Forensic Science, Medicine, and Pathology

, Volume 9, Issue 2, pp 225–230 | Cite as

Sudden twin infant death on the same day: a case report and review of the literature

  • Ping Huang
  • Rongjun Yu
  • Shiying Li
  • Zhiqiang Qin
  • Ningguo Liu
  • Jianhua Zhang
  • Donghua Zou
  • Yijiu ChenEmail author
Case Report


Sudden infant death syndrome (SIDS) is a major contributor to infant mortality. The cause of death is unknown: suggested possibilities include cardiovascular disease, anaphylactic shock, and suffocation. The occurrence of simultaneous sudden infant death syndrome is uncommon, such cases being extremely rare in forensic pathologic practice. We report two 10-week-old male twins who appeared well at the time of their evening feeding, yet died while sleeping on their backs. Both infants had petechial hemorrhages on the visceral pleura, epicardial surface of the heart, and thymus gland. Microscopic examination revealed pulmonary edema, intra-alveolar hemorrhage, and minor lymphocytic infiltration, again in both infants. In this report, we discuss the risk factors for SIDS, which should be considered individually or in combination as possible causes of death.


Autopsy Forensic pathology Petechial hemorrhage Risk factors Simultaneous sudden infant death syndrome 


  1. 1.
    Bajanowski T, Vege A, Byard RW, Krous HF, Arnestad M, Bachs L, et al. Sudden infant death syndrome (SIDS)-standardised investigations and classification: recommendations. Forensic Sci Int. 2007;165(2–3):129–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Li L, Fowler D, Liu L, Ripple MG, Lambros Z, Smialek JE. Investigation of sudden infant deaths in the State of Maryland (1990–2000). Forensic Sci Int. 2005;148(2–3):85–92.PubMedCrossRefGoogle Scholar
  3. 3.
    Tursan d’Espaignet E, Bulsara M, Wolfenden L, Byard RW, Stanley FJ. Trends in sudden infant death syndrome in Australia from 1980 to 2002. Forensic Sci Med Pathol. 2008;4(2):83–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Wedekind H, Bajanowski T, Friederich P, Breithardt G, Wulfing T, Siebrands C, et al. Sudden infant death syndrome and long QT syndrome: an epidemiological and genetic study. Int J Legal Med. 2006;120(3):129–37.PubMedCrossRefGoogle Scholar
  5. 5.
    Kinney HC, Thach BT. The sudden infant death syndrome. New Eng J Med. 2009;361(8):795–805.PubMedCrossRefGoogle Scholar
  6. 6.
    Getahun D, Demissie K, Lu SE, Rhoads GG. Sudden infant death syndrome among twin births: United States, 1995–1998. J Perinatology. 2004;24(9):544–51.CrossRefGoogle Scholar
  7. 7.
    Malloy MH. Sudden infant death syndrome among extremely preterm infants: United States 1997–1999. J Perinatology. 2004;24(3):181–7.CrossRefGoogle Scholar
  8. 8.
    Malloy MH, Freeman DH Jr. Sudden infant death syndrome among twins. Arch Ped & Adolescent Med. 1999;153(7):736–40.Google Scholar
  9. 9.
    Ladham S, Koehler SA, Shakir A, Wecht CH. Simultaneous sudden infant death syndrome: a case report. Am J Forensic Med Pathol. 2001;22(1):33–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Balci Y, Tok M, Kocaturk BK, Yenilmez C, Yirulmaz C. Simultaneous sudden infant death syndrome. J Forensic Leg Med. 2007;14(2):87–91.PubMedCrossRefGoogle Scholar
  11. 11.
    Mitchell EA, Elder DE, Zuccollo J. Simultaneous sudden unexpected death in infancy of twins: case report. Int J Leg Med. 2010;124(6):631–5.CrossRefGoogle Scholar
  12. 12.
    Saukko PJ, Knight B. Knight’s forensic pathology. London: Arnold; 2004.Google Scholar
  13. 13.
    Koehler SA, Ladham S, Shakir A, Wecht CH. Simultaneous sudden infant death syndrome: a proposed definition and worldwide review of cases. Am J Forensic Med Pathol. 2001;22(1):23–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Smialek JE. Simultaneous sudden infant death syndrome in twins. Pediatrics. 1986;77(6):816–21.PubMedGoogle Scholar
