CHILD DEATH

Dr. Saber Makki

1- CAUSES OF DEATH IN A NEW BORN
INFANT
Immaturity*

Congenital anamolies and mal formation*

Difficult labor*

Accidental suffocation by inhaled mucus*

Accidental strangulation during delivery by*
the umbilical cord

*Accidental cord prolapse leading to asphyxia

Congenital syphilis*

R H . incompatibility*
 SUDDEN INFANT DEATH -2 
SYNDROME
( SIDS ) ( COT OR CRIB DEATH )

• DEFINITION :-
Sudden and unexpected death of an infant in
apparent good health , without revealing a
commonly accepted cause of death in
.autopsy
 FEATURES:
1- Age range 2wks ---2years , most death takes
place between 1 and 7 months , with a peak
of 2- 3 month .

2- Little sex difference , slight preponderance of

males .

3-More common in multiple birth .

4- More common in premature .

5- Marked seasonal variation and more

common in colder countries and winter
months .

6- High incidence in disadvantaged families

such as poor housing , lower occupational
status , one – parent family etc .
CAUSES:- Unknown but there are some
suggested causes such as:-

.Allergy to cow’s milk or house mites -1

. Botulism -2

. Prolonged sleep apnea -3

. Spinal hemorrhages ( birth trauma ) -4

. Deficiency of liver enzymes -5

. Selenium and vitamin E deficiency -6

. Metabolic defects -7

.Vaccinations -8

. Hyper and hypothermia -9

. CO and CO2 poisoning – 10 

. Viral bronchiolitis -11

. Muscle hypotonia -12

. H – pylori infection -13

Hypernatraemia from incorrectly prepared -14

. food
AUTOPSY usually negative ( non- specific )

It is diagnosed by exclusion

 Infanticide

• Def : the actual meaning is killing of an infant

• Medico legally : murder of the newly – born
live – born infant
• Newly born : during the first 15 days after
birth
• Live – born : an infant born
• Alive : this detected by the signs of live birth
• The murderer here is usually the mother and
the victim is her illegitimate infant .
 Signs of live birth :
 
• 2 groups :

• 1- Non – medical evidence

* witness > infant moved a limb, cried ,
sneezed …….. etc
 2- Medical signs :
*External :
A- Umbilicus :
- 1 day after delivery > ring of hyperemia
- 2 days > ulceration starts in the ring
- 1 week > complete separation and falling of
the stump but leaving a raw area
- 2 weeks > complete healing with formation of
normal umbilicus
 
: B – The skin
Skin desquamation which starts 2 days in the
trunk and has the whole body in 2 weeks
 
C- Anti mortem injury :Instruments e.g.forceps
.(may be the cause of death)
. Violence before death
 
D- Yellowish stool in the wrapping ; denotes
feeding should be differentiated from
meconium

E – Presence of maceration ; against live birth (

indicates still birth )
* INTERNAL SIGNS :
 RESPIRATION
 
Eye appearance of the lungs -
Lungs large > filling the chest cavity covering -
the heart and the thymus
The lungs have rounded edges -
The lungs have mosaic appearance ( mottled) -
- Crepitus : when squeezed
: Non respired lungs are * 
Solid , sharps edges , small in size
Not filling the chest cavity , not covering the
heart and the thymus
Also have diffuse non- mottled purple color

: Microscopic : non respired

Columnar epithelium ( look like salivary
) glands
 : Respired lungs
distended alveoli ( filled with air ) which are
.lined with squamous epithelium
 
-:Static test
Respired(R) lungs are heavier than non
respired(NR) lungs
 
R = 2NR
R= 80grams = 1/35 of body wt
NR= 40grams = 1/70 of body wt
 
-:Hydrostatic test
Respiration reduces the specific gravity of the
lungs and they float in water
• Method :
the lungs and the heart as a mass are put in
water , then separate into pieces and put
again , after that squeezed and put again.
: Result 
If the whole mass and the pieces before after*
squeezing float = true positive

If the whole heart float and small pieces float*

put if don't float after squeezing : gases of
putrefaction

If the whole mass float , put some pieces*

don't this partial breathing

If the whole mass sinks down : still – birth *

 NOTES:
• Non – respired lungs might float due to
putrefaction or artificial respiration.

