Forensic Medicine
Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS)

‘Sudden Infant Death Syndrome’ or ‘cot deaths’ or ‘crib deaths’ are the sudden, unexplainable deaths of healthy babies. Even after thorough autopsy, toxicological analysis and investigation the death remains unexplained. In fact the death rate is 2 to 3 per 1000 live births. A lot of research has been carried out for the same but the reasons are still unknown.

It is also called crib death because the death is usually associated with sleep and often occurs when the baby is sleeping in the crib. Death is silent in this case and the most common cause of SIDS is asphyxia.

SIDS usually occur in infants of age between 2 weeks to 2 years with a peak around 2 to 4 months. It strikes the male infant more often than the female child. Premature infants are at higher risks of SIDS. The risk increases to threefolds in the twins as they are usually premature with low birth weight. 

About half of the victims have the symptoms of cold prior to death and some have a history of bowel upset.

Researchers have found that the babies with SIDS have low levels of butyrylcholinesterase (BChE) enzymes. BChE is responsible for sending signals to wake up. Turn his/her head and gasp for breath. It is a part of the autonomic system and control functions like breathing and blood pressure.

Causes of Sudden Infant Death Syndrome

Although the death in SIDS is unexplained, but there may be some possible causes which are as follows:

  • Viral infections
  • Respiratory infections or diseases
  • Milk allergy
  • Auto Beverage syndrome, i.e., conversion of milk into alcohol due to enzymatic activity of stomach, which causes alcohol poisoning
  • Sleeping on the stomach
  • Mothers who smoke or consume alcohol and drugs
  • Bad financial conditions of the family
  • Being born to a teenage mother
  • Lack of prenatal or late care
  • Shaken infant syndrome i.e., violent shaking as apart of playing with the kid which causes intracranial hemorrhages
  • Sleep apnea or overlying by the mother while breastfeeding the infant

Signs & Symptoms of SIDS

There are no specific signs and symptoms of SIDS, neither any treatment nor the diagnosis is easily possible except in cases of certain viral infections or diseases. 

The autopsy report of the infant shows the following changes:

  • Petechial hemorrhages on the visceral surface of pleura, pericardium and thymus
  • Blood stained fluid at the mouth and nose
  • Small amount of milk in the trachea and main bronchi
  • Shedding of individual tracheobronchial epithelial cells
  • Froth in the air passage and facial pallor
  • Microscopic traces of respiratory inflammation
  • Patchy or uniform purplish discoloration on the surface of the lungs
  • Lungs are firm in consistency with congestion, show oedema, alveolar collapse and increase in weight
  • Alveolar walls are thickened and are infiltrated with lymphocytes and sometimes with neutrophils and monocytes
  • Evidences of a brief burst of spasmodic motor activity
  • Bladder and bowels are empty
  • Sometimes blanket fibers are found in fingernails

Medicolegaly, SIDS can be considered as an act of negligence and infanticide. Thorough examination can aid to prove it a criminal act and the culprit would be charged with offence of infanticide

SIDS is a high risk to the infants, yet its diagnosis and treatment is not possible. Therefore continuous  interdisciplinary efforts are required for its resolution.

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