Autopsy findings of co-sleeping-associated sudden unexpected deaths in infancy: Relationship between pathological features and asphyxial mode of death

• Published in: Journal of paediatrics and child health Vol. 48; no. 4; pp. 335 - 341
• Main Authors: Weber, Martin A, Risdon, R Anthony, Ashworth, Michael T, Malone, Marian, Sebire, Neil J
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.04.2012; Blackwell Publishing Ltd
• Subjects: Asphyxia - etiology; Asphyxia - pathology; Autopsy; Babies; Cause of Death; co-sleeping; Confidence Intervals; Humans; infancy; Infant; Infants; London; Lung; Mortality; Pathogens; Pediatrics; Retrospective Studies; Risk Factors; SIDS; Sleep; Sudden Infant Death - etiology; Sudden Infant Death - pathology; Sudden infant death syndrome; sudden unexpected death; SUDI; Sudis; Suffocation; London; British Isles
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/j.1440-1754.2011.02228.x

Aim:  Co‐sleeping is associated with increased risk of sudden unexpected death in infancy (SUDI)/sudden infant death syndrome (SIDS). The aim of this study is to examine autopsy findings from a single UK specialist centre to determine the relationship between co‐sleeping and cause of death. Methods:  Retrospective analysis of >1500 paediatric autopsies carried out by paediatric pathologists over a 10‐year period. SUDI was defined as sudden unexpected death of an infant aged 7–365 days; deaths were categorised into explained SUDI (cause of death was determined) and unexplained SUDI (equivalent to SIDS). Results:  There were 546 SUDI; sleeping arrangements were specifically recorded in 314; of these, 174 (55%) were co‐sleeping‐associated deaths. Almost two thirds (59%) of unexplained SUDI were co‐sleeping compared to 44% explained SUDI (95% confidence interval (CI) 1.0–27.2%, P= 0.03); however, this difference remained statistically significant only for the first 5 months of life (95% CI 3.5–33.2%, P= 0.01). In unexplained SUDI aged < 6 months, there were no significant differences between co‐sleeping and non‐co‐sleeping deaths with respect to ante‐mortem symptoms, intrathoracic petechiae, macroscopic lung appearances, pulmonary haemosiderin‐laden macrophages, and isolation of specific bacterial pathogens; however, fresh intra‐alveolar haemorrhage was reported more commonly in co‐sleeping (54%) than in those that were not (38%; 95% CI 1.4–30.5%, P= 0.03). Conclusions:  Co‐sleeping is associated with unexplained SUDI/SIDS in infants aged < 6 months, suggesting that co‐sleeping is related to the pathogenesis of death in younger infants. The finding that intra‐alveolar haemorrhage is more common in co‐sleeping suggests that a minority of co‐sleeping‐associated deaths may be related to an asphyxial process.