Sudden Infant death

syndrome(SID)

Sudden infant death syndrome / Cot death/

Crib death is defined as the sudden and
unexpected death of apparently healthy
infant, whose death remains unexplained
even after thorough case investigation, death
scene examination, review of clinical history
and complete autopsy.
 Cause of death in SID

• Sleep apnea (a periodic failure to breathe

during sleep)
• Nasal edema and mucus secretion may further
narrow the small upper respiratory passage.
• In some hypotonic babies, a flaccid pharynx
and even neck pasture may further reduce the
airway.
• Laryngeal spasm.
 Cont
• Factors in pg that inhibit fetal circulation could
damage the child's brain, so that it no longer
controls breathing properly.

• Staphylococcus aureus infection of upper of

upper respiratory tract- cause anaphylactic
shock and sudden death.
 Cont
Others cause
• Conduction system anomalies.
• Anatomical abnormalities.
• Respiratory viral infection.
• Adrenal in sufficiency.
• Gastro - esophageal reflux.
• Hypersensitivity to cow's milk
• Hyperthermia
 Feature:

• Incidence: 0'2- 0'4% of live birth.

• Age:
1 week- 1 yrs.
Majority of cases between 6 wk--6m.
Marked peak between- 2-4 months.
• Sex: Male to female ratio- 3:2.
• Twins- Increased risk amongst members of
twin pairs.
 Cont
• Geographical distribution- The occurrence is
world wide.
• Time of death- Death always occurs during sleep
at all time of night with a moderate increase in the
early - morning.
• Prematurity- higher risk.
• Socioeconomic standard of the family is usually
low.
• Cigarette smoking and drug abuse by pg women
increase the risk.
 Autopsy findings
• Milk or blood- stained froth is sometime seen
on the child’s mouth, nostrils or bedding.
• The post- mortem findings are negative.
• The only constant findings are multiple
Petechial hemorrhage on the visceral surfaces
of the heart, lungs and thymus.
• In some pathological condition such as- frank
pneumonia, congenital heart d/s, Down's
syndrome or trachea bronchitis.
 cont
• There are no Petechial hemorrhage in the face
organs.
• The hands are often clenched around fires from
the bed clothes.
• The lungs show—
- patchy or uniform purplish discoloration of the
surface
- firm in consistency with congestion, edema,
patchy alveolar collapse and increase in weight..
 Child sexual abuse(child
molestation)
• It is the involvement of dependent ,
developmentally immature children and
adolescents in sexual activities they do not
truly understand and to which they are unable
to give informed consent or which violate
social taboos or family roles.
• It includes penile, digital or object penetration,
incest, pedophilia, exhibitionism or other forms
of deviant sexual contact.
 Cont
• The sequelae may be either physical or
psychological or both.
• The person can use violence or even murder
the child to avoid the identification.
• POCSO(protection of children from sexual
offence) Act deals with these kinds of
offences.
Battered baby (Caffey syndrome)

The battened baby syndrome is a term used

to define a clinical Condition in young children
who have received repetitive physical injuries
as a result of non accident violence, produced
by a parent or guardian.
 Features
• Age- Usually less than 3yers old, though it-may
occur at any age,
• Sex- slightly more in males.
• Position in family-commonly the eldest or the
youngest and often unwanted, such as the result
of pregnancy before marriage, failure of
contraception or a illegitimate child.
• Socio-economical factors--Lower social class and
lower education.
 Cont
• History –
There is obvious difference between the nature of
the injuries and the explanation given by the
parents, which may change an several time of
repetition, each time the child is taken to a different
doctor.
• Treatment- There is always delay between the injury
and medical attention.
• Precipitating factors: Violence is precipitate by
actions of the child itself e.g: Crying, refusal to be
quiet, persistent soiling of napkins etc.
 Injuries:
• Surface injuries-
Skin bruising is the most common injuries.
In small infant-
- bruise in lower legs indicate that the child has
been held by the leg or ankle.
- multiple bruise are seen on cheeks, mouth and
neck,
- either side of the chest, behind the axilla and
down the anterior chest wall.
 Cont
• Laceration - Found in the mucosa inside the
upper lip.
• The frenulum may be torn.
• Bite marks-Found on cheeks, shoulder, chest,
abdomen, arm, buttocks, legs.
 Cont
Eye :
• Retinal separation.
• Lens displacement
• Retinal hemorrhage.
• Sub-conjunctival hemorrhage.
• Vitreous hemorrhage.
Burns- Small circular, pitted burns may indicate
stubbing of cigarette ends upon skin.
 Cont
• Visceral injuries:
-subdural hemorrhage -40% fatal cases.
-bursting injuries of the liver or spleen or
perforation of distended hollow viscera including
the stomach, intestine or urinary bladder(crushing
and compressing force applied to the abdomen).
-the 2nd part of the duodenum and jejunum may be
completely transected.
-torn mesentery and disruption of small intestine .
 Cont.
• Skeletal injuries
-Fracture of the skull- These are common in fatal child
abuse often associated with intracranial hemorrhage.
Usually subdural hemorrhage.
-Avulsion of the metaphysis or chipping of the edges of
the metaphyssis /epiphyses may occur.

 
 Cont
-Fracture of rib in mid axillary line due to antero-
posterior compression of the chest.
-Fracture at the costochondral junction -violent
squeezing at the chest from side to side,
-Rib facture along the posterior angles also
occur.
-After 1-2 wks callus is formed and on x-ray a
string of beads appearance is seen in the Para
vertebral gutter. (Nobbing fracture)
 Diagnosis of battered baby
syndrome

Diagnosis depends upon -

• Nature of injuries.
• Time taken to seek medical advice.
• Recurrent injuries