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Osawa M, Ikeda H, Ueda A, Naito H, Nagao R, Kakimoto Y. Gastric aspiration in sudden unexpected infant death of Prader-Willi syndrome: immunohistochemical detection of feeding components. Int J Legal Med 2022; 136:1883-1888. [PMID: 36018383 PMCID: PMC9576639 DOI: 10.1007/s00414-022-02883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
Abstract
Prader–Willi syndrome (PWS) in infants is characterized by hypotonia and poor sucking with feeding difficulties. Two autopsy cases of sudden unexpected death during sleep after tube feeding are described herein. For one, gastric aspiration caused by the possible milk regurgitation was suspected. Immunohistochemical examination of lung sections was performed using three antibodies to human α-lactalbumin, human gross cystic disease fluid protein 15, and cow whey β-lactoglobulin. Five cases of sudden unexpected infant death occurring earlier than at 6 months old were selected as controls. Marked immune-staining for infant formula in one PWS subject was evident within terminal bronchioles and alveoli with granular and amorphous features. However, no positive staining was apparent in the other subject, who exhibited contrasting features in milk distribution. Among control cases, one showed mild staining in the bronchiole, but the others did not. The antibody to β-lactoglobulin reacted specifically with formula, with no nonspecific background. Gastric contents in the airway can be a difficult issue because of the consequent terminal gasping. However, because of an episode of antemortem symptoms of potential regurgitation, and from findings at autopsy such as petechiae, we inferred that fatal regurgitation occurred in this PWS infant after tube feeding. Several clinical reports have described milk aspiration, but this pathological report is the first related to aspiration in PWS during tube feeding.
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Affiliation(s)
- Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Haruka Ikeda
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Atsushi Ueda
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Haruaki Naito
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Ryoko Nagao
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yu Kakimoto
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Ritondo BL, Rogliani P, Facciolo F, Falco S, Vocale A, Calzetta L. Beclomethasone dipropionate and sodium cromoglycate protect against airway hyperresponsiveness in a human ex vivo model of cow's milk aspiration. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100010. [PMID: 34909646 PMCID: PMC8663930 DOI: 10.1016/j.crphar.2020.100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Recurrent cow's milk (CM) aspiration is often associated with gastroesophageal reflux in infants and toddlers and it seems to be implicated in the etiology of different inflammatory lung disorders. This study aimed to investigate ex vivo the impact of CM aspiration on human airways and whether treatment with beclomethasone dipropionate (BDP) or sodium cromoglycate (SCG) may prevent the potential CM-induced airway hyperresponsiveness (AHR). Methods Human isolated bronchi were contracted by electrical field stimulation (EFS10Hz) to mimic the contractile tone induced by the parasympathetic activity and challenged with CM, fat/lactose-free CM, or human breast milk (HM). The effect of pre-treatment with beclomethasone dipropionate (BDP) and sodium cromoglycate (SCG) was also investigated on the AHR induced by CM. Results After a 60 min-challenge with CM 1:10 v/v and fat/lactose-free CM 1:10 v/v, ASM significantly (P < 0.05) increased compared to control (+67.04 ± 17.08% and +77.91 ± 1.34%, respectively), a condition that remained stable for 150 min post-treatment, whereas HM did not alter ASM contractility. BDP 1 μM and 10 μM significantly (P < 0.05) reduced the AHR elicited by CM (−52.49 ± 10.97% and −66.98 ± 7.90%, respectively vs. control). At the same manner, SCG 1 μM and 10 μM significantly (P < 0.05) inhibited the CM-induced AHR (−59.03 ± 9.24% and −73.52 ± 7.41%, respectively vs. control). Conclusion CM induces AHR in human ASM by eliciting an increased parasympathetic contractile response. Preventive treatment with nebulized SCG may be indicated in infants or toddlers fed with CM, rather than with BDP due to a superior safety profile. Cow's milk aspiration seems to be associated with some inflammatory lung diseases. Cow's milk aspiration induces human airway hyperresponsiveness. Beclomethasone and sodium cromoglycate protect against cow's milk hyperresponsiveness in vitro. Inhaled sodium cromoglycate might be suitable in children at risk of cow's milk aspiration.
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Affiliation(s)
- Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Silvia Falco
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Aurora Vocale
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Via Rasori 10, 43126, Parma, Italy
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Maiese A, La Russa R, Arcangeli M, Volonnino G, De Matteis A, Frati P, Fineschi V. Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration: A case report. World J Clin Cases 2020; 8:4128-4134. [PMID: 33024771 PMCID: PMC7520785 DOI: 10.12998/wjcc.v8.i18.4128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/02/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The term sudden unexpected infant death (SUID) is not always properly invoked. It refers to a broad range of conditions that sometimes defy classification. There is not only a strong emotional impact on the family, but such cases are also quite complex. Underlying causes may be multiple, not always readily apparent, and have potential repercussions, especially in terms of forensics.
CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest. The parents had immediately rushed their child to the hospital, stating the baby was found prone and not breathing. Total-body postmortem computed tomography (PMCT) was performed, revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change. At autopsy, the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material. There was widespread airspace reduction due to parenchymal collapse. Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells. Immunohistochemical studies were performed, targeting CD15, CD68, and alpha-lactalbumin. Ultimately, the focus was on alpha-lactalbumin (milk protein), which showed marked immunopositivity within alveolar spaces. Cytoplasmic staining of macrophages was also particularly prominent.
CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances. PMCT is a useful tool in this setting, given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases. These findings, later confirmed by immunohistochemical investigations, were indicative of active pneumonia due to aspirated milk. The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern. PMCT is a very valuable aid in cases of forensic interest, as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa 56126, Italy
| | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Mauro Arcangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Alessandra De Matteis
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Paola Frati
- Department SAIMLAL, Sapienza University of Roma, Roma 00185, Italy
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
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Calkovska A, Mokra D, Calkovsky V, Matasova K, Zibolen M. Clinical considerations when treating neonatal aspiration syndromes. Expert Rev Respir Med 2019; 13:193-203. [DOI: 10.1080/17476348.2019.1562340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Andrea Calkovska
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Daniela Mokra
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Vladimir Calkovsky
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University and University Hospital Martin, Martin, Slovakia
| | - Katarina Matasova
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital Martin, Martin, Slovakia
| | - Mirko Zibolen
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital Martin, Martin, Slovakia
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D'Arcy C, Hazrati LN, Chiasson DA. Histopathologic Analysis in Sudden Infant and Child Deaths: A Practical Approach. Acad Forensic Pathol 2018; 8:492-538. [PMID: 31240057 DOI: 10.1177/1925362118797727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/02/2018] [Indexed: 12/20/2022]
Abstract
The forensic pathologist responsible for sudden unexpected death (SUD) investigation in the pediatric setting faces many challenges. It usually takes many years to obtain reasonable experience and exposure to the wide variety of diseases that may present as SUD in a pediatric context, and to appreciate the differences in the etiology and clinical context between the pediatric and adult SUD setting. In pediatric SUD, it is necessary to conduct a systematic, pediatric-focused autopsy investigation including extensive histopathological assessment and ancillary testing. Postmortem histologic findings in the context of SUD in the pediatric population are often subtle and distinctly different from those seen in the adult population. The pathologist must have an understanding of both developmental and pathological processes in order to correctly interpret the findings during a pediatric autopsy. A system-based, histopathology-focused review of common entities, normal variants, and incidental findings that can prove challenging will be discussed. For the forensic pathologist tasked with pediatric SUD autopsies, development of a strong collaborative relationship with a pediatric pathologist and/or neuropathologist to assist with histopathological analysis is strongly endorsed.
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Volodin IA, Efremova KO, Frey R, Soldatova NV, Volodina EV. Vocal changes accompanying the descent of the larynx during ontogeny from neonates to adults in male and female goitred gazelles ( Gazella subgutturosa ). ZOOLOGY 2017; 120:31-41. [DOI: 10.1016/j.zool.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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Dempers JJ, Coldrey J, Burger EH, Thompson V, Wadee SA, Odendaal HJ, Sens MA, Randall BB, Folkerth RD, Kinney HC. The Institution of a Standardized Investigation Protocol for Sudden Infant Death in the Eastern Metropole, Cape Town, South Africa ,. J Forensic Sci 2016; 61:1508-1514. [PMID: 27677096 DOI: 10.1111/1556-4029.13204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/30/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022]
Abstract
The rate for the sudden infant death syndrome (SIDS) in Cape Town, South Africa, is estimated to be among the highest in the world (3.41/1000 live births). In several of these areas, including those of extreme poverty, only sporadic, nonstandardized infant autopsy, and death scene investigation (DSI) occurred. In this report, we detail a feasibility project comprising 18 autopsied infants with sudden and unexpected death whose causes of death were adjudicated according to the 1991 NICHD definitions (SIDS, n = 7; known cause of death, n = 7; and unclassified, n = 4). We instituted a standardized autopsy and infant DSI through a collaborative effort of local forensic pathology officers and clinical providers. The high standard of forensic investigation met international standards, identified preventable disease, and allowed for incorporation of research. We conclude that an effective infant autopsy and DSI protocol can be established in areas with both high sudden unexpected infant death, and elsewhere. (SUID)/SIDS risk and infrastructure challenges.
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Affiliation(s)
- Johan J Dempers
- Division of Forensic Medicine and Pathology, Department of Pathology and Western Cape Forensic Pathology Health Services, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Jean Coldrey
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Elsie H Burger
- Division of Forensic Medicine and Pathology, Department of Pathology and Western Cape Forensic Pathology Health Services, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Vonita Thompson
- Western Cape Forensic Pathology Service, Cape Town, South Africa
| | - Shabbir A Wadee
- Division of Forensic Medicine and Pathology, Department of Pathology and Western Cape Forensic Pathology Health Services, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Mary Ann Sens
- Department of Pathology, University of North Dakota, Grand Forks, ND
| | - Brad B Randall
- Department of Pathology, Sanford University of South Dakota School of Medicine, Sioux Falls, SD
| | - Rebecca D Folkerth
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Hannah C Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Elkins KM. Rapid presumptive "fingerprinting" of body fluids and materials by ATR FT-IR spectroscopy. J Forensic Sci 2011; 56:1580-7. [PMID: 21827466 DOI: 10.1111/j.1556-4029.2011.01870.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human body fluids and materials were evaluated using attenuated total reflectance Fourier transform infrared spectroscopy. Purified proteins, cosmetics, and foodstuffs were also assayed with the method. The results of this study show that the sampled fluids and materials vary in the fingerprint region and locations of the amide I peaks because of the secondary structure of the composite proteins although the C = O stretch is always present. The distinct 1016 cm(-1) peak serves as a signature for semen. The lipid-containing materials (e.g., fingerprints, earwax, tears, and skin) can also be easily separated from the aqueous materials because of the strong CH(3) asymmetric stretch of the former. Blood-saliva and blood-urine mixtures were also successfully differentiated using combinations of peaks. Crime scene investigators employing rapid, portable, or handheld infrared spectroscopic instruments may be able to reduce their need for invasive, destructive, and consumptive presumptive test reagents in evaluating trace evidence.
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Affiliation(s)
- Kelly M Elkins
- Department of Chemistry, Criminalistics Program, Metropolitan State College of Denver, PO Box 173362, Campus Box 52, Denver, CO 80217-3362, USA.
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Nagai T, Aoyagi M, Ochiai E, Sakai K, Maruyama-Maebashi K, Fukui K, Iwadate K. Longitudinal evaluation of immunohistochemical findings of milk aspiration: an experimental study using a murine model. Forensic Sci Int 2011; 209:183-5. [PMID: 21333474 DOI: 10.1016/j.forsciint.2011.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/19/2010] [Accepted: 01/20/2011] [Indexed: 12/21/2022]
Abstract
To examine the longitudinal change of pathological findings of the lung and other organs in milk aspiration, an experimental study using a murine model was carried out. Either 0.5 or 1.0 ml cow's milk was instilled into the trachea of rats. From immediately after to 14 days after instillation, the animals were sacrificed, and the lungs, liver, kidneys, and spleen were removed. The results of immunostaining with anti-human α lactalbumin antibody indicated that not only the lung but also the kidney and spleen showed a positive reaction against the antibody over time. Experimentally aspirated milk was detectable in alveoli until 2 days after instillation. It was also detectable in renal tubules from 1 to 6h after instillation. Macrophages containing granules of aspirated milk were observed in splenic red pulp from 3h to 14 days after instillation. Detection of aspirated milk in other organs except the lung would be clear evidence of intravital milk aspiration and would suggest previous or recurrent milk aspiration.
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Affiliation(s)
- Tomonori Nagai
- Department of Forensic Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Al-Adnani M, Cohen MC, Scheimberg I. Gastroesophageal reflux disease and sudden infant death: mechanisms behind an under-recognized association. Pediatr Dev Pathol 2011; 14:53-6. [PMID: 20429661 DOI: 10.2350/09-11-0748-cr.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present 4 cases of sudden infant death in which we believe that gastroesophageal reflux (GOR) was a contributory, if not a causative, factor. Two of our patients had documented GOR reflux disease during life, and all 4 cases showed histologic evidence of GOR. No other cause of death was identified in any of the patients. Gastroesophageal reflux can cause sudden death in a vulnerable infant during a critical period of development through failure of "autoresuscitation" mechanisms.
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Affiliation(s)
- Mudher Al-Adnani
- Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, United Kingdom.
