Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

Bacon, Christopher M.; Braithwaite, West Yorkshire; Hey, Edmund

doi:10.1136/bmj.39203.430984.ad

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Previous research by CONI12 showed most repeat deaths are due to natural causes, but some may be unnatural, raising concerns for professionals managing such families. However, there is no consensus on which proportion of repeat deaths may be unnatural,13 14 and much of the increased recurrence risk relates to parental smoking, maternal age and social deprivation 15. Since this last research the standard of UK SUDI investigation has improved considerably,16 enabling a cause of death to be determined in more cases.…”

Section: Introductionmentioning

confidence: 99%

Recurrent sudden unexpected death in infancy: a case series of sibling deaths

et al. 2020

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ObjectivesTo determine the rate of sudden unexpected death in infancy (SUDI) for infants born after a previous SUDI in the same family, and to establish the causes of death and the frequency of child protection concerns in families with recurrent SUDI.DesignObservational study using clinical case records.SettingThe UK’s Care of Next Infant (CONI) programme, which provides additional care to families who have experienced SUDI with their subsequent children.PatientsInfants registered on CONI between January 2000 and December 2015.Main outcome measuresCause of death, presence of modifiable risk factors for SUDI and child protection concerns.ResultsThere were 6608 live-born infants registered in CONI with 29 deaths. 26 families had 2 deaths, and 3 families had 3 deaths. The SUDI rate for infants born after one SUDI is 3.93 (95% CI 2.7 to 5.8) per 1000 live births. Cause of death was unexplained for 19 first and 15 CONI deaths. Accidental asphyxia accounted for 2 first and 6 CONI deaths; medical causes for 3 first and 4 CONI deaths; and homicide for 2 first and 4 CONI deaths. 10 families had child protection concerns.ConclusionsThe SUDI rate for siblings is 10 times higher than the current UK SUDI rate. Homicide presenting as recurrent SUDI is very rare. Many parents continued to smoke and exposed infants to hazardous co-sleeping situations, with these directly leading to or contributing to the death of six siblings. SUDI parents need support to improve parenting skills and reduce risk to subsequent infants.

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Section: Introductionmentioning

confidence: 99%

Recurrent sudden unexpected death in infancy: a case series of sibling deaths

et al. 2020

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“…They stated that 80-90% of second SIDS cases were natural (28). This paper has not gone without challenge, including by Dr. V. Dimaio, and review of Carpenter's data by other authors has suggested a higher rate of unnatural deaths (29–31) than recorded by Carpenter et al Bacon and colleagues, in a review of papers on repeat SIDS, commented that the studies upon which risk of a second death was derived were flawed and may have overestimated the risk (31). They stated that by 2005, the risk of a first baby dying of SIDS in the UK was one in 3300 and of a subsequent child dying would be less than one in 500, based upon the data.…”

Section: Discussionmentioning

confidence: 91%

Ten Percent of SIDS Cases are Murder — or are They?

Milroy

Kepron

2017

Academic Forensic Pathology

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Sudden infant death syndrome (SIDS) has been used as a cause of death for over four decades. It has allowed deaths of infants to be registered as natural. Within this group of deaths, a certain number have been recognized to be homicides from inflicted smothering rather than being natural or accidental deaths. Research has been conducted using confidential inquires to determine how frequent homicide is in cases called SIDS. This paper traces the history of quoted rates of homicide. Early work suggested the figure was between 2-10% of all SIDS cases, though other workers have suggested figures as high as 20-40%. With the fall in the rate of infant deaths following the "Back to Sleep" campaigns, these figures have been reevaluated. If the higher figures were correct that 20-40% of SIDS were homicides, the fall in infant deaths would be expected to be less than it has been. Current data suggests a much lower figure than 10% of current cases, with much lower overall rates of infant deaths. As well as 10% of SIDS cases having been stated to be homicides, a related question is whether multiple deaths classified as SIDS are really homicides. The paper discusses the maxim that one death is a tragedy, two is suspicious, and three deaths indicate homicide. The paper also looks at court cases and the approach that has been made in prosecutions of sudden unexpected death in infancy as multiple murder.

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“…Eighteen families in the scheme had a second death attributed to SIDS, which gave a relative risk of 5.9 as compared with the population. This study is the largest to date and comes nearest to meeting our criteria, but the accuracy of diagnosis has been questioned 2 14…”

Section: Resultsmentioning

confidence: 99%

How common is repeat sudden infant death syndrome?

Bacon¹,

Hall

Stephenson

et al. 2008

Archives of Disease in Childhood

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Recurrence of sudden infant death syndrome (SIDS) is rare but may give rise to confusion and controversy because of the differential diagnoses of familial disease or covert homicide. We examine eight studies of recurrent SIDS published in English since 1970. These studies reported relative risks of recurrence, as compared with the population or with controls, ranging from 1.7 to 10.1. We assess the validity of the studies by three main criteria: accuracy of ascertainment, adequacy of investigation and matching of controls. We found that all the studies failed to meet these criteria, and we think that their flaws would have resulted mainly in overestimation of recurrence risk. We conclude that, although an increase in risk is probable on theoretical grounds, this risk cannot be quantified from the available evidence. We suggest that professionals should be cautious in their pronouncements on the chances of recurrence, and that parents who have lost a baby to SIDS can, with the exception of particularly vulnerable families, be reassured that the risk of recurrence is small.

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Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

Abstract: It is misleading to classify every unexplained infant death as natural if no unnatural cause has been established, argue C J Bacon and E N Hey

Cited by 6 publications

References 16 publications

Recurrent sudden unexpected death in infancy: a case series of sibling deaths

Recurrent sudden unexpected death in infancy: a case series of sibling deaths

Ten Percent of SIDS Cases are Murder — or are They?

How common is repeat sudden infant death syndrome?

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