الفهرس 
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Abstract
t-ra771411114y SUMMARY AND CONCLUSION
SUDDEN INFANT DEATH SYNDROME (SIDS)
This study was carried out on 160 SIDS cases and 85 cases of a known cause for thj er ’deaths. All cases had been
subjected to autopsy in the Sydney Institute of Forensic Medicine (Australia).
A standardized necropsy protocol designed to provide a standardized procedure for postmortem examination and
collection of tissues for later microscopic examination were followed.
A comparison of detailed histopathological observation between SIDS and non-SIDS cases was done. The most important histologic lesions worth to be mentioned are :
Inflammation of the Upper Respiratory Tract
Some degree of inflammation of the mucosa of the larynx and/or trachea is expected in approximately one-third of SIDS
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cases, which is close to what was found in this study. There was inflammation of the larynx in 28.8% of the 160 examined SIDS cases. Also, it was found in 37.6% of the 85 cases with explained deaths. Prevalence of tracheitis was 30.6% in SIDS
cases and 60% of non-SIDS cases which was statistically significant.
The fact that a greater percentage of control infants had upper airway inflammation than did SIDS infants is consistent with the fact that many of explained deaths were due to
respiratory infection, i.e. pneumonia, bronchitis and bronchiolitis.
Pulmonary Congestion
Pulmonary congestion is often mentioned as one of the classic findings in a SIDS autopsy and there is a satisfactory statistically significant difference between SIDS cases and non-SIDS cases. However, these results can not be considered to have practical discriminatory value since pulmonary congestion was noted to be present in 70% of SIDS infants but also, in 54.1% of explained deaths.
Pulmonary Oedema
Pulmonary oedema has also been mentioned as a
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Sfornmaty.
characteristic feature of typical SIDS autopsy. It was present in 68.8% of the SIDS autopsies, but, also, in 52.9% of
explained deaths. Some difference is apparent but it is not
marked.
Liver
Extramedullary Haematopoiesis
It is apparent that in about one fourth of the SIDS cases, some degree of hematopoiesis was evident in microscopic sections of the liver. In fact, it was present significantly more frequent than in explained deaths (36.3% of SIDS cases versus 9.4% of explained deaths). This observation confirms the earlier research finding on the subject.
Fatty Change
Fatty change in the liver was much more prevalent among explained deaths 16.5% than among SIDS 6.3%. This is to be expected since many of explained death infants were ill and probably had not been eating normally for days. That was not the case for most of SIDS infants.
Adrenal
In this particular instance, it is not the amount of periadrenal brown fat but simply its presence or absence that is
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Ye at a
being reported. Since the ages in both the SIDS cases and explained deaths range from 2 weeks up to 2 years and since the percent of the brown fat in the periadrenal adipose pad normally drops from about 95 in the first month of life to approximately 50 at eight months, it is not surprising that in
two these mixed groups (that vary in regard to age and mechanism of death), the percentage seen in the two groups are not different from each other.
The morphometric histologic studies which in the past, demonstrated differences in the percent of brown fat in this anatomical location-between SIDS cases and controls- were performed by means of painstaking microscopical morphometry and by comparing infants within strictly limited age categories. These data represented here are of a totally different character.
Thymus
Thymic petechiae were seen microscopically in 48.7% of SIDS cases and in 18.8% of non-SIDS cases. They were noted in the gross autopsies in 53.2% of SIDS cases and in 21% of explained deaths. In some cases petechiae were noted in the gross autopsy but were not seen microscopically and vice versa.
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t_9911.47147149,
Because thymic petechiae have long been considered one of the ”hallmarks” of the typical SIDS autopsy, it is of interest to know how frequently they had been documented either
grossly (at autopsy, or microscopically .They were observed in 68.9% of SIDS cases and in 36.5% of non-SIDS cases. It is
apparent, then that they are not specific nor diagnostic for SIDS cases since they are expected to be absent in about one third of SIDS cases.
Lung
Haemorrhages
Macroscopically, the incidence of pleural petechiae was significantly higher in SIDS (51.9%) than in non-SIDS cases (16.5%).
Microscopically, there were, in fact, significantly more haemorrhages in pleura, alveoli and septa in SIDS infants than in explained deaths. The percentages are all listed in table (7).
Macrophages in Alveoli
There were no more macrophages in alveoli among SIDS (6.9%) cases than they were among the explained deaths5.9%.