  15. 15.
    Beal S. Sudden infant death syndrome in twins. Pediatrics. 1989;84(6):1038–44.PubMedGoogle Scholar
  16. 16.
    Malloy MH, Hoffman HJ. Prematurity, sudden infant death syndrome, and age of death. Pediatrics. 1995;96(3Pt1):464–71.PubMedGoogle Scholar
  17. 17.
    Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA, et al. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics. 2009;123(4):1162–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Ostfeld BM, Perl H, Esposito L, Hempstead K, Hinnen R, Sandler A, et al. Sleep environment, positional, lifestyle, and demographic characteristics associated with bed sharing in sudden infant death syndrome cases: a population-based study. Pediatrics. 2006;118(5):2051–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ramos V, Hernandez AF, Villanueva E. Simultaneous death of twins. An environmental hazard or SIDS? Am J Forensic Med Pathol. 1997;18(1):75–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Waters KA, Gonzalez A, Jean C, Morielli A, Brouillette RT. Face-straight-down and face-near-straight-down positions in healthy, prone-sleeping infants. J Pediatrics. 1996;128(51):616–25.CrossRefGoogle Scholar
  21. 21.
    Yukawa N, Carter N, Rutty G, Green MA. Intra-alveolar hemorrhage in sudden infant death syndrome: a cause for concern? J Clin Pathol. 1999;52(8):581–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Randall BB, Wadee SA, Sens MA, Kinney HC, Folkerth RD, Odendaal HJ, et al. A practical classification schema incorporating consideration of possible asphyxia in cases of sudden unexpected infant death. Forensic Sci Med Pathol. 2009;5(4):254–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Alm B, Mollborg P, Erdes L, Pettersson R, Aberg N, Norvenius G, et al. SIDS risk factors and factors associated with prone sleeping in Sweden. Arch Disease Childhood. 2006;91(11):915–9.CrossRefGoogle Scholar
  24. 24.
    Mitchell EA, Ford RP, Stewart AW, Taylor BJ, Becroft DM, Thompson JM, et al. Smoking and the sudden infant death syndrome. Pediatrics. 1993;91(5):893–6.PubMedGoogle Scholar
  25. 25.
    Lahr MB, Rosenberg KD, Lapidus JA. Bedsharing and maternal smoking in a population-based survey of new mothers. Pediatrics. 2005;116(4):e530–42.PubMedCrossRefGoogle Scholar
  26. 26.
    Sturner WQ. Some perspectives in ‘cot death’. J Forensic Med. 1971;18(3):96–107.PubMedGoogle Scholar
  27. 27.
    Stanton AN, Scott DJ, Downham MA. Is overheating a factor in some unexpected infant deaths? Lancet. 1980;1(8177):1054–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Bacon C, Scott D, Jones P. Heatstroke in well-wrapped infants. Lancet. 1979;1(8113):422–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Hoffman HJ, Hunter JC, Damus K, Pakter J, Peterson DR, van Belle G, et al. Diphtheria-tetanus-pertussis immunization and sudden infant death: results of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death Syndrome risk factors. Pediatrics. 1987;79(4):598–611.PubMedGoogle Scholar
  30. 30.
    Opdal SH, Rognum TO. Gene variants predisposing to SIDS: current knowledge. Forensic Sci Med Pathol. 2011;7(1):26–36.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ping Huang
    • 1
  • Rongjun Yu
    • 2
  • Shiying Li
    • 3
  • Zhiqiang Qin
    • 1
  • Ningguo Liu
    • 1
  • Jianhua Zhang
    • 1
  • Donghua Zou
    • 1
  • Yijiu Chen
    • 1
    Email author
  1. 1.Department of Forensic Pathology, Institute of Forensic ScienceMinistry of JusticeShanghaiPeople’s Republic of China
  2. 2.Ningbo Public Security BureauNingboPeople’s Republic of China
  3. 3.Department of Forensic Medicine, Shanghai Medical CollegeFudan UniversityShanghaiPeople’s Republic of China

Personalised recommendations