SIDS: Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task Force on Infant Sleep Position and Sudden Infant Death Syndrome.

Pediatrics. 2000 Mar;105(3 Pt 1):650-6.

Pediatrics. 2001 Apr;107(4):809.

Abstract

The American Academy of Pediatrics has recommended since 1992 that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since that time, the frequency of prone sleeping has decreased from >70% to approximately 20% of US infants, and the SIDS rate has decreased by >40%. However, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (eg, maternal smoking), the importance of other hazards, such as soft bedding and covered airways, has been demonstrated only recently. The present statement is intended to review the evidence about prone sleeping and other risk factors and to make recommendations about strategies that may be effective for further reducing the risk of SIDS. This statement is intended to consolidate and supplant previous statements made by this Task Force.
http://www.ncbi.nlm.nih.gov/pubmed/10699127

J Paediatr Child Health. 1994 Apr;30(2):140-3.

Well health care and the sudden infant death syndrome.

Ford RP, Mitchell EA, Taylor BJ.

Community Paediatric Unit, Healthlink South, Christchurch, New Zealand.

Abstract

The aim of this study was to examine whether poor attendance at routine antenatal and postnatal 'well child' health services was associated with a higher risk of sudden infant death syndrome (SIDS, or cot death). A nationwide case-control study of SIDS in New Zealand enrolled 485 postneonatal deaths due to SIDS and 1800 control infants who were selected randomly. The risk for SIDS was found to be higher for infants whose mothers attended their first antenatal check later than 3 months into the pregnancy, made fewer antenatal visits, and did not go to antenatal education classes. However, this increased risk was largely explained by high parity, maternal smoking, the mother not being married, mother being < 20 years old at the birth of her first child, and delivery during the winter months. Infants not attending a 6 week postnatal check had an almost three-fold increased risk of SIDS compared with those who did attend (odds ratio [OR] 2.86; 95% confidence interval [CI] 1.93, 4.24). Similarly, infants not attending well child clinics were at increased risk of SIDS (OR 2.75; 95% CI 2.09, 3.62). These differences persisted when adjusted for likely confounders. This study demonstrates that infants who miss child health nurse clinics are those most at risk for SIDS and are those who warrant increased surveillance.
http://www.ncbi.nlm.nih.gov/pubmed/8198848

SIDS: Antenatal and intrapartum factors associated with sudden infant death syndrome in the New Zealand Cot Death Study.

J Paediatr Child Health. 1995 Oct;31(5):473-8.

Stewart AJ, Williams SM, Mitchell EA, Taylor BJ, Ford RP, Allen EM.

Department of Nursing and Midwifery, Otago Polytechnic, Dunedin, New Zealand.

Abstract

OBJECTIVE: To describe the relationship between antenatal and intrapartum factors and sudden infant death syndrome (SIDS).
METHODOLOGY: The New Zealand Cot Death Study was a 3 year case-control study, with 485 infants who died from SIDS in the postneonatal period and 1800 randomly selected control infants. Data were obtained from obstetric records, parental interview and community nursing records.
RESULTS: This study confirms many of the antenatal and intrapartum risk factors for SIDS noted in studies from both the southern and northern hemispheres. After controlling for potential confounders, such as occupational group and marital status, significant inverse effects were noted for interpregnancy interval, birthweight and gestation. Other factors that retained a significantly increased risk of SIDS were: increasing parity, bacteriological evidence of urinary tract infection (UTI) (adjusted odds ratio 1.73, 95% CI 1.10-2.73); smoking antenatally (AdjOR 2.14, 95% CI 1.61-2.84); less than six antenatal checks attended (AdjOR 1.84, 95% CI 1.19-2.84); second stage of labour less than 16 min (AdjOR 2.06, 95% CI 1.35-3.14) and multiple birth (AdjOR 3.23, 95% CI 1.70-6.02). No interaction was observed between maternal haemoglobin and antenatal smoking. Interactions were tested for and not found between antenatal smoking and three antenatal risk factors (UTI, short second stage of labour and number of antenatal appointments). The only significant interaction between these three factors and three modifiable postnatal risk factors (prone sleeping, bed sharing and bottle feeding) was between bed sharing and fewer antenatal appointments. The risk of SIDS associated with bed sharing was greater among those whose mothers had fewer antenatal appointments.
CONCLUSIONS: Although many of the previously identified antenatal and intrapartum risk factors for SIDS are confirmed, the risks of SIDS associated with obstetric factors are in general considerably lower than the risks associated with the four modifiable postnatal risk factors.
http://www.ncbi.nlm.nih.gov/pubmed/8554873

SIDS: Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study.

Pediatrics. 1997 Nov;100(5):835-40.

Mitchell EA, Tuohy PG, Brunt JM, Thompson JM, Clements MS, Stewart AW, Ford RP, Taylor BJ.

Department of Paediatrics, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVES: To identify the risk factors for sudden infant death syndrome (SIDS) following a national campaign to prevent SIDS.
METHODS: For 2 years (October 1, 1991 through September 30, 1993) data were collected by community child health nurses on all infants born in New Zealand at initial contact and at 2 months.
RESULTS: There were 232 SIDS cases in the postneonatal age group (2.0/1000 live births) and these were compared with 1200 randomly selected control subjects. Information was available for 127 cases (54.7%) and 922 (76.8%) of controls. The previously identified modifiable risk factors were examined. The prevalence of prone sleeping position of the infant was very low (0.7% at initial contact and 3. 0% at 2 months), but was still associated with an increased risk of SIDS. In addition, the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position (at 2 months: adjusted odds ratio (OR) = 6.57; 95% confidence interval (CI) = 1.71, 25.23). Maternal smoking was found to be the major risk factor for SIDS. Bed sharing was also associated with an increased risk of SIDS. There was an interaction between maternal smoking and bed sharing on the risk of SIDS. Compared with infants not exposed to either bed sharing or maternal smoking, the adjusted OR for infants of mothers who smoked was 5.01 (95% CI = 2.01, 12.46) for bed sharing at the initial contact and 5.02 (95% CI = 1.05, 24. 05) for bed sharing at 2 months. In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS. The other risk factors for SIDS identified were: unmarried mother, leaving school at a younger age, young mother, greater number of previous pregnancies, late attendance for antenatal care, smoking in pregnancy, male infant, Maori ethnicity, low birth weight, and shorter gestation.
CONCLUSIONS: After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.
http://www.ncbi.nlm.nih.gov/pubmed/9346984

SIDS: Bedsharing and maternal smoking in a population-based survey of new mothers.

Pediatrics. 2005 Oct;116(4):e530-42.

Lahr MB, Rosenberg KD, Lapidus JA.

Disability Determination Services, Oregon Department of Human Services, Salem, OR 97305-1350, USA. lahr_mdmph@web-ster.com

