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Autopsy findings of co‐sleeping‐associated sudden unexpected deaths in infancy: Relationship between pathological features and asphyxial mode of death
Author(s) -
Weber Martin A,
Risdon R Anthony,
Ashworth Michael T,
Malone Marian,
Sebire Neil J
Publication year - 2012
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2011.02228.x
Subject(s) - medicine , autopsy , pediatrics , pathological , sudden infant death syndrome , cause of death , infant mortality , sudden death , population , disease , environmental health
Aim: Co‐sleeping is associated with increased risk of sudden unexpected death in infancy (SUDI)/sudden infant death syndrome (SIDS). The aim of this study is to examine autopsy findings from a single UK specialist centre to determine the relationship between co‐sleeping and cause of death. Methods: Retrospective analysis of >1500 paediatric autopsies carried out by paediatric pathologists over a 10‐year period. SUDI was defined as sudden unexpected death of an infant aged 7–365 days; deaths were categorised into explained SUDI (cause of death was determined) and unexplained SUDI (equivalent to SIDS). Results: There were 546 SUDI; sleeping arrangements were specifically recorded in 314; of these, 174 (55%) were co‐sleeping‐associated deaths. Almost two thirds (59%) of unexplained SUDI were co‐sleeping compared to 44% explained SUDI (95% confidence interval (CI) 1.0–27.2%, P = 0.03); however, this difference remained statistically significant only for the first 5 months of life (95% CI 3.5–33.2%, P = 0.01). In unexplained SUDI aged < 6 months, there were no significant differences between co‐sleeping and non‐co‐sleeping deaths with respect to ante‐mortem symptoms, intrathoracic petechiae, macroscopic lung appearances, pulmonary haemosiderin‐laden macrophages, and isolation of specific bacterial pathogens; however, fresh intra‐alveolar haemorrhage was reported more commonly in co‐sleeping (54%) than in those that were not (38%; 95% CI 1.4–30.5%, P = 0.03). Conclusions: Co‐sleeping is associated with unexplained SUDI/SIDS in infants aged < 6 months, suggesting that co‐sleeping is related to the pathogenesis of death in younger infants. The finding that intra‐alveolar haemorrhage is more common in co‐sleeping suggests that a minority of co‐sleeping‐associated deaths may be related to an asphyxial process.