Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.4128
Peer-review started: April 14, 2020
First decision: July 25, 2020
Revised: August 2, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: September 26, 2020
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.
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.
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.
Core Tip: The most frequent causes of pulmonary aspiration were caused by milk (31.8%). Predisposing factors include any condition that alters the state of consciousness or creates dysfunction of deglutition. In general, Gastric contents are related to aspiration pneumonia and present in the lungs of 30% to 40% of infants whose deaths are attributed to sudden infant death. The postmortem diagnosis of milk aspiration is a challenge for clinician and pathologist. In case of sudden unexpected infant death from milk aspiration a broad diagnostic approach is necessary for an identification of the cause of death. Postmortem computed tomography 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.