Abstract

OBJECTIVE: Sudden infant death syndrome (SIDS) remains the number 1 cause of postneonatal infant death. Prone infant sleep position and maternal smoking have been established as risk factors for SIDS mortality. Some studies have found that bedsharing is associated with SIDS, but, to date, there is only strong evidence for a risk among infants of smoking mothers and some evidence of a risk among young infants of nonsmoking mothers. Despite the lack of convincing scientific evidence, bedsharing with nonsmoking mothers remains controversial. In some states, nonsmoking mothers are currently being told that they should not bedshare with their infants, and mothers of infants who died of SIDS are told that they caused the death of their infant because they bedshared. The objective of this study was to explore the relationship between maternal smoking and bedsharing among Oregon mothers to explore whether smoking mothers, in contrast to nonsmoking mothers, are getting the message that they should not bedshare.
METHODS: Oregon Pregnancy Risk Assessment Monitoring System surveys a stratified random sample, drawn from birth certificates, of women after a live birth. Hispanic and non-Hispanic black, non-Hispanic Asian/Pacific Islander and non-Hispanic American Indian/Alaskan Native women, and non-Hispanic white women with low birth weight infants are oversampled to ensure sufficient numbers for stratified analysis. The sample then was weighted to reflect Oregon's population. In 1998-1999, 1867 women completed the survey (73.5% weighted response). The median time from birth to completion of the survey was 4 months. Women were asked whether they shared a bed with their infant "always," "almost always," "sometimes," or "never." Frequent bedsharing was defined as "always" or "almost always"; infrequent was defined as "sometimes" or "never."
RESULTS: Of all new mothers, 35.2% reported bedsharing frequently (always: 20.5%; almost always: 14.7%) and 64.8% infrequently (sometimes: 41.4%; never: 23.4%). Bedsharing among postpartum smoking mothers was 18.8% always, 12.6% almost always, 45.1% sometimes, and 23.6% never; this was not statistically different from among nonsmoking mothers. Results for prenatal smokers were similar. When stratified by race/ethnicity, there was no association between smoking and bedsharing in any racial or ethnic group. In univariable and multivariable logistic regression, there were no statistical differences in frequent or any bedsharing among either prenatal or postpartum smoking mothers compared with nonsmokers; the adjusted odds ratio for postpartum smokers who frequently bedshared was 0.73 (95% confidence interval [CI]: 0.42-1.25) and for any bedsharing was 1.05 (95% CI: 0.57-1.94). Results for prenatal smoking were similar. This is the first US population-based study to look at the prevalence of bedsharing among smoking and nonsmoking mothers. Bedsharing is common in Oregon, with 35.2% of mothers in Oregon reporting frequently bedsharing and an additional 41.4% sometimes bedsharing. There was no significant association between smoking and bedsharing for either prenatal or postpartum smokers among any racial or ethnic group. Smoking mothers were as likely to bedshare as nonsmoking mothers. The frequency of bedsharing in Oregon was similar to estimates from other sources. Our study has the advantage of being a population-based sample drawn from birth certificates, weighted for nonresponse.
CONCLUSIONS: Although a number of case series have raised concerns about the safety of mother-infant bedsharing, even among nonsmoking mothers, this has not yet been confirmed by careful, controlled studies. There have been 9 large-scale case-control studies of the relationship between bedsharing and SIDS. Three case-control studies did not stratify by maternal smoking status, but found no increased risk for SIDS. Six case control studies reported results stratified by maternal smoking status: 1 study, while asserting an association, provided an unexplained range of univariable odds ratios without CIs; 3 found no increased risk for older infants of nonsmoking mothers; and 2 found a risk only for infants <8-11 weeks of age. Despite the preponderance of evidence that bedsharing by nonsmoking mothers does not increase the risk for SIDS among older infants, the recent specter of bedsharing as a cause of SIDS, based on uncontrolled case series and medical examiners' anecdotal experience, has led some medical examiners to label a death "suffocation" or "overlay asphyxiation" simply because the infant was bedsharing at the time of death. This "diagnostic drift" may greatly complicate future studies of the relationship between bedsharing and SIDS. Epidemiologic evidence shows that there is little or no increased risk for SIDS among infants of nonsmoking mothers but increased risk among infants of smoking mothers and younger infants of nonsmoking mothers. It seems prudent to discourage bedsharing among all infants <3 months old. Young infants brought to bed to be breastfed should be returned to a crib when finished. It would be worthwhile for other researchers to reanalyze their previous data to evaluate the consistency of the interaction of young infant age and bedsharing. Large controlled studies that include infants who are identified as dying from SIDS, asphyxia, suffocation, and sudden unexplained infant death, analyzed separately and in combination, are needed to resolve this and other issues involving bedsharing, including the problem of diagnostic drift. Recommendations must be based on solid scientific evidence, which, to date, does not support the rejection of all bedsharing between nonsmoking mothers and their infants. Cribs should be available for those who want to use them. Nonsmoking mothers should not be pressured to abstain from bedsharing with their older infants; they should be provided with accurate, up-to-date scientific information. Infants also should not co-sleep with nonparents. In Oregon, if not elsewhere, the message that smoking mothers should not bedshare is not being disseminated effectively. Because it is not known whether the risk caused by smoking is associated with prenatal smoking, postpartum smoking, or both, bedsharing among either prenatal or postpartum smokers should be strongly discouraged. Much more public and private effort must be made to inform smoking mothers, in culturally competent ways, of the very significant risks of mixing bedsharing and smoking. Public health practitioners need to find new ways to inform mothers and providers that smoking mothers should not bedshare and that putting an infant of a nonsmoking mother to sleep in an adult bed should be delayed until 3 months of age.
http://www.ncbi.nlm.nih.gov/pubmed/16199682

SIDS: The triple risk hypotheses in sudden infant death syndrome.

Pediatrics. 2002 Nov;110(5):e64.

Guntheroth WG, Spiers PS.

Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington 98195-6320, USA. wgg@u.washington.edu

Abstract

Sudden infant death syndrome (SIDS) victims were regarded as normal as a matter of definition (Beckwith 1970) until 1952 when Kinney and colleagues argued for elimination of the clause, "unexpected by history." They argued that "not all SIDS victims were normal," and referred to their hypothesis that SIDS results from brain abnormalities, which they postulated "to originate in utero and lead to sudden death during a vulnerable postnatal period." Bergman (1970) argued that SIDS did not depend on any "single characteristic that ordains a infant for death," but on an interaction of risk factors with variable probabilities. Wedgwood (1972) agreed and grouped risk factors into the first "triple risk hypothesis" consisting of general vulnerability, age-specific risks, and precipitating factors. Raring (1975), based on a bell-shaped curve of age of death (log-transformed), concluded that SIDS was a random process with multifactorial causation. Rognum and Saugstad (1993) developed a "fatal triangle" in 1993, with groupings similar to those of Wedgwood, but included mucosal immunity under a vulnerable developmental stage of the infant. Filiano and Kinney (1994) presented the best known triple risk hypothesis and emphasized prenatal injury of the brainstem. They added a qualifier, "in at least a subset of SIDS," but, the National Institute of Child Health and Development SIDS Strategic Plan 2000, quoting Kinney's work, states unequivocally that "SIDS is a developmental disorder. Its origins are during fetal development." Except for the emphasis on prenatal origin, all 3 triple risk hypotheses are similar. Interest in the brainstem of SIDS victims began with Naeye's 1976 report of astrogliosis in 50% of all victims. He concluded that these changes were caused by hypoxia and were not the cause of SIDS. He noted an absence of astrogliosis in some older SIDS victims, compatible with a single, terminal episode of hypoxia without previous hypoxic episodes, prenatal or postnatal. Kinney and colleagues (1983) reported gliosis in 22% of their SIDS victims. Subsequently, they instituted studies of neurotransmitter systems in the brainstem, particularly the muscarinic (1995) and serotenergic systems (2001). The major issue is when did the brainstem abnormalities, astrogliosis, or neurotransmitter changes occur and whether either is specific to SIDS. There is no published method known to us of determining the time of origin of these markers except that the injury causing astrogliosis must have occurred at least 4 days before death (Del Bigio and Becker, 1994). Because the changes in neurotransmitter systems found in the arcuate nucleus in SIDS victims were also found in the chronic controls with known hypoxia, specificity of these markers for SIDS has not been established. It seems likely that the "acute control" group of Kinney et al (1995) died too quickly to develop gliosis or severe depletion of the neurotransmitter systems. We can conclude that the acute controls had no previous episodes of severe hypoxia, unlike SIDS or their "chronic controls." Although the average muscarinic cholinergic receptor level in the SIDS victim was significantly less than in the acute controls, the difference was only 27%, and only 21 of 41 SIDS victims had values below the mean of the acute controls. The study of the medullary serotonergic network by Kinney et al (2001) revealed greater reductions in the SIDS victims than in acute controls, but the questions of cause versus effect of the abnormalities, and whether they occurred prenatally or postnatally, remain unanswered. Hypoplasia of the arcuate nucleus was stated to occur in 5% of their SIDS cases by Kinney et al (2001), but this is a "primary developmental defect" according to Matturri et al (2002) with a larger series, many of whom were stillbirths. These cases should not be included under the rubric of SIDS, by definition. There are difficulties with Filiano and Kinney's (1994) explanation of the age at death distribution of SIDS. They postulate that the period between 1 and 6 months represents an unstable time for virtually all physiologic systems. However, this period demonstrates much less instability than does the neonatal period, when most deaths from congenital defects and severe maternal anemia occur. We present data for infants born to mothers who were likely to have suffered severe anemia as a consequence of placenta previa, abruptio placentae, and excessive bleeding during pregnancy; these infants presumably are at increased risk of hypoxia and brainstem injury. The total neonatal mortality rate in these 3 groups of infants is 4 times greater than the respective postneonatal mortality, and in the postneonatal period the non-SIDS mortality rate is between 14 and 22 times greater than the postneonatal SIDS rate in these 3 groups. A preponderance of deaths in the neonatal period is also found for congenital anomalies, a category that logically should include infants who experienced prenatal hypoxia or ischemia; this distribution of age of death is very different from that for SIDS, which mostly spares the first month and peaks between 2 and 3 months of age. Finally, evidence inconsistent with prenatal injury as a frequent cause of SIDS comes from prospective studies of ventilatory control in neonates who subsequently died of SIDS; no significant respiratory abnormalities in these infants have been found (Waggener et al 1990; Schectman et al 1991). We conclude that none of the triple risk hypotheses presented so far have significantly improved our understanding of the cause of SIDS. Bergman's and Raring's concepts of multifactorial causation with interaction of risk factors with variable probabilities is less restrictive and more in keeping with the large number of demonstrated risk factors and their varying prevalence. If prenatal hypoxic damage of the brainstem occurred, it seems likely that the infant so afflicted would be at risk for SIDS, but it is even more likely that their death would occur in the neonatal period, as we have demonstrated in infants who have known maternal risk factors that involve severe anemia. This is in contrast to the delay until the postneonatal period of most SIDS deaths. A categorical statement that the origin of SIDS is prenatal is unwarranted by the evidence. Brainstem abnormalities have not been shown to cause SIDS, but are more likely a nonspecific effect of hypoxia.
http://www.ncbi.nlm.nih.gov/pubmed/12415070

SIDS: Changes in the timing of SIDS deaths in 1989 and 1999: indirect evidence of low homicide prevalence among reported cases.

