Answers Elude in Baby Deaths

"All these parents, they are given a diagnosis of 'undetermined', which doesn't mean anything. They are left under suspicion. The focus has been lost, because what kind of research can you do on 'undetermined?'"
Dr. Ernest Cutz, pathology professor, University of Toronto

"I do understand how some people may feel they may have contributed to that [death]. I can't say 'No' to them, because I don't know the actual answer. We need to be completely transparent with families about what we know."
Dr. Dirk Huyer, chief coroner, Ontario

 MedicineNet.com

What could possibly be more devastating for any parent than to discover a baby in its crib, unresponsive, cold, its life slipped away into death. Mothers of newborns are accustomed to hearing their babies communicate their needs by crying to be fed, for diapers to be changed, to be fussed with, expressing distress over feeling unwell, the usual routine when a baby is new to life and its mother is new to motherhood. What mother hasn't imagined in her darkest moments that the atmosphere is suddenly too still, no fussing, no crying, is the baby all right?

Baby care is a matter of utmost significance and tension to any new mother looking for what worked best for her mother, for her friends, asking probing questions, reading baby-care instructions to still the uncertainty and instill a measure of confidence. There are opinions of proper baby care that encompass the spectrum from best practices to experimental. At one time in poor households where space was at a premium and money scarce, newborns slept with their mothers in the marital bed. No end of accidents where roll-overs during a night of sound sleep could smother a tiny baby.

There has been a renaissance of having a baby or infant sleep in the same bed as its parents, among a more modern, well-to-do cohort of new parents, with disagreement among health professionals and older parents alike over the safety involved for the child. New mothers were often told that babies could sleep in any position, on their backs, stomachs, or propped on their sides to help them expel gas, or to ensure they would not choke when they threw up as babies often do.

No baby's welfare, or potential to come to harm, however, should ever be neglected by not checking in from time to time for reassurance and speedy response should the need arise. A phenomenon of babies appearing to be normal and healthy suddenly dying became an issue which was identified as SIDS (sudden infant death syndrome), associated with a number of issues, in an scientific attempt to try to understand why these deaths were occurring. And also to help parents reach an emotional exoneration.

Fotolia   Everyone agrees that educating parents to make their babies’ “sleep environment” safer has sharply reduced the number of SIDS deaths. But the problem has been far from eradicated.

 

The 'root causes' are still not fully understood to have been made explicable, but there are many theories, that arose in the mid 1960s onward when the nomenclature of SIDS first came into use. Above all, there has been a public mass educational effort put forward to exhort parents always to place their babies on their backs during sleep, not to smoke in the baby's presence, to be watchful for signs of physical distress. In fact, since that public expression of best-practise in babycare was undertaken, the incidence of SIDS decreased.

Now, however, coroners believe that proclaiming a death the results of SIDS is too ill-defined; their emphasis is on the need to single out recognized safety issues, such as a baby's sleeping position, and indulging in truthful introspection when no clear answer responds to an incident of a baby's death. Though the sense of parental feelings of grief and guilt can be overwhelming, pediatricians tend to agree with the conclusion of coroners in this matter.

It was the compassionate solution of Dr. Abraham Bergman, a pediatrics professor in Seattle who led the issue in the medical community in an effort to bring relief from guilt to parents of infants who had suddenly died, and to try to understand just what might be the driving issues behind the phenomenon of a seemingly healthy child suddenly dying. The SIDS categorization achieved two ends: it gave relief to grief-stricken parents, and drove medical science to undertake research into the issue.

Lately, in North America, there have been scant designations of SIDS deaths by medical examiners, overturning the practise of the past decades to label little-understood sudden deaths of infants as SIDS-occasioned. It was observed that these deaths decreased markedly once the public education campaign had made its mark; emphasizing to new parents that babies require a safe "sleep environment" where they are placed on their backs to sleep, no one smokes near them, or shares a bed with them.

Drs. Cutz and Bergman remain convinced that an unknown biological or genetic problem is involved making some infants susceptible to SIDS. That risk factors like sleeping on their stomachs face down doesn't harm all babies, but does some who are for some unidentified reason, vulnerable. Dr. Cutz points out that many babies sleep on their stomachs, but a mere handful pay the deadly consequences for doing so.

Ontario's chief coroner points to the fact that underlying illness is seldom identified in a SIDS death, compelling those in his profession to attempt to discover more identifiable risk issues involved. He finds himself at odds with the natural lethality of a disease brought on by a baby sleeping on its stomach, whereas he can identify with the act itself of placing a baby to sleep on its stomach capable of compromising airways.

The Canadian Chief Coroners and Medical Examiners group agreed on a resolution in 2012 to favour classifying the issue as "undetermined" in assessing the cause of death, rather than SIDS, when an autopsy is unable to identify a singular cause of death. Dr. Cutz, who published an article in the journal JAMA Pediatrics arguing for the re-application of the SIDS terminology in the instances of sudden deaths of infants, disagrees.