2000. MAIN OUTCOME MEASURES: Court judgements and the objective decisions of legally constituted Social Services Case Conferences to place siblings on the Child Protection Register (CPR), or provide equivalent safeguards. RESULTS: Sixty nine families had 72 unexpected deaths; three families had two deaths, with two families raising maltreatment issues. Three families had other children subsequently put on the CPR, all identifiable as likely problems of maltreatment at the time of the single SUDI. In 64/69 families, no child protection issues were formally raised at the time of the SUDI; 41/64 of these families already had 63 children. Four families were lost to follow up after the SUDI; 52/60 of the remaining families have had 93 more children without objective evidence of maltreatment. CONCLUSIONS: The association of SUDI and maltreatment within families was at the lower end of previous estimates, 3-10%. Child protection intervention is rarely needed, but investigation and follow up for maltreatment is mandatory where apparent life threatening episodes are reported with a second baby, and after a recurrence of apparent SUDI.

Child Abuse↗
PubMed1984

Sudden infant death. Overheating and cot death.

Four risk factors for overheating were sought in the histories of 34 cot-death victims in Oxford and Scarborough. 19 babies were unusually hot or sweating when found dead; 14 died in an unusually warm environment; 17 had evidence of a terminal infective illness; and 24 were excessively clothed or overwrapped. 3 babies had all four risk factors, 8 had three, 17 had two, and 4 had one risk factor. Only 2 had no risk factor; both had had very low birthweights. In 6 of 15 babies (40%) whose rectal temperature was recorded after death the temperature was above 37 degrees C, the highest being 42 degrees C. If parents could be educated to anticipate the dangerous situations preceding febrile apnoea, many cot deaths could probably be avoided.

Body Temperature↗
PubMed1983

Pattern of illnesses before cot deaths.

The reasons for referral to hospital of 147 babies subsequently included in the DHSS study of postneonatal infant mortality were analysed and compared with those of 104 control infants. Although similar numbers were seen as outpatients, 71 (16%) of the babies who died unexpectedly, but only 28 controls had previously been admitted to hospital. The excess was explained by acute infections, loss of consciousness, possible child abuse, and failure to thrive for non-organic reasons. The average length of admission was almost twice that required by controls, and 31% were admitted more than once. The admissions were often clues to important family problems that might have been investigated further. There were no admissions for unexplained apnoea and 'near miss' cot deaths may not therefore represent a suitable model for the investigation of most unexpected deaths during infancy.

Age Factors↗
PubMed1980

Is overheating a factor in some unexpected infant deaths?

Clinical and pathological evidence of overheating was sought in a consecutive series of infants dying in Newcastle and Gateshead. In 8 of 33 cases of cot death investigated pathologically histological changes in the small intestine of the kind described in association with heatstroke were seen. Such changes were not seen in any of 12 deaths from chronic or congenital conditions, and in only 1 of 8 acute explained deaths--in a baby who died with necrotising enterocolitis. 15 of 34 cot-death babies investigated clinically were judged to have been excessively clothed or covered at the time of death. 7 babies were unusually hot when found dead, and 4 others had been noticed to be hot shortly before death. 10 more babies had evidence of a terminal infection without observed fever. The possibility that overheating contributes to some cot deaths has important implications for health education.

Clothing↗
PubMed1980

Management of acute illness in infants before admission to hospital.

Parents and family doctors were questioned about the management of 150 infants with acute illness before their admission to hospital. When 108 of the children were first assessed the family doctor did not consider that admission was necessary, but follow-up was arranged in only 14 of these cases. Thus in 94 cases the initiative for recall was left to the parents, who in 44 cases already wanted their child to be admitted. Forty-eight infants were referred because the doctors thought that the parents could not cope. The parents of 31 of the children delayed in seeking help. As over half the children were ill for more than three days before they were admitted to hospital, regular follow-up could have been arranged. Doctors should normally retain the initiative for this rather than leave it to the parents' discretion.

Acute Disease↗
PubMed1979

Meningococcal infections during infancy: confidential inquiries into 10 deaths.

The first 10 deaths from meningococcal infections in children aged under 2 years that were reported to a DHSS multicentre study were reviewed. Confidential inquiries were made of the parents, family doctors, health visitors, and hospital staff concerned with each case, and management was discussed with a paediatrician and pathologist. Diagnosis and treatment were often delayed because doctors did not realise the importance of the purpuric rash. One child died at home, and by the time they were admitted to hospital all the remaining nine were shocked and needed resuscitation. Prodromal symptoms, mainly changes in behaviour, preceded the rash in all cases. These prodromal symptoms should arouse the suspicion of septicaemia and prompt a search for petechiae so that early effective treatment may be started.

Behavior↗
PubMed1978

Terminal symptoms in children dying suddenly and unexpectedly at home. Preliminary report of the DHSS multicentre study of postneonatal mortality.

Terminal symptoms in 145 children who died suddenly and unexpectedly at home were investigated and compared with symptoms in 154 control children. Eighty-five (59%) of the children who died had had terminal symptoms, which in 69 cases (48%) appeared to have been major. Non-specific symptoms were especially common among the children who died. Symptoms were often present for several days before death. Only 12 of the 69 children who died with major symptoms had been seen by a doctor within 24 hours before death. We conclude that many deaths in young children might be prevented if doctors and parents were more aware of the importance of non-specific symptoms as markers of life-threatening illness.

Age Factors↗
PubMed1978

Respiratory viruses and cot death.

Respiratory viruses and histological appearances of the lung were studied prospectively in an unselected series of 104 children who died between 1 week and 2 years of age. Thirty-one of the cases were cot deaths. Seven of these showed evidence of active virus infection in the lower respiratory tract. Similar evidence was found in two children who died from known causes and did not have a severe respiratory illness terminally. Although in some cases of cot death respiratory viruses may be responsible for a severe and rapidly overwhelming illness, the present results are compatible with an alternative hypothesis-namely, that minor respiratory illness may trigger sudden apnoea.

Child, Preschool↗
PubMed1978

Evaluation of the Sheffield system for identifying children at risk from unexpected death in infancy. Results from Birmingham and Newcastle upon Tyne.

The "at birth" system which is used in Sheffield to identify children likely to die unexpectedly in infancy, was tested retrospectively in Birmingham (83 cases) and in Newcastle upon Tyne (56 cases). The discrimination between cases and age-matched controls was poor in both cities. Analysis of the 8 factors used in the system showed that only 2 maintained significant case/control differences in Birmingham and Newcastle. Further investigation showed that other factors from maternity records showed significant case/control differences in these cities. Although the system used in Sheffield would not be of use in a prospective prevention programme in either Newcastle or Birmingham, the possibility of evolving an "at risk" system which might apply more widely is discussed.

England↗