Paediatr Perinat Epidemiol. 2006 Jan;20(1):2-13.

Pollack HA.

University of Chicago School of Social Science Administration, Chicago, IL 60637, USA. haroldp@uchicago.edu

Abstract

An unknown proportion of cases diagnosed as sudden infant death syndrome (SIDS) are misdiagnosed, and in some cases are homicides. Because recent SIDS prevention measures were unlikely to reduce homicides, changes in the reported timing of SIDS cases provide an indirect measure of covert homicides in this group. This paper uses United States vital statistics microdata to explore these questions. The sample includes all reported infant deaths to singletons with birthweight > 500 g in the 1989 and 1999 US birth cohorts. Deaths attributed to SIDS (n = 7708), homicide (n = 597), or object inhalation and mechanical suffocation (n = 860) are specifically examined. If reported SIDS cases were a mixture of 'true' cases and misdiagnosed homicides, it is hypothesised that the age-at-death distribution of SIDS deaths would have changed to reflect greater prevalence of misdiagnosed homicide. We find that the age-at-death distribution of reported SIDS cases was virtually unchanged in the two cohorts, showing no increase during periods of infancy when relative homicide risk is most pronounced. One cannot reject the hypothesis that the timing was drawn from the same distribution (chi2(52)= 62.2, P = 0.157). Analogous results hold for infants born in circumstances associated with high homicide risk (chi2(50) = 61.5, P = 0.12). The stable age-at-death distribution of reported SIDS cases between 1989 and 1999 suggests that covert homicides are a small fraction of reported SIDS cases.
http://www.ncbi.nlm.nih.gov/pubmed/16420336

SIDS: Sudden unexpected death and covert homicide in infancy.

Arch Dis Child. 2004 May;89(5):443-7.

Levene S, Bacon CJ.

Foundation for the Study of Infant Deaths, Artillery House, 11-19 Artillery Row, London SW1p 1RT, UK.

Abstract

It is impossible to be certain, but it is estimated that each year in England and Wales there may be about 30-40 infant deaths from covert homicide, which represents about 10% of the current annual total of sudden unexpected deaths in infancy. This paper reviews the features that have been suggested as possible indicators of covert homicide, describes the difficulties in its identification and the need for better evidence, and emphasises the importance of thorough medical investigation of all sudden infant deaths.
http://www.ncbi.nlm.nih.gov/pubmed/15102637

SIDS: The dark figure of infanticide in England and Wales: complexities of diagnosis.

J Interpers Violence. 2006 Jul;21(7):869-89.

Brookman F, Nolan J.

University of Glamorgan, South Wales.

Abstract

Infants aged younger than 12 months have the highest homicide victimization rate of any single age group in England and Wales. In addition, there are good grounds for believing that the official homicide statistics for this particular age group are an underestimate and subject to distortion. At the same time there is evidence mounting in the United Kingdom that some parents have been incorrectly convicted of infanticide. This article first explores all recorded cases of infanticide in England and Wales for the period 1995-2002 (298 cases in total). Characteristics of the offenders, victims, offense, and court outcomes are examined. The second part of the article takes a critical gaze at the complexities involved in distinguishing infanticide from sudden infant death syndrome (SIDS) and other sudden unexplained deaths in infancy (SUDI). The article ends by considering in what ways infant deaths might be more effectively investigated.

J Interpers Violence. 2006 Jul;21(7):869-89.

http://www.ncbi.nlm.nih.gov/pubmed/16731989?dopt=Abstract&holding=f1000,f1000m,isrctn

SIDS: potential cardiac issues

Introduction: Nearly 3000 infants die from sudden infant death syndrome (SIDS) in the United States each year and 10% of SIDS may stem from potentially lethal cardiac channelopathies such as long QT syndrome (LQTS) and Brugada Syndrome (BrS). Recently, a sodium channel-centric view of channelopathic SIDS has emerged, implicating the Nav1.5 sodium channel alpha subunit and its interacting proteins. Here, we detail a systematic genetic and functional analysis of the Nav1.5 channelsome for pathogenic SIDS-associated mutations.
Methods: In this IRB-approved study, DNA was obtained from 292 SIDS cases (114 females, 203 white, avg age 2.9 ± 1.9 mos, range 6 hours - 12 mos). The Nav1.5 macromolecular complex (channelsome) was investigated by analyzing the genes encoding its key components including SCN5A, SCN1B-4B, CAV3, SNTA1, GPD1L, & GJA1. 65 exons were analyzed using PCR, DHPLC, and direct DNA sequencing. Putative SIDS-associated mutations were characterized functionally via heterologous expression and whole cell or dual whole cell patch clamp.
Results: Overall, 26 SIDS victims (8.9%) harbored at least one of 24 unique, rare missense mutations: SCN5A (7), SCN3B (2), SCN4B (1), CAV3 (4), SNTA1 (6), GPD1L (2) and GJA1 (2). All missense mutations were absent in over 600 reference alleles. All 24 putative SIDS-associated mutations have been characterized functionally and 17 (71%) conferred abnormal channelopathic properties to the sodium channel macromolecular complex. Notably, 12 of these 17 cases (71%) were outside the peak age range of 2-4 months for SIDS compared to 41% for cases without a channelopathic complex (p=0.02), and 50% were over the age of 4 months (p=0.01).
Conclusions: This study demonstrates that at least 5% of SIDS may be precipitated by a specific perturbation in the heart's Nav1.5 macromolecular complex. Postmortem genetic testing of the Nav1.5 channelsome should be considered for a sudden unexplained death during infancy, particularly for those infant deaths occurring before 2 months of age or after 4 months of age. However, with nearly 30% of the rare missense mutations detected demonstrating a wild-type phenotype in vitro, assignment of mutation pathogenicity and possible SIDS causality in the absence of functional data should be avoided.
http://circ.ahajournals.org/cgi/content/meeting_abstract/122/21_MeetingAbstracts/A13448

SIDS: FDA warns against sleep positioners

Nancy Zielinski

September 29th, 2010

The Food and Drug Administration, FDA, and the Consumer Product Safety Commission, CPSC, have issued warnings not to use infant sleep positioners due to the reported deaths of 12 babies due to suffocation. Most of the babies suffocated after rolling from the side to the stomach.
The most common types of sleep positioners feature bolsters attached to each side of a thin mat and wedges to elevate the baby's head. The sleep positioners are intended to keep a baby in a desired position while sleeping, and often used with infants under six months old.
The government agencies are warning consumers to stop using infant positioning products, and to never put pillows, sleep positioners, comforters, or quilts under the baby or in the crib. To reduce the risk of Sudden Infant Death Syndrome, SIDS, the American Academy of Pediatrics recommends infants be placed to sleep in their backs on a firm surface free of soft objects, toys, and loose bedding.

The Consumer Product Safety Commission is advising consumers to report any incident or injury from an infant sleep positioner by visiting their website at www.cpsc.gov/cgibin/incident.aspx or calling 800-638-2772.

Over a twelve year period, the state of Michigan has reduced the number of SIDS deaths by 80 percent. This reduction in infant mortality is credited, in part, to the Back-to-Sleep campaign and an increased recognition of unsafe sleep conditions. The Back-to-Sleep campaign was initiated in 1994 nationally with the collaboration of the National Institute of Child Health and Human Development, American Academy of Pediatrics, Association of SIDS and Infant Mortality Programs and SIDS Alliance. Michigan saw its first significant decline in SIDS death between 1992 and 1995, reflecting the positive impact of the message to change infant position.

