PubMed · 4704674
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C Wood, K H Ng, D Hounslow, H Benning. 1973. Time--an important variable in normal delivery.. https://doi.org/10.1111/j.1471-0528.1973.tb11194.x
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AIM: To identify features to help paediatricians differentiate between natural and unnatural infant deaths. METHOD: Clinical features of 81 children judged by criminal and family courts to have been killed by their parents were studied. Health and social service records, court documents, and records from meetings with parents, relatives, and social workers were studied. RESULTS: Initially, 42 children had been certified as dying from sudden infant death syndrome (SIDS), and 29 were given another cause of natural death. In 24 families, more than one child died; 58 died before the age of 6 months and most died in the afternoon or evening. Seventy per cent had experienced unexplained illnesses; over half were admitted to hospital within the previous month, and 15 had been discharged within 24 hours of death. The mother, father, or both were responsible for death in 43, five, and two families, respectively. Most homes were disadvantaged--no regular income, receiving income support--and mothers smoked. Half the perpetrators had a history of somatising or factitious disorder. Death was usually by smothering and 43% of children had bruises, petechiae, or blood on the face. CONCLUSIONS: Although certain features are indicative of unnatural infant death, some are also associated with SIDS. Despite the recent reduction in numbers of infants dying suddenly, inadequacies in the assessment of their deaths exist. Until a thorough postmortem examination is combined with evaluation of the history and circumstances of death by an experienced paediatrician, most cases of covert fatal abuse will go undetected. The term SIDS requires revision or abandonment.
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Accidental aspiration of a foreign body (FB) is an event which is reasonably frequent and dramatic in children and is still today one of the main causes of death due to accidents at home in children up to three-four years of age. The severity of the clinical picture varies according to the size, shape, type and site of arrest of the material aspirated and can be associated with both severe asphyxial forms and forms with insidious and vague symptoms which are difficult to diagnose correctly. A late diagnosis is however a fairly common event in literature. An anamnesis suggesting probable aspiration in a child under the age of 3 should direct doctors towards diagnostic and operative endoscope examinations of the patient, even where there is a negative clinical and radiological picture. Organic material, mainly peanuts, represented 60-75% of the findings, particularly in the 0-3 year age-band. In the other of cases inorganic material was extracted from school-age children. Aspiration of a FB exposes the patient to risk of serious complications and sequelae. Antibiotic, dexamethasone therapy and the ventilation support in the CPAP helped to avoid post-extractive sequelae. Prevention should in any case be the primary aim as regards to aspiration of foreign bodies in children. This should be stimulated by appropriate educational campaigns to raise awareness. The study included 62 child patients observed in the Department of Anesthesia and Intensive Care of the S.Orsola-Malpighi Hospital of Bologna over the last 11 years who were admitted for suspected FB aspiration.