Sudden Infant Death Syndrome: an infantile death-bed misadventure

Abstract

A case of Sudden Infant Death Syndrome, aka cot-death is reported. The significance of Sudden Infant Death Syndrome in Zambia is highlighted. The objective is to shine the spotlight on a preventable cause of death in Africa, and the research work and public health campaigns to reduce infant mortality. Sudden Infant Death Syndrome has been defined as an unexpected death of an infant under twelve months old whilst asleep and which remains unexplained after reviewing the clinical history, performing an adequate thanatopsy investigation and examining the scene of death. The aetiopathogenesis is yet to be determined and the cause of death remains elusive. The clinical features are non-specific, and typically an asymptomatic healthy baby is found dead whilst asleep. The diagnosis is reached by excluding any other cause of death. This may pose a diagnostic challenge when there is a concomitant disease which might be a coincidental finding but not the cause of death.

In the case reported, a thanatopsy examination followed up by ancillary investigations assisted in determining the cause of death. A suspicion of suffocation by maternal overlaying may not be substantiated without distinguishing signs of trauma. A concealed infanticide may be overlooked and misdiagnosed as a cot-death. There is no legal definition of a cause of death, and it is at best an informed clinical opinion, not a medical fact. It is important to be accurate and interpret the subtle findings carefully. It may be ethically wise to err on the side of caution and not risk a miscarriage of justice. Since Sudden Infant Death Syndrome is due to a natural cause for registration purpose, there were no judicial proceedings. The bereaved family were consoled and the essentials of the cause of death were sensitively explained to bring about a satisfactory outcome.

There has been an assortment of hypothetical causes of Sudden Infant Death Syndrome ranging from the sublime to the ridiculous, published in the medical literature but lacking any conclusive evidence. The outstanding risk factors have been identified as prone sleeping position and sharing maternal bed. The public health campaigns in the Western world have reinforced the supine safe-sleeping position for infants and significantly lessened the incidence of infant deaths. The research studies on the incidence and prevalence, and risk factors of Sudden Infant Death Syndrome in Africa have been minimal. They are a prerequisite for the development and implementation of a standardized thanatopsy protocol for investigating deaths in infancy. An international thanatopsy guideline has been developed but its non-African orientation may overwhelm under-resourced African nations. A public health campaign in Africa has to compete with the challenges of cultural rituals and traditions of infant sleeping position and maternal bed-sharing, perpetuated by community elders. Recommendations are made for the provision of accurate data for research work and development of a health awareness programme to reduce the risk factors of Sudden Infant