SIDS: Canadian: Former charity head charged with fraud

The former head of a St. Catharines-based charity that helps families deal with sudden infant death syndrome is accused of stealing more than $170,000 from the organization.
The St. Catharines woman was arrested Thursday by Niagara Regional Police after an investigation was launched more than 20 months ago into alleged fraud at the Canadian Foundation for the Study of Infant Deaths.
Police said they were contacted by the national foundation's board of directors that alleged its acting director had issued a number of unauthorized cheques between January and November 2008.

The board also alleged the employee had used the foundation's credit cards for unauthorized purchases during the same period. The employee was fired, police said.
Mary Darlene MacCormick, 50, is charged with four counts of fraud over $5,000 and one count of identity fraud.
MacCormick founded the Niagara chapter of the Canadian Foundation for the Study of Infant Deaths after her grandson died of sudden infant death syndrome 20 years ago.
http://www.stcatharinesstandard.ca/ArticleDisplay.aspx?e=2843262

SIDS: Diagnosis of SIDS to be reviewed in North Carolina

 LISA HAMMERSLY - The Charlotte Observer

With the goal of educating families and saving babies' lives, North Carolina's new chief medical examiner is going to re-examine how the state diagnoses the unexpected deaths of sleeping infants.
Dr. Deborah Radisch says she plans to consult with path ologists statewide about how the medical-examiner system should handle the deaths that are now usually labeled sudden infant death syndrome.
She also wants to discuss a federal project under way in five states that aims to better investigate and diagnose these deaths. Those states are finding they record fewercases of SIDS, and more often label the deaths suffocation, cause unknown, neglect or even homicide. 

It's the first time since she took office in late June that Radisch has said she'll study SIDS deaths and related cases. She expects to start after she finishes hiring her staff.
The hope is to "establish consistency in diagnosis of all infant deaths that come through the medical examiner's system," Radisch said in an interview this week. "We want to continue to encourage families to be aware of preventive measures such as safe-sleep practices."
A Charlotte Observer series in June showed that N.C. medical examiners often have applied the SIDS ruling tobabies even when evidence showed they might have suffocated. They were often found sleeping in unsafe situations: with adults on beds or couches, for example, or facedown among pillows and fluffy blankets.
The investigation found that two-thirds of SIDS autopsies in North Carolina between 2004 and 2008 listed risks that raised the possibility of suffocation. The newspaper also found that law enforcement agencies were sometimes frustrated by the SIDS ruling if they thought the case involved neglect or - rarely - homicide. A SIDS ruling, they said, made successful prosecution of infant deaths almost impossible.
About 100 North Carolina infants each year die from SIDS. After years of research, those deaths are still a medical mystery. The label means that doctors don't know why a baby died and that the death was unpreventable. In North Carolina, SIDS also is considered a natural manner of death.
Advocates of safe-sleep practices for infants worry that SIDS diagnoses can be misleading. They want parents to understand that the risk of SIDS goes down when babies are put to sleep on their backs, alone in their cribs, without blankets or pillows that could suffocate them.
Georgia's medical-examiner system is taking part in the federal project coordinated by the Centers for Disease Control and Prevention in Atlanta.
Beoncia Loveless, a medical investigator with the Georgia system, says some people think of the SIDS label as merely an issue of semantics. "But it's important, if you're trying to get a message out to the community," she says. People once thought SIDS deaths "were unpreventable. But many appear to be preventable. It changes your message."
Although doctors still don't know what makes some infants vulnerable to dying in their sleep, they do know that sleep conditions are related, Loveless said. "The chances of that death go up significantly if the baby is in an unsafe environment."
Loveless said that in Georgia, very few sleep-related deaths are labeled SIDS. The term is reserved for a baby that dies unexpectedly in a safe-sleep situation.
Radisch says she won't start the process of examining infant deaths and other issues until she has a full staff, and she's still working to fill three open jobs forforensic pathologists in her Chapel Hill office. She says the pool of qualified applicants is small - about 40 graduate each year, and about 30 pass board examinations. Several states and jurisdictions are trying to hire.
The medical examiner's office is charged with investigating suspicious, unusual or unnatural deaths. North Carolina's Office of the Chief Medical Examiner oversees about 11,000 cases per year and about 4,500 autopsies.
http://www.newsobserver.com/2010/11/07/786502/diagnosis-of-sids-to-be-reviewed.html#ixzz15dTIqqsJ

SBS: Califonia: James Lujan

Samantha Yale

November 9, 2010

James Lujan escaped punishment for nearly beating to death the 17-month-old daughter of his girlfriend, only to fatally injure the son of another girlfriend three years later.
That was the scenario Senior Deputy District Attorney Jerry McBeth presented to jurors Tuesday morning in his opening statement for the trial of Lujan, who is charged with murdering 4-year-old Diego Calles, the son of Lujan’s then live-in girlfriend, Meagan Davis, in July 2009.
Lujan’s attorney, David Bixby, shifted the jury’s focus in his opening statement to Davis, who he said has changed her story to investigators and used cruel means of punishing her son.
The process of selecting a jury started Friday and continued and concluded Monday for Lujan, 30, of Lompoc.
Opening statements Tuesday morning were followed by testimony from witnesses for the prosecution.
Lujan is accused of physically abusing Diego for several days before the child died on July 18, 2009. He was arrested hours later.
Emergency medical responders had been summoned to a motel room in the 800 block of North H Street in Lompoc, where Diego, Lujan, Davis and Diego’s 5-year-old sister were staying.
Diego, who was not breathing, was taken to Lompoc Valley Medical Center, where he was pronounced dead.
Lujan is charged with murder, as well as assault on a child causing death and torture in Diego’s death. He also faces abuse allegations involving two other children in separate incidents, and a count of domestic violence against Davis.
She has pleaded guilty to a felony charge of child abuse based on her failure to protect her son. Davis was sentenced to a year in county jail, a year in a residential drug treatment program and five years probation.
The defendant’s trial before Superior Court Judge Edward Bullard in Santa Maria could last more than a month.
McBeth, the case prosecutor, said in his opening statement that the evidence will show that a 17-month-old identified as Lina suffered two fractured collar bones, a black eye and a serious head injury in 2006 — allegedly at the hands of Lujan.
Doctors at the time were unable to pinpoint the exact time the toddler suffered the injuries.
Lina’s mother, Stacy Burns, was convicted of child endangerment and lost custody of the girl.
Three years later, Diego suffered blunt-force trauma so severe that his small intestine was seriously damaged, McBeth said. Injuries to Diego’s fingernails were similar to those Lina received, the prosecutor added.
McBeth said the evidence will indicate that Lujan was angered by Diego’s potty-training problems and speech impediment. He beat the boy over the course of several days, forcing him to stand in a certain posture and kicking him when he was unable to hold the pose, McBeth said.
Davis sustained bruising when she tried to help her son.
Lujan’s attorney, Bixby, countered that the prosecution’s pieces of evidence don’t fit together.
Former neighbors of Davis will testify that they didn’t hear any of the abuse Davis will speak about in court, Bixby said, and that her focus was on scoring methamphetamine.
There will be testimony that Davis bit Diego’s fingers and put him in cold showers as a consequence for bad behavior, he said.
The bruising Diego suffered indicates he was abused over an extended period of time, not just in the last few days of his life as Davis will say, according to Bixby.
“I just ask you respectfully, listen to both sides,” the defense attorney concluded.
The testimony from prosecution witnesses Tuesday centered around the abuse of Lina.
Lompoc police Officer Agustin Arias testified that he responded to the call of Lina not breathing, and saw Lujan standing over the girl with his hand on her chest.
“She was pale, looked like she was turning blue,” the officer said.
“He said that she just fell,” Arias testified. “He was nervous, he was rubbing his face, covering his face.”
Lina’s mother, Burns, fidgeted nearby, he said. She had recently used methamphetamine, heroin and alcohol, Arias testified.
Under cross-examination by Bixby, Arias said that anyone would be nervous in a situation where a child is seriously hurt.
Dr. Steven Reichel, an emergency room doctor, said on the witness stand that Lina’s injuries indicated shaken baby syndrome, and that she was having trouble breathing because her brain was injured.
The trial continues this morning.
http://www.lompocrecord.com/news/local/crime-and-courts/article_3bc337fa-ec97-11df-879d-001cc4c002e0.html

SBS: Virginia: Morales

Baby dies after shaking

By: Scott McCabe
Examiner Staff Writer
November 8, 2010

A 2-month-old Manassas child who was found critically injured at his house last month has died, according Prince William County Police.
On the evening of Oct. 17, police responded to Daisy Court for a report of a child not breathing and determined that the child, Dominick Morales, had suffered critical head injuries. Police called it a case of shaken baby syndrome.
At the time, police charged Dominick's father, 25-year-old Henry Morales, with felony child abuse and aggravated malicious wounding, but those charges could be upgraded to murder now that the Dominick Morales has died, police said. Morales remains behind bars without bond. The case remains under investigation.

 http://www.washingtonexaminer.com/local/crime/Baby-dies-after-shaking-1498654-106918628.html#ixzz15aN8wn6M

SBS: Missouri: Caringer: Timetable of infant's death disputed during trial

Kathryn Wall November 11, 2010

Doctor says baby's injuries within hours of death; defense disagrees.
While prosecutors worked to prove an infant died of an abusive head injury in a single day, the defense questioned a pattern of injuries that they say were the real cause of the 9-month-old's death.

