BMJ Puts Sudden Unexpected Infant Death Under The Microscope Again

Editor's Choice
Main Category: Pediatrics / Children's Health
Also Included In: Psychology / Psychiatry;  Sleep / Sleep Disorders / Insomnia
Article Date: 20 Jul 2007 - 0:00 PDT

email to a friend   printer friendly   opinions  

An article in this week's British Medical Journal (BMJ) will most likely re-open the controversy over sudden unexpected infant death, or cot death.

A recent study published in The Lancet looked at repeat sudden unexpected infant deaths in 46 families. That article suggested that in the majority of cases, the deaths were natural. This contrasted with earlier studies which had indicated that the majority were the result of homicide.

The impact of the Lancet article has been such that organizations like the American Academy of Pediatrics have accepted it.

At the end of last year the BMJ questioned how these deaths had been classified in the study.

This new BMJ report was prepared by two retired paediatricians, Christopher Bacon and Edmund Hey, who checked the 46 second deaths to identify how many may be reasonably regarded as undetermined. They have both conluded that three deaths, which had been attributed to natural causes, should perhaps be classed as undetermined. The two deaths exhibited many features, such as violent family relationships, asphyxia and parental mental health problems.

The authors are not saying that violence in a family should imply that a death was unnatural, they explain that the feature of violence in the family should be taken into account when determining the cause of death of a second baby in the same family.

In the 13 further deaths that were classed as natural, the original authors recognized the fact that they did not have enough information to distinguish between sudden infant death syndrome and a specific natural cause.

It does not make sense, say Bacon and Hey, to exclude homicide when you do not have sufficient information to exclude a specific natural cause.

The authors conclude that:

-- 13% of the second deaths should be classed as probably unnatural
-- 43% of the second deaths were probably natural (includes six cases they were not able to review)
-- 43% of the second deaths should be classed as undetermined

The original Lancet study had indicated that 87% of the deaths were natural. This BMJ study seems closer to the previous studies (before the Lancet one) which indicated that about two-fifths of repeat deaths were probably the result of homicide.

Bacon and Hey suggest that using a dichotomy of unnatural and natural is more likely to lead to mistakes. They both acknowledge the Lancet's report for helping shift suspicion away from innocent parents, but wonder whether the present stance may not be undermining the safety of children.

Sitting on the fence is more likely to lead to a more scientific inquiry, they say, than dogmatically taking one side or the other.

The authors conclude "We would encourage professionals to keep an open mind in assessing unexplained infant deaths, to be aware of the difficulties in diagnosis, and to try to keep a balance between the need to support parents and the need to protect children."

"Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant Programme"
BMJ Volume 335, pp 129-31
http://www.bmj.com

Written by: Christian Nordqvist
Editor: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations