Global trends in the extent of death scene investigation performed for sudden and unexpected death of infant (SUDI) cases: A systematic review

Bereaved Parents' Perceptions of the Doll Reenactment After Sudden Unexpected Infant Deaths

BACKGROUND AND OBJECTIVES

A death scene investigation is required to determine sudden infant death syndrome, and a doll reenactment optimizes the information obtained. The aim of this study was to explore how acutely bereaved parents experience doll reenactments that are conducted after the sudden and unexpected deaths of their infants.

METHODS

A mixed-methods design, including surveys and semi-structured interviews, was used in a cross-sectional, national study to explore the experiences of doll reenactment among 45 bereaved parents.

RESULTS

Forty-four percent of parents reported moderate to high distress during the doll reenactment, with significantly heightened distress in those who discovered their child lifeless and who later reported posttraumatic intrusions. An analysis of parents' narratives showed that the doll reenactment was challenging, particularly because of the doll's appearance and the activation of intrusive images in those who found their child lifeless. Parents overall experienced less distress than anticipated during the reenactment, and no lasting difficulties were reported. Some parents identified benefits from the reenactment, such as sharing a coherent narrative of the death. The parents' reactions to the doll reenactment were multifaceted and complex.

CONCLUSION

These findings illuminate the emotional challenges parents face during a doll reenactment and emphasize the delicate balance between obtaining crucial information and avoiding additional trauma in the aftermath of infant deaths. Because the doll reenactment's diagnostic utility or benefits to post-loss coping are uncertain, anticipatory guidance about its psychological dimensions may mitigate distress, and incorporating a gateway for professional support may further align it with the needs of acutely bereaved parents.

Rechtsmedizinische Leichenfundortuntersuchung mit Leichenschau

Hintergrund

Die Leichenfundortuntersuchung mit rechtsmedizinischer Leichenschau im Vorfeld der Obduktion kann für deren Planung hilfreich sein. Häufigkeit, Umfang und Art der dokumentierten Leichenfundortuntersuchung mit Leichenschau unterliegen interindividuellen und interinstitutionellen Einflüssen. Eine wissenschaftliche Untersuchung rechtsmedizinischer Leichenfundortuntersuchungen und eine systematische Standardisierung gibt es bisher nicht.

Material und Methoden

Insgesamt 3622 Akten aus dem Archiv des Instituts für Rechtsmedizin der Justus-Liebig-Universität Gießen aus den Jahren 2005–2014 wurden gesichtet. 121 Fälle mit einer Leichenfundortuntersuchung mit Leichenschau durch eine/n Rechtsmediziner/in vor Ort wurden ausgewertet.

Ergebnisse

Die Leichenfundortuntersuchungen, einschließlich Dokumentation der Befunde, wurden während des 10-jährigen Untersuchungszeitraums unterschiedlich gehandhabt. Es zeigte sich eine Zunahme an Leichenfundortuntersuchungen um rund 380 % vom ersten zum letzten Untersuchungsjahr. Der Anteil an Tötungsdelikten bei den Leichenfundortuntersuchungen betrug 46 %. In 63 % aller Fälle fanden sich Dokumentationslücken, die im Verlauf des Untersuchungszeitraums und mit der häufigeren Anfertigung von Leichenfundortuntersuchungsberichten deutlich abnahmen. Bei der Dokumentation von Verletzungsmustern sank der Anteil an unvollständigen Daten von 89 % auf 11 %, bei den Temperaturmessungen am Leichenfundort von 73 % auf 27 %. Exklusiv am Leichenfundort erhebbare dokumentierte Zusatzinformationen fanden sich im Sinne von Blutspurenverteilungsmustern (48 %) und Hinweisen auf mögliche Tatwerkzeuge (57 %).

Schlussfolgerungen

Die rechtsmedizinische Leichenfundortuntersuchung mit Leichenschau wurde zunehmend häufiger durchgeführt. Die Untersuchung des Leichnams vor Ort und die Inaugenscheinnahme der Umgebung liefern Informationen, die über die alleinige autoptische Befunderhebung hinausgehen und eine wertvolle Grundlage für die Einordung von Obduktionsbefunden und für rekonstruktive Überlegungen zu Tatgeschehen darstellen. Um die Qualität der Befunderhebungen am Leichenfundort und die Qualität der zugehörigen Dokumentation zu verbessern, ist eine standardisierte Leichenfundortuntersuchung mit Leichenschau und Dokumentation anzustreben.