Lucas Theede-Bennett died Jan. 6, 2009. His baby-sitter, Brenda Caringer, is charged with his murder.
Throughout the trial, prosecutors have argued that Caringer was the only person who could be responsible for the traumatic head injuries that ultimately lead to Lucas' death.
The defense claims Caringer was preparing a bottle for Lucas when she heard a thump and came into the living room to see the infant falling back from her coffee table. He stopped breathing a short time later, the defense has said.
They contend that a series of falls Lucas experienced in the eight days prior to the Jan. 6 incident were a slow lead-up that triggered his death.
The prosecution presented Dr. Martin Jones, the trauma doctor who directed Lucas' care after he was flown to Cox South hospital.
"His injury was severe. His presentation was just as dramatic ... I have not seen a minor fall like that ever cause that type of injury," Jones said.
Jones noticed shortly after Lucas' death that he had retinal hemorrhages -- bleeding in the arteries of the eyes most commonly connected with Shaken Baby Syndrome.
CT scans performed on Lucas after his death revealed a skull fracture and bleeding and swelling of his brain. Jones declared Lucas' cause of death "abusive head trauma."
Caringer's defense attorneys cited the mention of an older area of bleeding on the brain in Jones' report that they say points to previous, older injuries that slowly contributed to Lucas' death.
Jones acknowledged that the CT scans showed an area that could have been another, smaller area of bleeding that was older than other areas in the brain, but he said those areas were considered "questionable" in the scans and could have easily been an overlap or another error in the image. He said if the area was bleeding, it was unrelated to the skull fracture and the massive bleeding that caused Lucas' death.
"It's not significant enough to cause the profound injury we found on the child," he said of the possible past injury.
Jones also said the extent of Lucas' injuries would have been immediately apparent. He said the skull fracture and subsequent bleeding had to have occurred within hours of Lucas' death.
The prosecution presented five other witnesses Wednesday -- including police personnel who responded to the scene, paramedics who treated Lucas and another woman whose daughter was being watched by Caringer at the time.
Police and paramedics who responded to Caringer's home said many of the same things heard Tuesday -- Lucas was cold to the touch when they arrived, Caringer was frantic and wasn't answering questions and that Caringer's story seemed to change as the time went on.

SBS: Dobson: Maryland

TRAPPE, Md.- Sentencing has been delayed for a Talbot County day care provider found guilty in the death of a 9-month-old boy in her care. The child's mother wants to know the reason behind the delay.

Trevor Ulrich died in September 2009 of head injuries suffered while in the care of 53-year-old Gail Dobson at her home in Trappe. Autopsy results revealed the child died of inflicted head trauma, which is an injury associated with shaken baby syndrome. 

In August, a  jury convicted Dobson guilty of second-degree murder, first-degree child abuse resulting in death, and second-degree assault in connection with the infant's death. Dobson was supposed to be sentenced on Oct. 28. However, a judge in Talbot County held off sentencing to give Dobson's new defense team the opportunity to re-examine whether enough evidence was presented during the trial to warrant the second-degree murder conviction.

Dobson's defense lawyer, Flynn Owen, said the judge does have discretion in the case and is simply allowing the defense team to see whether the state presented enough evidence to warrant a second-degree murder conviction. Flynn denied that this was a new trial for his client. He added that whatever the defense finds will be brought up during the new sentencing hearing scheduled in January. 

The Dorchester County State's Attorney's Office, which is handling the case for Talbot County, would not comment until after the case against Dobson is over.

Meantime, Dobson will now be sentenced on Jan. 6. 

http://www.wboc.com/Global/story.asp?S=13476276

SBS: Scotland: Mark Simpson

Alexis Matheson: Died in 2007 Pic: © STV

A baby allegedly murdered by her mother's ex-boyfriend suffered injuries consistent with being shaken with "severe, violent and massive" force, a court heard.
Six-week-old Alexis Matheson - allegedly assaulted and murdered by Mark Simpson - also showed classic signs of fractures at the arc of the ribs associated with squeezing and shaking when her body was examined by experts.
Days before her death, the young baby was taken to her local GP by her teenage mother, Ilona Sheach, due to concerns over red marks in her eyes.
She was visually checked over by the doctor in her pram and diagnosed with sub-conjunctival haemorrhaging, ruptured blood vessels.
Dr Helen Hammond, Consultant Paediatrician, said she associated the haemorrhaging of the eyes with the first time she had been shaken. And she told the court: "I was very disappointed that the child was not properly examined at that time."
Dr Hammond told the court her opinion following examinations of the baby was that she had suffered a "non-accidental head injury by shaking."
Advocate Depute Iain McSporran asked: "Has there ever been an alternative explanation which has caused you to doubt your opinion in this case?"
She replied: "No." Mr McSporran asked: "You have no other possible explanation?" She replied: "No."
The child expert said she relied on various guidance and tests which determines the damage caused to babies injured through shaking incidents.
Past tests concluded that damage is dependent on the speed of the shake and how much the head of a vulnerable baby rotates
Dr Hammond told the High Court in Aberdeen that the shaking required generating the injuries seen in baby Alexis was "severe, violent and massive".
She said previous experts determined that such injuries were said to bear "no resemblance to the trivial jostling that occurs during play such as holding the baby overhead or bouncing it on the knee".
She added: "It would be obvious to the perpetrator and to any witnesses that the baby was severely distressed and in danger, at the end of the assault, the baby is usually described as limp with absent of shallow respirations."
Dr Hammond's report, which was read to the court, said the baby's multiple rib fractures was likely explained by the fact her chest had been compressed while she was shaken.
The report added that the young child presented "type two classical shaken baby syndrome'. The court heard it was clear that some of her injuries were at least 10 days old.
It further stated that all the clinical and radiological features along with her rapid deterioration and death were indicative of inflicted injury.
Baby Alexis was discovered "lifeless" by Mark Simpson and then-girlfriend Ms Sheach at his home. But there was a delay before the baby was taken to hospital.
Dr Hammond told the court: "In Alexis' case, it's felt she was probably hypoxic (suffering a lack of oxygen) for some time before she got to hospital."
Her report said Simpson gave a textbook description of how he resuscitated the young baby. She questioned in the report: "Why did he not get help sooner?"
Alexis died a few hours after she was admitted to hospital. Simpson, of Aberdeen, is on trial accused of assaulting and murdering the baby in December 2007.
He is further accused of breaching bail conditions. He denies both charges. The trial continues.

SBS: Goenaga: 2-Month-Old Baby Dies From Allegedly Being Shaken By Mom

November 11, 2010

EL PASO, Texas -- Las Cruces Police detectives have learned that 2-month-old Baby Jade died Wednesday afternoon at an El Paso hospital.
Jade passed away at around 4:30 p.m. Wednesday after three days on life-support at Las Palmas Medical Center in El Paso.
Jade's mother, Diana Atima Goenaga, 17, of the 1100 block of Monte Vista Avenue in Las Cruces, was charged on Monday, Nov. 8, with one count of child abuse causing death or great bodily harm. Goenaga was arrested Monday evening and remains at the El Paso County Detention Center .
LCPD detectives were notified on Monday that Jade was at the El Paso hospital with what is commonly referred to as shaken baby syndrome.
Las Cruces Police said that on Wednesday, Nov. 3, the baby's 23-year-old father arrived at the couple's apartment and noticed Jade was unresponsive and limp. The couple began driving Jade to a Las Cruces hospital but, according to statements made to detectives, the baby appeared to regain consciousness so they returned home.
The couple told detectives that two days later they took Jade to a family doctor in Las Cruces who examined the baby and attributed the baby's symptoms, which included vomiting, to a change in formula. The couple again returned home with baby Jade.
Detectives learned that on Sunday morning the baby's father again noticed Jade to be unresponsive and rushed her to Mountain View Regional Medical Center . The girl was then transported by ambulance to Las Palmas where pediatric specialists determined Jade was suffering from head trauma consistent with shaken baby syndrome.
Jade's body will be transported to the medical examiner's office in El Paso for autopsy. LCPD detectives continue their investigation and additional charges remain a possibility.

http://www.kvia.com/news/25751630/detail.html

SBS: Whitehall, Ohio, Bryan Johnson Arrested After Baby's Death

November 7, 2010
WHITEHALL, Ohio — Whitehall police arrested a man on Saturday after a baby in his care was severely injured.
London Hodge was taken to Nationwide Children's Hospital with head trauma, according to the Whitehall Police Department.

Hodge, 21-months-old, died early Sunday, police said. She suffered injuries consistent with abusive head trauma and shaken baby syndrome, police said.
Police were called to a home in the 5300 block of Great Oak Way at 7:40 p.m., 10TV's Glenn McEntyre reported. Bryan M. Johnson was initially charged with felonious assault. Police said on Sunday after the child died that they will seek additional charges against Johnson. Johnson, 19, lives at the same home as the baby. The child's mother, Natasha Steele, said Johnson was not the baby's father.  
Steele, 21, was attending an event for her internship and was not at home when the alleged assault occurred.
"I loved him, my daughter loved him, and I trusted him," Steele said. "They said she had brain stem damage. A part of her brain had shifted; she had shaken baby syndrome."
Steele said that Johnson called her from jail and said he had accidentally dropped the baby on the stairs.
"And I said 'Sorry? My baby girl is dying right now.' And he said, 'You don't even know what happened,'" Steele said. "I said 'Will you please tell me what happened?' He said 'I dropped her on her head when I put her in the bathtub walking up the steps.'"
Steele said Johnson was violent with her once before, striking her across her mouth, and choking her, McEntyre reported.
In what she called the worst decision of her life, she gave him a second chance.
"I have to pay for my decision," Steele said. "Trust me, I wish I could go back because everything would have been different. Everything."

SBS: Autopsy reveals Florida infant died of shaken baby syndrome

November 5, 2010

An autopsy by the Lee County medical examiner revealed 7-month-old David Landron died from intentionally inflicted injuries, known as shaken baby syndrome.
According to a Lee County sheriff’s report, the child could only have received the injuries while in the care of his babysitter, Maria Corsa-Hernandez.

Deputies arrested Corsa-Hernandez Thursday, charging her with murder while engaged in a felony and cruelty towards a child.
http://www.news-press.com/article/20101105/CRIME/101105017/1075/Autopsy-reveals-Lehigh-infant-died-of-shaken-baby-syndrome

SBS: Abused New Mexico infant dies in Texas hospital

Nov. 10, 2010

LAS CRUCES, N.M. — Las Cruces police say an infant girl who was the victim of shaken baby syndrome has died.
Detectives say 2-month-old Baby Jade died Wednesday afternoon after three days on life-support at Las Palmas Medical Center in El Paso, Texas.
Police say the baby's 17-year-old mother was charged Monday with one count of child abuse causing death or great bodily harm.
The teen remains at the El Paso County Detention Center. Her name is not being released by The Associated Press because she's a juvenile.
Police say the baby's body will be transported to the medical examiner's office in El Paso for an autopsy. Las Cruces detectives say additional charges are possible in the case.
http://www.chron.com/disp/story.mpl/ap/tx/7289104.html

SBS: Forensic Science

“In any legitimate justice system, … truth must play a paramount and integral role…. The very survival of the rule of law depends not only on a justice system that administers the law fairly, but a system that is just by being well-grounded in … truth….[M]ore research is needed in the techniques and science already in use. With the importance of forensic science to truth and justice, the science employed and relied upon by judges and juries must be valid. It does not matter how well forensic scientists abide by testing protocols, or how reliable the techniques are, if the underlying science does not actually reveal what the expert says it does. Method validation studies and new research must be on-going even in the area of traditional forensic disciplines.” Kenneth E. Melson, President, AAFS, 2003–2004

 http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2009.01255.x/full

SBS: Calise trial in Ohio analyzes shaken baby syndrome

Edward Markovich
November 15th, 2010
On November 15, 2010 the State of Ohio will begin to try the case of  young Tiffani Calise in Akron, Ohio for the crime of allegedly shaking a baby to death. The charge is involuntary manslaughter, and child endangering. The case is somewhat incoherent, either she hurt the baby bad enough to cause its death or she didn't. If she did, it seems a case of simple homicide, until you examine the shaky basis of so-called shaken baby syndrome.

For the past quarter of a century, medical professionals have routinely been taught that shaking a baby can cause injuries so severe that irreversible brain damage or death will likely result from the act of shaking alone. In Akron, Childrens' Hospital's Dr. Steiner has specialized in diagnosing and testifying regarding alleged cases of shaken infants, resulting in past convictions of young parents and caregivers. But international courts, most recently in Canada and Great Britain, have called for a review of all shaken baby convictions on the basis of new scientific data undermining its reliability as a forensic medical diagnosis.

In American courts, the rule of admissibility of expert scientific opinions follows the case of Daubert v. Merrill Dow Pharmaceuticals, 509 U.S. 579 (1993) . The United States Supreme Court held in that case that the enactment of the Federal Rules of Evidence impliedly overturned the earlier Frye rule. In a 1923 case, Frye v. United States, 293 F. 1013 (D.C. Cir. 1923), the court held that evidence could be admitted in court only if "the thing from which the deduction is made" is "sufficiently established to have gained general acceptance in the particular field in which it belongs." After Daubert changes in medical science can be admitted even before all opinions have agreed in one scientific area.

In 2008, a Wisconsin jury convicted Audrey Edmunds of murdering her baby by shaking, and she was sentenced to eighteen years in prison. On January 31, 2008, Audrey Edmunds was granted a new trial on the basis of new scientific thinking. For the first time, a court examining the foundation of shaken baby syndrome held that it had become sufficiently shaky itself that a new jury probably would have a reasonable doubt as to the defendant‘s guilt. As the United States Supreme Court emphasized in Daubert v. Merrell Dow Pharmaceuticals, Inc., ―[v]igorous cross-examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence.‖”
Could it be that shaken-baby syndrome has become itself such a shaky, negative forensic diagnosis, (meaning it attaches to the last person who happened to be caring for the child when it loses consciousness), that Ohio doesn't have the heart to charge her with murder? In Tiffani Calise's case, she happened to be babysitting for the baby who died later from alleged shaking. Although involuntary manslaughter is much less serious than intentional or negligent homicide, it seems that her case may depend not just on facts and law, but on a growing awareness that past cases of infant death may have been decided on a very shaky scientific foundation, which is now under reconstruction.
http://www.examiner.com/courts-in-akron/a-shaky-case

SBS: Miller, Pennsylvania: Doctors give conflicting opinions on shaken baby

November 9, 2010
SANDRA K. REABUCK
sreabuck@tribdem.com
A jury of six men and six women is expected to begin deliberating by this afternoon whether a Johnstown father is guilty of shaking his infant son so severely that it caused bleeding into the baby’s brain and eyes.
Joshua W. Miller, 42, formerly of Stone Street, is charged with aggravated assault, child endangerment, reckless endangerment and simple assault.
Miller is accused of shaking his 2-month-old son on the evening of  Jan. 14, 2009, while the mother was at work and Miller and his son were home alone. The baby was rushed to Memorial Medical Center by ambulance shortly after 10 p.m. when Miller made a frantic call for help to 911 because his son was unresponsive and grasping for breath.
The infant was treated at the Johnstown hospital before being transferred early the next morning to Children’s Hospital of Pittsburgh, where he was admitted for seven days.
The trial in Cambria County court neared its end Tuesday with testimony from two doctors – one for the prosecution and the other for the defense – who gave conflicting opinions on what caused the bleeding in the baby’s brain.
Dr. Janet Squires, a pediatrician who heads the child advocacy program at Children’s Hospital, said the bleeding was due to shaking of the infant. She was the prosecution’s medical expert.
“With medical certainty, I believe this child was abused,” Squires said.
No evidence was found of any underlying medical problems that would have caused the bleeding, she said.
But Dr. Ronald Uscinski, a Maryland neurosurgeon who has written extensively about shaken baby cases, said the bleeding was caused by an older injury to the membrane around the brain that “existed weeks or months and was missed (in medical exams). It was a birth injury, quite likely.”
Uscinski, hired by the defense, said the fresh blood that was seen on CAT scans does not mean a fresh injury, but bleeding from a chronic previous injury. Areas of old blood “almost certainly” remained from an injury during childbirth, he said.
Chief public defender Lisa Lazzari, who is representing Miller, has not indicated whether she will call him or other defense witnesses before resting her case.
Tamara Bernstein and Beth Bolton Penna, assistant district attorneys prosecuting the case, also have the option of calling rebuttal witnesses before the attorneys present their closing statements to the jury.
Testimony on Tuesday was delayed for an hour when Lazzari made a motion for a mistrial. She said the prosecution and the Johnstown police had failed to turn over reports about contacts with the baby’s mother last year.
The mother, who testified Monday, had denied there were any attempts by police to communicate with her, although a police report indicated there had been some contact with or attempts to contact her.
Lazzari said she could have used the information in her cross-examination of the mother.
Judge David Tulowitzki refused to grant a mistrial. Instead, with the agreement of both sides, he read to the jurors a statement that the prosecution “did not maintain proper contact with the mother in the case against Joshua Miller.”
http://tribune-democrat.com/local/x1213154128/Doctors-give-conflicting-opinions-on-shaken-baby/print

SBS: Long article with references

Susan Wishart and Mayland McKimm

In the 1980s SBS took on a more sinister connotation and was used to described physical abuse on an infant whereby the infant is held around the rib cage and shaken violently causing the infant’s head to snap back and forth. The defining symptoms of SBS are stated to be: subdural hematoma, encephalopathy (usually manifest in fatal cases by brain swelling) and retinal hemorrhage. These symptoms are commonly referred to as "the triad." Although there are no accounts of anyone witnessing an infant being shaken in this manner with the resultant triad of symptoms, doctors offered SBS as an explanation for these injuries where there was no apparent

impact injury to the head. For some doctors SBS became not only a possible explanation for the triad of symptoms, but the only explanation.

Over the past three decades thousands of individuals around the world have been charged and convicted of murder/manslaughter/assaults on infants with the mechanism of brain injury defined as SBS. Proponents of the syndrome have attended annual medical conferences on SBS and some have declared themselves to be experts. Doctors have testified on behalf of the prosecution at criminal trials and stated as fact that when the triad of symptoms is present, the only mechanism of injury is SBS. Parents who testified that their child fell and hit his head were disbelieved in the face of the unquestioned expert medical opinion.

At the same time that the SBS experts were testifying in this manner, other doctors and scientists were conducting studies and demonstrating that the mechanism of SBS could not cause the injuries associated with the syndrome. One research study demonstrated that the forces needed to cause a subdural hematoma far exceeded the amount of force that could be generated by shaking.

4 The forces generated inside the skull by impact with a rotational component, such as with some falls, are 50 times greater than the forces that can be generated by shaking alone, and still 40 times greater than shaking when the impact is onto a soft surface. Another study determined that impact injuries to an infant’s head did not always result in any injury to the skull or scalp.

Even more compelling are the studies involving documented short distance falls that resulted in the triad of symptoms, with no external head injury. The documentation included falls witnessed by disinterested third parties and falls that were caught on film.

These studies all indicate that the triad of symptoms that are said to be the signature of SBS can also result from accidental short distance falls. The biomechanical studies go even further to suggest that the triad of symptoms attributed to SBS cannot be caused by shaking alone. Despite this body of scientific evidence expert SBS doctors continued to testify at criminal trials and routinely denied that the injuries could be caused by anything other than intentional assaultive shaking.
http://www.cba.org/CBA/newsletters/pdf/07-08_criminaljustice_witnesses.pdf

SBS: Charles Smith story

On a typical case, he might have to decide whether a child had been shaken to death or accidentally fallen from a highchair.
Dr. Charles Smith was once considered top-notch in his field of forensic child pathology. In 1999, a Fifth Estate documentary singled him out as one of four Canadians with this rare expertise.
For 24 years, Smith worked at Toronto's Hospital for Sick Children. In the hospital's pediatric forensic pathology unit, he conducted more than 1,000 child autopsies.
But Smith no longer practises pathology. An Ontario coroner's inquiry reviewed 45 child autopsies in which Smith had concluded the cause of death was either homicide or criminally suspicious.
The coroner's review found that Smith made questionable conclusions of foul play in 20 of the cases — 13 of which had resulted in criminal convictions. After the review's findings were made public in April 2007, Ontario's government ordered a public inquiry into the doctor's practices.
That inquiry, led by Justice Stephen Goudge and concluding in October 2008, found that Smith "actively misled" his superiors, "made false and misleading statements" in court and exaggerated his expertise in trials.


http://www.cbc.ca/canada/story/2009/12/07/f-charles-smith-goudge-inquiry.html#ixzz15Yp0T98L

SBS: Useful references to development of terminology

Shaken baby syndrome theory, by whatever name it morphs into, which holds that a small dead child displaying certain limited soft tissues pathologies but no other injuries was shaken to death by the last person who held the child when he or she was conscious. Of all the questioned forensic theories and practices, this is the one I would put at the top of the list for the threshold examination. Of all the currently questioned practices, this is the only one asserted by a respectable minority of specialists to be completely invalid. While a vitriolic dispute continues between the pro and con groups, defendants continue to be sentenced to exceedingly long prison terms based on the theory. While the theory’s supporters accuse the doubters of profiting from defending baby-killers, the doubters label the supporters as zealots lacking any knowledge of physics or of the scientific method. It is long past time that an authoritative body outside the adversarial system examined the underpinnings of the theory and published its results.

Response:

The Shaken Baby Syndrome is a fabricated diagnosis. It was fabricated by doctors who do not understand the pathophysiology of haemostasis and osteogenesis.
Editor,
Vitamin K is a fat soluble vitamin and is a co-factor for an enzymatic conversion of
glutamic acid (Glu) to γ-carboxyglutamic acid (Gla) by γ-glutamyl-carboxylase  and
along with other essential nutrients including Vitamins C and D is  necessary for the
biological activity of the blood coagulation factors and the formation of bone.
A reduction or abnormality of Vitamin K is known to cause  Haemorrhagic Disease of the New Born and fractures in children with Cystic Fibrosis.
Subdural and retinal hemorrhages, encephalopathy and fractures in children which have hitherto been attributed to Shaken Baby Syndrome, Non-accidental injury, Abusive Head Trauma or Inflicted Brain Injury are features of Vitamin K and/or C deficiency and other essential nutrients – Innis’ Syndrome would be an appropriate name change for this combination of signs and symptoms.
Commencing in the mid 20th Century with the publication of a report by an American Radiologist on fractures and haemorrhages in infants1  a Neurosurgeon in England suggested that the cause of the lesions was  violent shaking of the infant by an adult2  a claim echoed by the Radiologist3.  This was the first mention of the “Shaken Baby Syndrome”.
When it was realized that skull fractures could not be explained by shaking, a Professor of Paediatrics in England suggested that a violent impact of the skull against a hard object was the most probable cause of this type of fracture4.  The Shaken Baby Syndrome morphed into “Shaken –Impact  Syndrome”.
Retinal haemorrhages  seen in these children were claimed to be conclusive proof of abuse and Ophthalmologists  added  acceleration –deceleration of the head  as it is violently rotated by the abuser as the cause of the retinal haemorrhages5.
Throughout Academia the current teaching is,  it is the  triad of subdural and retinal haemorrhage with brain damage, as well as the characteristics of each of these components that allow a reconstruction of the mechanism of injury, and assessment of the degree of force employed. Academics claim it is the application of rotational acceleration and deceleration forces to the infant’s head which causes the brain to rotate in the skull. Abrupt deceleration, it is claimed, allows continuing brain rotation until bridging veins are stretched and ruptured, causing a thin layer of subdural haemorrhage on the surface of the brain6-17.
Maguire et al;17  claim that their review, the largest of its kind, offered for the first time, a valid “statistical probability of Inflicted Brain Injury” when certain key factors are present. The “key factors”  included retinal hemorrhages and apnoea both of which are known to be associated with vitamin K deficiency18,19 .
Michael Innis
References
1. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol 1946;56:163–173.
2  Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. BMJ 1971;ii:430-1.
3.  Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked  with residual permanent brain damage and mental retardation. Pediatrics  1974;54:396-403.
4. David TJ. Shaken baby (shaken impact) syndrome: non-accidental injury in infancy. J R Soc Med 1999;92:556-561.
5.  Update from the Ophthalmology Child Abuse Working Party Royal   College  Ophthalmologists Eye (2004) 18, 795-798. doi:10.1038/sj.eye.6701643  Published online 25 June 2004
6.    American Academy of Pediatrics: Shaken Baby Syndrome. Rotational Cranial Injuries.- Technical Report. Committee of Child Abuse and Neglect  PEDIATRICS:2001:198:206-210.
7.    Hoskote A, Richards P, Anslow P, McShane T.  Subdural haematoma and non-accidental injury in children. Child’s Nerv Syst 2002; 18:311-317
8.  Duhaime AC, Christian CW, Rorke LB, et al.  Non-accidental  head injury in infants – the shaken baby syndrome. N Engl J Med 1998;338:1822-1829
9.  Joint statement on Shaken Baby Syndrome.Paediatrics &amp; Child Health
2001;6(9) 663-7
10.  Minns RA.  Busuttil A. Patterns of presentation of the shaken baby syndrome Four types of inflicted brain injury predominate BMJ  2004;328:766
11. Harding  B, Risdon RA, Krous HF Shaken baby syndrome
BMJ, Mar 2004; 328: 720 – 721
12. Green MA. A practicle approach to suspicious death in infancy – a  personal view. J Clin Pathol 1998, 51; 561-563
13  Reece RM. The evidence base for shaken baby syndrome: Response to editorial from 106 doctors. BMJ, May 2004; 328: 1316 – 1317 ;  doi:10.1136/bmj.328.7451.1316
14. Alexander RC, Sato Y, Smith W, Bennett T. Incidence of impact trauma with cranial injuries ascribed to shaking. Am J Dis Child 1990;144: 724-6
15   Protocol for the investigation of sudden and unexpected deaths in children under 2 years of age [Memorandum No 631].Ontario: Ministry of the  Solicitor General and Correctional Services, 1995.
16.  Kempe CH, Silverman FN, Steele BF, et al. The battered child syndrome. JAMA 1962;181:17–24.
17.Maguire SA,  Pickerd N, Farewell D,  Mann MK, Tempest V, Kemp AM. Arch Dis Child. Which clinical features distinguish inflicted from non-inflict brain injury? A Systematic Review Published Online First: 15 June 2009. doi:10.1136/adc.2008.150110
18. Innis MD. Vitamin K Deficiency Disease Jour OrthoMol Med 2008:23;15-20
19.  Innis MD.  Inflicted Brain Injuries: Don’t Disregard Differential Diagnosis. Jour  Amer Phys an d Surg;2010:15  11-12
http://medicalmisdiagnosisresearch.wordpress.com/2010/11/10/letter-to-the-editor-strengthening-forensic-science/

SBS: Social workers who snatched four-day-old baby put her up for adoption over unproven abuse claim

Mum’s heartbreaking fight to get her daughter back. A mum and dad have been told they will never see their young daughter again… after she was snatched away at only four days old. Tiny Baby A was taken from her mum by social workers who claimed the tot, who we will call Emily, was at risk in the family home. Not because of the mum’s failure to care for her – but because of a six-year-old unproven claim that her husband had injured his son from a previous marriage. Yet, although interviewed by police, he never faced a criminal court over that allegation. And he has even been allowed unsupervised access to watch his boy grow up.
Now the High Court, in a devastating civil court ruling, has decided that a decision to forcibly adopt Emily – now aged four – away from her parents (who we are calling Tania and Stephen) must stand. Revealing her agony for the first time, mum Tania said: “I had my beautiful baby girl snatched from me at just four days old. Only a mother could understand the horror of that. “My only crime is that I love and trust my husband. I don’t believe he could ever harm a child, and the courts have been unable to prove it. I have already missed years of Emily’s childhood.”
Stephen, in his 40s, married Tania, in her mid-20s, in 2003. Almost a year after their wedding Tania gave birth to Emily in hospital and they were overjoyed to take her home two days later. But they were to enjoy just two days alone with their little girl before she was taken from them. Social workers claimed there was a danger her dad would hurt her because of the case six years earlier. Stephen had been married before and has a 10-year-old son, Jamie. When he was eight weeks old, Jamie was taken to hospital with a suspected brain injury and was found to have suffered bleeding behind his eyes. The episode left him permanently disabled, and he now has cerebral palsy. A medical expert said that he had been shaken viciously.
Stephen, who also has a 12-year-old daughter from the previous marriage, said: “Doctors couldn’t tell for certain what was wrong with Jamie. But one came up with a theory it could be ‘shaken baby syndrome’, even though there was no conclusive evidence. “My wife and I were told that care proceedings were being started. It was heartbreaking to be accused of harming your own child. I vehemently denied doing anything wrong, but no one listened.”
A whole year later – during which time Jamie stayed with his parents and came to no further harm – the couple were taken to a family court in London, where a judge concluded on the basis of an expert’s opinion that the child’s injuries had been caused by one of his parents.
http://medicalmisdiagnosisresearch.wordpress.com/2010/11/12/social-workers-snatch-baby-on-previous-shaken-baby-case/

SBS: TRIAL TACTICS AND TECHNIQUES

Useful overview on lawyers in court

The Goudge Report (2008)

much broader implications for civil and criminal justice in Ontario. It sets out

fertile ground for objections to expert evidence. In the context of criticizing the

pathologist, Dr. Smith, the Inquiry identified 10 criticisms, all of which can be

relevant in any case:

(i) he failed to understand his role was not to support the crown (or party

retaining him) (this goes to bias and may affect both weight and

admissibility);

(ii) he failed to adequately prepare for court (this would be relevant to the

weight of his evidence);

(iii) he overstated his knowledge in a particular area (this may be relevant to

his qualification as an expert or to weight);

(iv) he gave anecdotal evidence which was inappropriately unscientific (this

goes primarily to the weight of his evidence);

(v) he failed to give a balanced view of the evidence and was dogmatic and

was unduly certain (this again goes more to weight);

(vi) he was unprofessional and gave unwarranted criticism of other

professionals (this again goes more to weight);

(vii) he testified on matters outside his area of expertise (this should be the

subject of an immediate objection);

(viii) he gave opinions which were speculative, unsubstantiated and not based

on (pathology) findings (this goes to weight);

(ix) he used loose and unscientific language (again, this goes to weight); and

(x) he lacked candour and honesty (again, this goes to weight).

http://www.stevensonlaw.net/TrialTactics.pdf on flaws in Ontario's forensic pathology system had

SIDS: Pennsylvania: prevention law questioned

By Adam Brandolph
PITTSBURGH TRIBUNE-REVIEWThursday, November 4, 2010

Medical professionals say a new state law requiring parents to acknowledge they've received information about Sudden Infant Death Syndrome is well-intentioned but flawed.
"Education is a good thing, but it has to be good education and targeted at a time people can hear it and learn from it," said Raymond Firth, director of behavioral health at the University of Pittsburgh's Office of Child Development.
"Moms in the hospital are fatigued; they have a whole new role. They're getting medical exams, the baby's getting medical exams. They're getting all this information on domestic violence, crib sizes, car seats -- they're getting bombarded with information, and they may not take the time to read the details."
Sudden Infant Death Syndrome, or SIDS, is the sudden death of an infant younger than one year old that cannot be explained. One of the leading causes of death among newborns in Allegheny County, 68 infants died of SIDS from 2001 to 2006. In the first eight months of this year, as many deaths were attributed to SIDS -- 15 -- as in all of 2008. The toll was 14 last year. A board of medical professionals meeting monthly determines whether a death is from SIDS.
Pennsylvania's law, signed last week by Gov. Ed Rendell, requires the state Health Department to develop a program to promote SIDS awareness and education, and distribute educational materials to hospitals and birth centers. Parents are required to sign a statement indicating they read and understand the materials provided by their physician before mother and baby are discharged from the hospital.
"Any effort at the hospital would help, but that just can't be the remedy," said Peggy O'Malley, a public health administrator for the Allegheny County Health Department.
"We need obstetricians and family practices to talk about this in the second trimester; instructors at child birth classes, Lamaze -- any kind of education they're receiving ... and right after the hospital. You're just not going to change attitudes or behaviors because someone signed this form."
Eileen Carlins, director of support and education at Sudden Infant Death Services of Pennsylvania, a nonprofit organization on the North Side that backed the legislation, is on the front lines of the fight.
"In my job, I'll talk to a mom and she'll say, 'Well, I didn't know about this. ... I didn't know it was dangerous to sleep with the baby, or I didn't know to put my baby on his back.'"
Sen. John Pippy, R-Moon, who sponsored the legislation, said it's designed to prevent those conversations.
"A lot of parents are just unaware of the dangers that are out there," he said. "We've heard stories of people who've lost babies, and it's really tragic. We know that informing parents about SIDS prevents deaths, and this new law will make that information more readily available."
http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_707280.html