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Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

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Abstract

Background

A comprehensive child death review (CDR) program was introduced in England and Wales in 2008, but as yet data have only been analyzed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for sudden unexpected death in infancy (SUDI) as determined by the new CDR program.

Methods

This was a descriptive outcome study using data from child death overview panel Form C for SUDI cases dying during 2010–2012 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia.

Results

Data were obtained for 65/70 (93 %) SUDI cases. 20/65 (31 %) deaths were initially categorized as due to medical causes; 21/65 (32 %) as SIDS; and 24/65 (37 %) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as “undetermined” had significantly higher total family and environmental risk factor scores (mean 2.6, 95 % CI 2.0–3.3) compared to those classified as SIDS (mean 1.6, 95 % CI 1.2–1.9), or medical causes for death (mean 1.1, 95 % CI 0.8–1.3). 9/20 (47 %) of medical deaths, 19/21 (90 %) SIDS, and 23/24 (96 %) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25 %) of medically explained deaths.

Conclusions

The CDR program results in detailed information about risk factors for SUDI cases but failed to recognize deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as “undetermined deaths” is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future.

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Abbreviations

CDOP:

Child death overview panel

CDR:

Child death review

SIDS:

Sudden infant death syndrome

SUDI:

Sudden unexpected death in infancy

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Acknowledgments

The authors would like to thank the Department of Perinatal Pathology at Birmingham Women’s Hospital and the Department of Pathology and Birmingham Children’s Hospital for their help with finding SUDI cases and all the CDOPs in the West Midlands for providing Form Cs for SUDI cases.

Funding

This study forms part of JG’s doctoral thesis and was funded by a National Institute of Health Research (Doctoral Research Fellowship) (DRF—2010-03-045). The funder had no involvement in the study design, data collection, analysis or interpretation of the data, or in the decision to submit the paper for publication. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.

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Correspondence to Joanna Garstang.

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Conflict of interest

JG had financial support from NIHR for the submitted work; all authors had no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities could appear to have influenced the submitted work.

Ethical approval

This study was approved by the University of Warwick Biomedical and Scientific Research Committee, Reference Number 245-10-2012.

Authors contributions

The study was designed by JG, FG, and PS. JG collected all data, conducted the analyses, and wrote the initial report. CE and JG reanalyzed Form Cs. FG and PS advised on study progress and data analysis. All authors commented on and approved the final version of the manuscript, have a copy of the manuscript, and share responsibility for the results.

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Data may be available on request from the first author.

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Garstang, J., Ellis, C., Griffiths, F. et al. Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy. Forensic Sci Med Pathol 12, 407–415 (2016). https://doi.org/10.1007/s12024-016-9802-0

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