The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we—and where are we going?

Abstract

Abstract:Purposes: Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants under one year of age in many countries. Unfortunately, a paucity of published research data exists in South Africa, with regard to the incidence of and investigation into the circumstances surrounding Sudden Unexplained Deaths in Infants (SUDI) and/or SIDS. Currently, even though most academic centers conform to a protocol consistent with internationally accepted standards, there exists no nationally accepted infant death investigation protocol in South Africa. It is the aim of this study to review the current practice of infant death investigation in two representative but geographically and demographically distinct centers. Methods:Retrospective case audit over a five-year period (2000 to 2004) was conducted at two large medico-legal mortuaries in Pretoria (Gauteng) and Tygerberg (Cape Town). Case files on all infants younger than one year of age were reviewed. The outcome measures included number of deaths, demographic details and the nature and final outcome of the post mortem examinations.Results: A total of 512 cases were identified as possible SIDS cases and of these, 171 was classified as SIDS. The study showed marked inter-case and inter-divisional variation in terms of the investigation of infant deaths at the two institutions. Conclusions:It is envisaged that this study will focus attention on the current lack of usable data regarding sudden/unexplained/unexpected infant deaths in South Africa, and aid in the formulation and implementation of a practical (yet internationally accountable) infant death investigation protocol, which could facilitate comparisons with other countries and initiate further structured research in this field.

Toward a standardized investigation protocol in sudden unexpected deaths in infancy in South Africa: a multicenter study of medico-legal investigation procedures and outcomes

“…Thus far it would appear that only one study has addressed the investigation of SUDI/SIDS in forensic pathology practice. This study showed that there were apparently substantially more cases admitted as SUDIs and a substantially larger number of SIDS cases in the Cape Town -Tygerberg metropolitan region in comparison to the Pretoria metropolitan region [9]. The study also confirmed that no nationally accepted or standardized infant death investigation protocol exists in South Africa, a country with a population in excess of 50 million people.…”

Review of immunological and virological aspects as contributory factors in Sudden Unexpected Death in Infancy (SUDI)

“…No standard national guidelines exist for examination of these cases [6]. The need for standard national and international protocols to streamline SUDI investigations and facilitate research has been clearly acknowledged internationally [7,8] and in South Africa [5,6].…”

“…Since SIDS is documented to be higher in the two to four month age group, this could represent a critical developmental period that coincides with a loss of immune protection due to of waning maternally transferred antibodies [5,42].…”

“…After years of international research, attempts to identify and confirm the cause of death for some SUDI cases are still unsuccessful, leaving SIDS a medical mystery [4]. Data on South African SUDI and SIDS cases is limited [5] and a question in desperate need of an answer, specifically in terms of infectious investigations, is what constitutes a complete and thorough SUDI medico-legal autopsy in South Africa [4]?…”

“…Du Toit-Prinsloo et al [5] [5]. Tygerberg FPS Mortuary may currently be one of the few academic institutions in South Africa where SUDI cases are more extensively investigated.…”