Display options
Cite
Pasquale-Styles MA, Regensburg M, Bao R. Sudden Unexpected Infant Death Certification in New York City: Intra-Agency Guideline Compliance and Variables that May Influence Death Certification. Acad Forensic Pathol. 2017;7(4):536-550doi: 10.23907/2017.046.
Pasquale-Styles, M. A., Regensburg, M., & Bao, R. (2017). Sudden Unexpected Infant Death Certification in New York City: Intra-Agency Guideline Compliance and Variables that May Influence Death Certification. Academic forensic pathology, 7(4), 536-550. https://doi.org/10.23907/2017.046
Pasquale-Styles, Melissa A, et al. "Sudden Unexpected Infant Death Certification in New York City: Intra-Agency Guideline Compliance and Variables that May Influence Death Certification." Academic forensic pathology vol. 7,4 (2017): 536-550. doi: https://doi.org/10.23907/2017.046
Pasquale-Styles MA, Regensburg M, Bao R. Sudden Unexpected Infant Death Certification in New York City: Intra-Agency Guideline Compliance and Variables that May Influence Death Certification. Acad Forensic Pathol. 2017 Dec;7(4):536-550. doi: 10.23907/2017.046. Epub 2017 Dec 01. PMID: 31240005; PMCID: PMC6474437.
Copy Download .nbib Format: NLM
Share it on

Acad Forensic Pathol. 2017 Dec;7(4):536-550. doi: 10.23907/2017.046. Epub 2017 Dec 01.

Sudden Unexpected Infant Death Certification in New York City: Intra-Agency Guideline Compliance and Variables that May Influence Death Certification.

Academic forensic pathology

Melissa A Pasquale-Styles, Margaret Regensburg, Ruijun Bao

Affiliations

  1. New York City Office of Chief Medical Examiner.

PMID: 31240005 PMCID: PMC6474437 DOI: 10.23907/2017.046

Abstract

INTRODUCTION: Differences in certification of similar sudden infant deaths exists among forensic pathologists. This study sought to measure adherence to intra-agency guidelines for infant death certification in one jurisdiction and describe variables that may be associated with the differentiation of sudden infant death syndrome (SIDS), asphyxia, and undetermined death certifications.

METHODS: A retrospective study of deaths at the New York City Office of Chief Medical Examiner identified 427 sudden infant deaths with investigation and autopsy whose cause of death was ruled SIDS, asphyxia, or undetermined. Cases were reviewed for number and types of risk factors for asphyxia, demonstrable evidence of asphyxia, potential competing causes of death, and a doll reenactment. Descriptive and statistical analysis was performed.

RESULTS: Of 427 deaths, the causes of 100 deaths (23.4%) were ruled asphyxia; 43 (10.0%) SIDS; and 284 (66.5%) undetermined. Forensic pathologists conformed to agency guidelines in 406 deaths (95.1%). Three or more risk factors for asphyxia were found in 328 deaths (76.8%). Demonstrable evidence of asphyxia (40.7%) was most associated with a certification of asphyxia. A potential competing cause of death (20%) was most associated with undetermined. A doll reenactment had little association with certification type.

DISCUSSION: Guidelines in one agency were effective at limiting incorrect SIDS diagnoses. The interpretation of risk factors can be subjective. Diagnostic overlap occurred in deaths certified differently as SIDS, asphyxia, and undetermined, despite similar findings. Elimination of SIDS as a certification option and better guidelines that help differentiate asphyxia and undetermined deaths are recommended for improved infant death certification.

Keywords: Forensic pathology; Infant death certification; Infant death investigation; SIDS; Sudden infant death; Unsafe sleep asphyxia

Conflict of interest statement

DISCLOSURES & DECLARATION OF CONFLICTS OF INTEREST This work was presented at the 2017 NAME Annual Meeting. The authors, reviewers, editors, and publication staff do not report any relevant conflicts

References

  1. Pediatrics. 2000 Sep;106(3):E41 - PubMed
  2. Am J Forensic Med Pathol. 2000 Dec;21(4):311-4 - PubMed
  3. J Neuropathol Exp Neurol. 2001 Mar;60(3):228-47 - PubMed
  4. Pediatrics. 1992 Jun;89(6 Pt 1):1120-6 - PubMed
  5. Pediatrics. 2004 Jul;114(1):234-8 - PubMed
  6. JAMA. 1992 May 6;267(17):2359-62 - PubMed
  7. J Forensic Sci. 2005 Jan;50(1):147-51 - PubMed
  8. Pediatrics. 2005 Nov;116(5):1245-55 - PubMed
  9. Am J Epidemiol. 2006 Apr 15;163(8):762-9 - PubMed
  10. Pediatr Pathol. 1991 Sep-Oct;11(5):677-84 - PubMed
  11. J Forensic Sci. 2007 Jul;52(4):924-9 - PubMed
  12. Immunopharmacol Immunotoxicol. 2009;31(4):516-23 - PubMed
  13. Pediatrics. 2012 Apr;129(4):630-8 - PubMed
  14. Pediatrics. 2014 Jul;134(1):e240-1 - PubMed
  15. Pediatrics. 2014 Jul;134(1):e210-9 - PubMed
  16. Pediatrics. 2014 Aug;134(2):e406-12 - PubMed
  17. Forensic Sci Med Pathol. 2015 Jun;11(2):283-8 - PubMed
  18. Pediatrics. 2016 Jan;137(1):null - PubMed
  19. Forensic Sci Med Pathol. 2016 Dec;12(4):407-415 - PubMed
  20. J Neuropathol Exp Neurol. 2016 Oct;75(10):981-997 - PubMed
  21. Pediatrics. 2016 Nov;138(5): - PubMed
  22. Pediatrics. 2017 Jul;140(1): - PubMed
  23. Pediatr Ann. 1995 Jul;24(7):358-64 - PubMed
  24. Arch Dis Child. 1994 May;70(5):445-9 - PubMed
  25. Biol Neonate. 1994;65(3-4):194-7 - PubMed
  26. J Pediatr. 1993 Jun;122(6):874-80 - PubMed

Publication Types