• Respired lungs may sink due to disease (atelectasis

or pneumonia).

• Pathology : confirmed by histopathology in cases

of putrefaction gases are not in the alveoli put
collect under the pleura can be expelled by
squeezing , also other signs of putrefaction are
found
• * Child might respire inside the uterus
( vagitus uterinus) or inside the vagina
( vagitus vaginalis )
 STOMACH – BOWEL FLOATATION
TEST
 
• The stomach ,

• The duodenum and the upper and the lower

part of the intestine are ligated separately
and divided then they are put in water.
 
:RESULTS
If stomach only float : respiration -1

If the stomach , duodenum and the upper -2

part of the intestine float : respiration and
survival for at least 3hrs

If all parts float : respiration and survival for-3

at least 6 hrs
 SIGNS OF FEEDING:
In the stomach in the form of colostrums or -1
digested milk

2- In the intestine : well – formed stool

 CARDIOVASCULAR CHANGES :
: Umbilical vessels -1 
They undergo certain changes till complete
:obliteration
2days after birth : become shrunken and filled
with clotted red blood
wk organization of clot starts 1
wk complete organization 2
wk complete disappearance of the 4
lumen and transformation of umbilical
vessel into fibrous cords ( ligaments )
: Foramen ovale -2
Closes completely in 7 days

3- Ductus anteriosus
Functional closure 6 hrs
 How long the infant survived after
birth :
The changes occurring around the base of the -1
umbilical cord

Desquamation of the skin and its extent-2

Antemartem injuries -3
Floatation of the stomach and intestines -4

Changes in the umbilical vessels -5

Closure of foramen ovale -6

Closure of ductus arteriosus -7

 MECHANISMS OF DEATH :
Negligence or omission *
Feeding , clothing , non-tying the cord ( causes
septic complications ) may cause death of the
infant
 
:Violence or acts of commission *
E.g. smothering , throttling , strangulation ,
drowning , choking , cut throat or head
injury
 NOTE:-
•  Some times death may be attributed to
Difficult labor , precipitate labor

Or

• Instrumentation ( eg forceps )
 
 1- IN difficult labor :
 Primigravida

 With narrow passages

 Infant : huge caput succedaneum

 Injury simple fissure ( never depress)

: IN precipitate labor -2
Multi Para *

With wide passages *

Relative small size*

No caput in the head*

Cord is long enough to reach the ground or*

may be torn
Simple fissure in parietal or frontal ( never*
depressed )

-:NB

The presence of an extensive fracture in the

skull is against precipitate labour
: IN forceps -3

Injury in the from of depressed fracture taking

the shape of the blades of the forceps.
 FEATURES OF MATURITY ( 9month )
Length = 50cm -1 

Wt= 3,5 kg-2

Wt of placenta = 500grams -3

The length of cord = 50 cm and joins , the body at -4

.its middle

5- Nails project beyond the fingers but just the end of

the toes.
Posterior fontanel is closed , anterior fontanel -6
.still open

Ossific centers appear in the cuboid and upper-7

end of the tibia and the centre of the lower end
.of the femur reaches 0,5 cm in diameter

Head circumference is 33cm and the head hair is -8

.2 – 3 cm in length

Testicles are present in the scrotum ( in males ) -9

IMPORTANT POINTS AT AUTOPSY:
Identification features -1 

Is it viable or not in case of premature -2

Is it born alive or still born -3

4- Time of survival after birth in the case of live

birth
Is it mature or premature -5 

The type of delivery , normal , difficult or-6

precipitate

The cause of death -7

Time passed since death-8

•Thank you very
much