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An autopsy case of severe pleuritis induced by misinsertion of a nasogastric nourishment tube: diagnostic significance of multinucleated giant cells. Leg Med (Tokyo) 2009; 11:191-4. [PMID: 19362870 DOI: 10.1016/j.legalmed.2009.02.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 02/27/2009] [Accepted: 02/27/2009] [Indexed: 11/20/2022]
Abstract
An 87-year-old female who had been hospitalized due to pneumonia was administered nourishment through a nasogastric tube. She collapsed as a result of dyspnea after the insertion of a new tube and administration of nourishment. Chest X-rays revealed that the tube was inserted into the left pleural cavity passing the trachea and left bronchi and that the nourishment pooled. In spite of immediate treatment including removal of the tube and insertion of a drain, she died 12 days later. Autopsy findings: Both the left pulmonary and parietal pleurae were thickened and covered with a dirty gray-yellowish moss-like paste. The left lower lobe was softened, and this region was suspected as the ruptured site of the pleura. Histological findings: A part of the thick pleura with inflammatory cells, including multinucleated giant cells, was positive-stained for anti alpha-lactalbumin antibody immunohistochemically. These giant cells are often observed in granulomatous inflammation against a foreign material. It was considered that those in the pleura had been induced by the nourishment, and that those in the pulmonary parenchyma had been affected by the insertion of the tube. The multinucleated giant cells clarified the cause of fatal pleuritis and pneumonia and the misinsertion of the tube.
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Ishikawa T, Zhu BL, Li DR, Zhao D, Michiue T, Maeda H. An autopsy case of an infant with Joubert syndrome who died unexpectedly and a review of the literature. Forensic Sci Int 2008; 179:e67-73. [DOI: 10.1016/j.forsciint.2008.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 05/30/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
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Krous HF, Masoumi H, Haas EA, Chadwick AE, Stanley C, Thach BT. Aspiration of gastric contents in sudden infant death syndrome without cardiopulmonary resuscitation. J Pediatr 2007; 150:241-6. [PMID: 17307537 DOI: 10.1016/j.jpeds.2006.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 10/31/2006] [Accepted: 12/07/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVES (1) To compare demographic profiles among sudden infant death syndrome (SIDS) infants with or without gastric aspiration, for whom cardiopulmonary resuscitation (CPR) had not been attempted; (2) to review the severity and potential significance of aspiration in those SIDS cases; and (3) to assess the risk of supine sleep position with regard to gastric aspiration. STUDY DESIGN Retrospective review of records and microscopic slides for all postneonatal SIDS cases (29 to 365 days of age) accessioned by the San Diego County Medical Examiner from 1991 to 2004. RESULTS Ten (14%) of 69 cases of SIDS infants who had not undergone CPR before autopsy revealed microscopic evidence of gastric aspiration into the distal lung; this group was not otherwise clinically or pathologically different from cases of SIDS infants without aspiration. Similar proportions of infants were found supine or prone, regardless of gastric aspiration. CONCLUSIONS Gastric aspiration is not uncommon in infants dying of SIDS, and supine sleep position does not increase its risk. Gastric aspiration may be a terminal event that some infants, representing a subset of SIDS cases, cannot overcome.
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Affiliation(s)
- Henry F Krous
- Department of Pathology, Rady Children's Hospital, San Diego, California 92123, USA.
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Alex N, Thompson JMD, Becroft DMO, Mitchell EA. Pulmonary aspiration of gastric contents and the sudden infant death syndrome. J Paediatr Child Health 2005; 41:428-31. [PMID: 16101977 DOI: 10.1111/j.1440-1754.2005.00660.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine ante-mortem and post-mortem risk factors for the finding of gastric contents in pulmonary airways (aspiration of gastric contents) at post-mortem examination in the sudden infant death syndrome (SIDS). METHODS There were 217 post-neonatal deaths in the Auckland region of the New Zealand Cot Death Study. No deaths were certified as due to aspiration of gastric contents. There were 138 SIDS cases. The parents of 110 (80%) of these cases were interviewed. Histological sections from the periphery of the lungs in 99 of the 110 cases were reviewed for evidence of aspiration of gastric contents. A wide range of variables were analysed in SIDS cases with and without aspiration to determine risk factors. RESULTS Aspiration of gastric contents was identified in 37 (37%) of SIDS cases. Aspiration was of mild-to-moderate degree and in no case was severe and a potential cause of death. Finding infants on their backs at death (P = 0.024) and conducting the post-mortem on the day after the death or subsequently (P = 0.033) were statistically significant variables linked to identification of aspiration. Position placed to sleep, symptoms of gastro-oesophageal reflux and other variables were not related to aspiration. CONCLUSIONS The only determinants for aspiration of gastric contents identified were agonal or post-mortem events, supporting the contention that aspiration has limited relevance to the mechanism of SIDS.
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Affiliation(s)
- Nishi Alex
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
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