Abstract â–¡ 79

Although the Beckwith definition specified that a 'thorough' autopsy was required before a death could be attributed to SIDS, and despite the prevalence of numerous recent autopsy protocols, consensus is lacking as to what constitutes an acceptable postmortem examination in cases of unexpected infant death. In fact, it is well known that the term 'SIDS' is being used in cases where autopsies are not being performed, and the possibility of limited, or even 'verbal' autopsies has recently been discussed. Part of the difficulty in the examination of these cases has resulted from the somewhat artificial separation of the disciplines of pediatric from forensic pathology. However, unless consensus can be reached regarding the appropriate pathological investigation of these infants, comparisons of data among centers will be seriously flawed, and individual cases will be diagnosed without application of consistent criteria. The following additional steps to supplement the routine examination are proposed to engender discussion as to what is required to adequately investigate the unexpected death of an infant or young child by excluding occult trauma: External examination to include otoscopic examination of the nares, nasal septum and ear canals for trauma; specific examination for the presence or absence of retroauricular petechiae; and genital and anal examination with swabs, scrapings and material for DNA if required. Radiological examination to consist of a full skeletal survey with directed views of metaphyses and posterior ribs. Internal examination to include anterior neck, chest, abdomen, buttock, posterior neck and back soft tissue dissection to exclude deep bruising. Toxicological examination to exclude potentially lethal levels of prescription and nonprescription drugs. Removal and examination of the eyes and and at least the cervical and upper thoracic spinal cord to be undertaken if any significant injury is detected, if there is cerebral oedema and hemorrhage, if there are concerns from the death scene examination or clinical/family history review. Undertaking such extra activities may result in positive findings which would prevent the term 'SIDS' from being used e.g. skin petechiae indicating accidental or inflicted asphyxia, or bruises or fractures indicating inflicted injury.