Consistent Investigation and Reporting of Sudden Unexplained Infant Death

1. Consistent Investigation and Reporting of Sudden Unexplained Infant Death SOUTH CAROLINA INITIATIVE David Belk, Lieutenant, SLED Cynthia Schandl, MD, PhD, Forensic Pathologist, MUSC Bert von Herrmann, 15th Circuit 1st Asst Solicitor Rae Wooten, RN, Charleston County Coroner’s Office

2. SUID = Sudden Unexplained Infant Death • Definition: The sudden and unexpected death of an infant due to natural or unnatural causes. • CDC text: Sudden, Unexplained Infant Death Investigation, www.cdc.gov (CDC = Center for Disease Control)

3. SIDS • Definition: “Sudden death of an infant under one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.” • Pediatr Pathol 1991;11(5):677-684.

4. State Observations • Sudden Infant Death Syndrome (SIDS) cases may be over-reported • Infant death cases may be under-investigated

5. Current Status • Investigation protocols inconsistent from county to county • Reporting protocols inconsistent from county to county • Insufficient information provided to pathologist • Duplication of efforts • Lack of uniformity in death certification • Ineffective prosecution of infant homicide cases

6. An Ideal Situation • Uniformity of investigation • All investigative information is available to those who need it in a timely manner • Uniformity of reporting • All agencies can accurately report results • Uniformity in classification • Public health issues identified early • Accurate and early identification of criminal cases • Enhancement of successful prosecutions of criminal cases

7. CDCs SUIDI Program • Sudden Unexplained Infant Death Investigation Reporting Form • Interviews and Research • The Scene • Pathologist

9. Interview • The Interview • Introduce yourself and your purpose • Obtain demographic information of infant and caregiver(s) • Ask open ended questions • “What happened” – include previous 72 hours • Determine person who placed infant and person who found infant • Determine infants’ position when placed, last seen alive, and found • Use a checklist to be thorough

10. Research • Child protective services • Medical and birth history • Recent events

11. Scene Investigation • May provide vital information for the pathologist prior to his/her examination • Information regarding the sleeping and living conditions will remain only BRIEFLY once the infant is removed • Death certification CANNOT be accurate without adequate scene investigation

12. Doll Re-enactment and Photographic Documentation • How infant is PLACED – by placer • How infant is FOUND – by finder • How infant was LAST SEEN ALIVE • Photography: as if it is a CRIME SCENE • Overall sleep situation • Intermediate view • Close-up of body/doll position

13. PLACED POSITION FOUND POSITION

15. Pathologist • Case demographics and history • Scene information and photography • Doll re-enactment • Position placed, last seen alive, and found • Any suspicions after initial investigation • Investigator availability

16. The “Top 25” • National forensic pathologist survey has resulted in a list of data required prior to autopsy • These are divided into FIVE groups • Sleeping environment • Infant history • Family information • Exam • Investigator insight

17. Sleeping Environment • Asphyxia • Evidence of overlying, wedging, choking, nose/mouth obstruction, rebreathing, neck compression, immersion in water, etc • Sharing sleep surfaces • Changing sleep condition • Hypo/hyperthermia • Environmental hazards • Unsafe sleeping conditions

18. Infant History • Diet • Recent hospitalization • Previous medical diagnoses • History of acute life-threatening events • History of medical care without diagnosis • Recent fall or other injury • History of religious, cultural or ethnic remedies • Cause of death due to natural causes other than SIDS

19. Family Information • Prior sibling deaths • Previous encounters with police and/or social service agencies • Request for tissue or organ donation • Objection to autopsy

20. Exam • Pre-terminal resuscitative treatment • Death due to trauma, poisoning or intoxication

21. Investigator Insight • Suspicious circumstances • Other alerts for pathologist’s attention

22. Prosecution • In-depth interviews with written notes • Photographs of the scene and autopsy • Accurate death certification • Complete research of medical history

23. One way to convey scene information • www.mdilog.net

25. Conclusion • Interview • Scene Investigation and Re-enactment • Information Dissemination WITH KNOWLEDGE, TEAM WORK AND COMMITMENT, WE CAN MAKE A DIFFERENCE!!!