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L.9:14,Mettay
Heart
Epi- and/or myocardial petechiae in or on the heart, observed either grossly or microscopically, were documented in 49.4% of SIDS cases and in 29.4% of the explained deaths. Only about 1.3% of the petechiae in the heart were noted
during the review of microscopic slides, the vast majority were noted on gross examination.
For the purposes of discussion, however, it should be pointed out that many of microscopic findings seen in both SIDS infants and explained deaths represent normal histologic morphology of infant of this age, rather than abnormalities.
Besides a complete and thorough postmortem examination,
the diagnosis of SIDS depends on a careful death scene investigation and case history of the child’s health since birth in determining the cause and mode of death. The morphological findings above may not clearly distinguish them from SIDS cases.
Summary of Positive Morphologic Findings
The statistically significant positive morphologic findings in SIDS infants in this study are :
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‘.9eminaty
1.Thymic petechiae, grossly and microscopically.
2.Pleural petechiae, grossly and microscopically.
3.Alveolar and septal haemorrhages microscopically.
4.Lung congestion and oedema microscopically.
5.Epi- and myocardial petechiae grossly.
6.Extramedullary haematopoiesis in the liver microscopically.
Interpretation of the results of this study revealed that all these positive pathological findings have no definite relation to the cause of death in SIDS cases and so SIDS has to be considered as a separate cause of death in infant up till now. The diagnosis of SIDS is reached by exclusion of explainable deaths from sudden unexpected deaths.
In developed countries, sudden infant death syndrome has become the most common cause of death in the immediate postneonatal period. Because of its importance, a special categories (Code 798.0) was created in the Ninth International Classification of diseases (ICD) in 1977. For last few months I have been to several death registration offices in Gharbia, Kaliobia and Cairo Governorates. No case has been reported as died from SIDS.
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4-9QCMI/lItaty
On the light of this, we recommend the following :
1.Medical legislation of Sudden Infant Death Syndrome (SIDS) as a definite disease entity.
2.Legislation of performing a thorough postmortem examination, with careful death scene investigations and case history of child’s health since birth, for any case of sudden infant death.
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STILLBIRTH
The study was carried out on 56 cases of stillbirth according to the detected clinical causes of death.
The most common cause that attributed for stillbirth was maternal disease (26.78%) where toxaemia of pregnancy
mounted to 44.80% of the cases.
The second maternal cause was diabetes mellitus in the whole sample was 25%. The foetuses were macerated.
Maternal bleeding, peptic ulcer, chronic nephritis were equally presented in the sample amounting to 6.66% of maternal causes.
Rheumatic heart disease was met with in 2 cases. These
were concomitant diseases that had no bearing on the stillbirth cases as other precipitating factors were present.
Two mothers had anaemia representing 12.3% of maternal causes.
In case of maternal chronic glomerulonephritis, the foetus died in utero and it was extensively macerated while the placenta showed extensive areas of infarction.
The second common cause of stillbirth in this study was antepartum haemorrhage. These included cases of placenta
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previa (57.14%) and cases of accidental haemorrhage (42.86%). The leading causes in such cases were anoxia due to placental separation and prematurity.
Birth trauma accounted for 17.86% of stillbirths cases including cases of intracranial haemorrhage. Out of these 70%
died from anoxia.
The next common cause was cord accidents. Cord prolapse accounted for 10.17% where two thirds of the cases were present in cases of vertex presentation. All mothers were multiparae. Only one case showed excessive torsion where the umbilical cord was twisted along its length and its thickness from part to part.
Congenital defects were detected in 10.71% of the stillbirth cases. Anencephaly was detected in 4 cases one of them was associated with spina bifida. Hydrocephaly, achondroplasia, cyclops deformity, each anomaly was detected in one case.
The least common cause of stillbirth in this series was premature labour without an apparent cause.
Most of the cases of stillbirth belonging to illiterate, low social classes. So, if we raise the level of education and
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improve the health condition of these people we can lower the incidence of stillbirth.
Antenatal care of utmost importance as this helps to detect any complications as early as possible and avoid any danger to the foetus.
Health education as regard diet, hygiene, spacing of pregnancy is essential. So, it is important to improve the antenatal care of clinics attached to the rural health units.
The prevention of congenital defects is still a subject of academic rather than practical interest. So, help may be offered by protection of the mothers from certain illness and perhaps by improving diet during pregnancy.
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