Is the aeration of the lungs a reliable sign of live birth?

Abstract

One of the most important medico-legal questions is whether an infant was born alive or not. The aerated lungs do not mean in every case that the newborn had taken a breath. Under various conditions the aerated lungs may turn into unaerated ones and, on the other hand, a stillborn's lungs may seem aerated. The critical evaluation of the histological and macroscopical examinations may aid in solving the question.

Post-mortem computed tomography is a useful tool for determining the pulmonary ventilation status in newborns

“…From the very early conceptions of flotation tests by Johannes Schreyer in 1690 [9] to recent studies utilizing imaging techniques, mainly CT [9][10][11][12][13], proving that a newborn has been alive is mainly based on these findings, with histology as gold standard in ambiguous cases. The flotation test has been discussed extensively [3,4,14], its use criticized but maintained until today. It is known to deliver unreliable results in cases of putrefaction or infections.…”

“…Post-mortem computed tomography (PMCT) has been proven to be a useful tool for detecting gas and its distribution patterns [1,2]. It seems likely that the classical task of assessing the presence of air in the lungs of newborns by flotation tests [3][4][5][6][7][8] as a sign of life should be diagnosable by PMCT, because PMCT enables measuring Hounsfield units (HU) as a rough correlate of physical density, the same factor as examined with the flotation test. In recent studies, investigations including histology, macroscopic morphology and PMCT have been promoted.…”