The global burden of sudden infant death syndrome from 1990 to 2019: a systematic analysis from the Global Burden of Disease study 2019

BACKGROUND

Sudden infant death syndrome (SIDS) still remains one of the leading causes of infant death worldwide, especially in high-income countries. To date, however, there is no detailed information on the global health burden of SIDS.

AIMS

To characterize the global disease burden of SIDS and its trends from 1990 to 2019 and to compare the burden of SIDS according to the socio-demographic index (SDI).

DESIGN

Systematic analysis based on the Global Burden of Disease (GBD) 2019 data.

METHODS

Epidemiological data of 204 countries from 1990 to 2019 were collected via various methods including civil registration and vital statistics in the original GBD study. Estimates for mortality and disease burden of SIDS were modeled. Crude mortality and mortality rates per 100 000 population were analyzed. Disability-adjusted life years (DALYs) and DALY rates were also assessed.

RESULTS

In 2019, mortality rate of SIDS accounted for 20.98 [95% Uncertainty Interval, 9.15-46.16] globally, which was a 51% decrease from 1990. SIDS was most prevalent in Western sub-Saharan Africa, High-income North America and Oceania in 2019. The burden of SIDS was higher in males than females consistently from 1990 to 2019. Higher SDI and income level was associated with lower burden of SIDS; furthermore, countries with higher SDI and income had greater decreases in SIDS burden from 1990 to 2019.

CONCLUSIONS

The burden of SIDS has decreased drastically from 1990 to 2019. However, the improvements have occurred disproportionately between regions and SDI levels. Focused preventive efforts in under-resourced populations are needed.

Circumstances and factors of sleep-related sudden infancy deaths in Japan

Background

Sudden unexpected death in infancy (SUDI) comprises both natural and unnatural causes of death. However, few epidemiological surveys have investigated SUDI in Japan.

Objective

This retrospective study was conducted to investigate the latest trends of circumstances and risk factors of SUDI cases in which collapse occurred during sleep.

Methods

Forensic pathology sections from eight universities participated in the selection of subjects from 2013 to 2018. Data obtained from the checklist form were analyzed based on information at postmortem.

Results

There were 259 SUDI cases consisting of 145 male infants and 114 female infants with a mean birth weight of 2888 ± 553 and 2750 ± 370 g, respectively. Deaths most frequently occurred among infants at 1 month of age (18%). According to population data as the control, the odds ratio (95% confidence interval) of mother’s age ≤19 years was 11.1 (6.9–17.7) compared with ages 30–39. The odds ratio for the fourth- and later born infants was 5.2 (3.4–7.9) compared with the frequency of first-born infants. The most frequent time of day for discovery was between 7 and 8 o’clock, and the time difference from the last seen alive was a mean of 4.1 h. Co-sleeping was recorded for 61%, and the prone position was found for 40% of cases at discovery. Mother’s smoking habit exhibited an odds ratio of 4.5 (2.9–5.8).

Conclusion

This study confirmed the trends that have been observed for sudden infant death syndrome; particularly, very high odds ratios were evident for teenage mothers and later birth order in comparison with those in other developed countries. Neglect was suspected in some cases of the prolonged time to discovery of unreactive infants. To our knowledge, this is the first report of an extensive survey of SUDI during sleep in Japan.

A retrospective study of death scene investigation practices for sudden unexpected death of infants (SUDI) in Cape Town, South Africa

A death scene investigation (DSI) forms an integral part of the inquiry into death, particularly for sudden unexpected death of infants (SUDI). Global guidelines exist for DSI, however, previous studies have shown that South Africa does not routinely perform DSI for SUDI cases, nor is there a standard protocol in this regard. This was largely attributed to the large burden of SUDI cases as well as the lack of resources, due to South Africa being a developing country. This study assessed DSI practices at one of the largest mortuaries in Cape Town (Salt River Mortuary) to assess the scope of these practices within a resource-constrained context. Data were collected by retrospectively reviewing medico-legal case files (n = 454) from SUDI cases investigated at Salt River Mortuary over a two-year period. The results showed that SUDI death scenes were visited in 59.2% of cases at Salt River Mortuary, with poor and inconsistent levels of documentation. Death scenes were never investigated in cases where the infant was pronounced dead on arrival at a medical facility. The findings support the need for a locally relevant approach to DSI, coupled with specialized training for staff. Based on the limited resources, this should focus on the training of staff using the available resources and accurate use of documentation.