Investigation of sudden infant deaths in the State of Maryland (1990–2000)

Li, Ling; Fowler, David; Liu, Liang; Ripple, Mary G.; Z, Lambros; Smialek, John E.

doi:10.1016/j.forsciint.2004.01.021

Cited by 24 publications

(14 citation statements)

References 27 publications

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“…Other studies of outcomes of SUDI investigations found that missing information from death scenes or concerning parental alcohol and smoking habits were commonplace [14,17,18]; in comparison only minimal information was missing in this study. This shows not only the quality of the CDOP data but also of the robustness of the multi-agency investigative process.…”

Section: Discussioncontrasting

confidence: 47%

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Garstang

Ellis

Griffiths

et al. 2016

Forensic Sci Med Pathol

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BackgroundA comprehensive Child Death Review (CDR) program was introduced in England and Wales in 2008 but as yet data have only been analysed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for Sudden Unexpected Death in Infancy (SUDI) as determined by the new CDR program. MethodsThis was a descriptive outcome study using data from Child Death Overview Panel (CDOP) Form C for SUDI cases dying during 2010-2 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia. ResultsData were obtained for 65/70 (93%) SUDI cases. 20/65 (31%) deaths were initially categorised as due to medical causes; 21/65 (32%) as SIDS, and 24/65 (37%) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as 'undetermined' had significantly higher total family and environmental risk factor scores (mean 2.6, 95% CI 2.0-3.3) compared to those classified as SIDS (mean 1.6, 95% CI 1.2-1.9), or medical causes for death (mean 1.1, 95% CI 0.8-1.3). 9/20 (47%) of medical deaths, 19/21 (90%) SIDS and 23/24 (96%) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25%) of medically explained deaths. ConclusionsThe CDR program results in detailed information about risk factors for SUDI cases but failed to recognise deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as 'undetermined deaths' is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep-environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future. Key Words Key pointsThe CDR program provides valuable information on the profile of causes and risk factors for SUDI but is currently not recognising deaths from unintentional asphyxia and often not classifying unexplained infant deaths as SIDS.Most SUDI still occur in hazardous sleep environments despite public health campaigns.Poor parenting, particularly the combination of excess parental alcohol consumption and cosleeping, was a factor in many unexplained SUDI deaths.Research is needed to help target safe-sleep information better at high risk families.Difficulties with health care service provision may have contributed to some medically explained deaths.

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Section: Discussioncontrasting

confidence: 47%

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Garstang

Ellis

Griffiths

et al. 2016

Forensic Sci Med Pathol

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“…33,34 SIDS remains a leading cause of infant death in the Western world, however, and more work is needed to discern its causes. 16,35 Evidence for genetic subsets in SIDS has come from work identifying mutations in various genes. 36,37 Deficiencies in fatty acid metabolism caused by mutations in the mediumchain acyl-CoA dehydrogenase gene have been extensively investigated.…”

Section: Table 3 Level Of Persistent Sodium Current Under Different mentioning

confidence: 99%

Cardiac Sodium Channel Dysfunction in Sudden Infant Death Syndrome

et al. 2007

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Background— Mutations in genes responsible for the congenital long-QT syndrome, especially SCN5A , have been identified in some cases of sudden infant death syndrome. In a large-scale collaborative genetic screen, several SCN5A variants were identified in a Norwegian sudden infant death syndrome cohort (n=201). We present functional characterization of 7 missense variants (S216L, R680H, T1304M, F1486L, V1951L, F2004L, and P2006A) and 1 in-frame deletion allele (delAL586-587) identified by these efforts. Methods and Results— Whole-cell sodium currents were measured in tsA201 cells transiently transfected with recombinant wild-type or mutant SCN5A cDNA (hH1) coexpressed with the human β1 subunit. All variants exhibited defects in the kinetics and voltage dependence of inactivation. Five variants (S216L, T1304M, F1486L, F2004L, and P2006A) exhibited significantly increased persistent sodium currents (range, 0.5% to 1.7% of peak current) typical of SCN5A mutations associated with long-QT syndrome. These same 5 variants also displayed significant depolarizing shifts in voltage dependence of inactivation (range, 5 to 14 mV) and faster recovery from inactivation, but F1486L uniquely exhibits a depolarizing shift in the conductance-voltage relationship. Three alleles (delAL586-587, R680H, and V1951L) exhibited increased persistent current only under conditions of internal acidosis (R680H) or when expressed in the context of a common splice variant (delQ1077), indicating that they have a latent dysfunctional phenotype. Conclusions— Our present results greatly expand the spectrum of functionally characterized SCN5A variants associated with sudden infant death syndrome and provide further biophysical correlates of arrhythmia susceptibility in this syndrome.

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“…The most effective death scene investigations were reported where one public health nurse conducted all SUDI death scene investigations for the region [10]; this resulted in considerably more complete information than the use of the US national templates by multiple death scene examiners [11,12] or when there was no information concerning or variable use of templates [13][14][15]. Trained death scene examiners did obtain detailed information concerning the scene but frequently missed relevant information on other risk factors such as parental smoking [16].…”

Section: Coroner or Medical Examiner-led Models Of Sudi Investigationmentioning

confidence: 99%

“…SUDI investigations should be fully integrated with those conducted by the coroner or led by the coroner as this leads to a smoother investigative service, less duplication of investigation and better sharing of information. Based on strong evidence - [16,11,12,10,15,14,24] …”

Section: Integration Of Sudi Investigations With Coronial Servicesmentioning

confidence: 99%

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An evidence-based guide to the investigation of sudden unexpected death in infancy

Garstang

Ellis

Sidebotham

2015

Forensic Sci Med Pathol

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MethodsThis was a systematic review of papers from Europe, North America and Australasia, detailing models of SUDI investigation or the outcomes of SUDI investigations. ResultsThe review includes data detailing four different models of investigation: police-led, coroner or medical examiner-led, healthcare-led or joint agency approach models.There were 18 different publications providing evidence of effectiveness of these models. All models, with the exception of police-led models have the potential to reach best practice standards for SUDI investigation. Key factors identified for effective SUDI investigation include the need for mandatory investigation, strong leadership, integration with coronial services and for investigations to be provided by specialist professionals.3 ConclusionDetailed SUDI investigation should lead to greater understanding of why infants die and should help prevent future deaths. The challenge is now to ensure that local SUDI investigative practices are as effective as possible. (208 words

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Investigation of sudden infant deaths in the State of Maryland (1990–2000)

Cited by 24 publications

References 27 publications

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Cardiac Sodium Channel Dysfunction in Sudden Infant Death Syndrome

An evidence-based guide to the investigation of sudden unexpected death in infancy

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