Breakfast Symposium of October 8th, 2008

FULL Panel Discussion: Certifying Sudden Unexpected Infant Deaths

Melissa Pasquale-Styles, MD, City Medical Examiner in Brooklyn, provided a detailed overview of the medico legal death scene investigations of infant deaths in NYC. When an infant is unresponsive, usually the caregivers call 911. First responders rush the baby to the nearest emergency room and there, if attempts at resuscitation fail, a doctor pronounces the infant dead. The medico legal investigator (MLI), who is a physician assisant, is then summoned to talk with the caregivers. He or she examines the infant for external evidence of injury or illness and records his or her observations.

Shortly thereafter, the investigation moves to the location where the infant died. Dr. Pasquale stressed the importance of the police response to the quality of the investigation, since part of the police’s role is to preserve the scene for analysis. The scene investigation follows a detailed set of rules in which the MLI thoroughly interviews the parents/caregivers and other witnesses, using a ten page form. The inquiry includes questions about how the caregiver put down the infant for sleep and how the unresponsive baby was found. The MLI asks the parents or caregivers to conduct a scene reenactment using a doll provided for this purpose. The caregiver then reenacts the exact position of the infant when put down to sleep, and when finding the infant unresponsive. It provides information about unsafe sleep environments including an adult bed, bedsharing, unsafe cribs, soft bedding, and prone sleep position. Without this critical investigation, the medical examiner would not know enough about the circumstances to determine the cause of death.

The medical examiner usually completes the autopsy within 24 hours. Blood and tissue samples are sent for analysis, and toxicology ordered. The medical examiner conducts a thorough review of the infant’s medical history, as well as a review of the prenatal history, if that is available. This comprehensive process and the certification of the cause of death take about 3-4 months.

Monica Smiddy, MD, City Medical Examiner in the Bronx discussed a variety of changes in SIDS that she has observed over the past 15 years, including, advances in technology are making it possible for very premature infants to survive and be discharged from the hospital; an increase in fatalities in premature infants post-discharge; many families are under greater economic stress; maternal risk factors, such as obesity and diabetes have increased; soft bedding intended for adult beds is increasingly being used in babies’ cribs/bassinets, which increases risk. On the other hand, the quality of scene investigations has improved; there is better funding for research and educational programs; the cause and manner of death are more accurately determined; there are more programs supporting the community; and infant death certification continues to evolve, reflecting better education and greater knowledge and experience. Dr. Smiddy also stressed the importance of collaboration with other organizations and the need for public health initiatives to support safe sleep outreach work.


45 Minute 20.5 MB Audio File