Article
Nasal and intrapulmonary haemorrhage in sudden infant death
syndrome
D M O Becrofta, J M D Thompsonb, E A Mitchellb
a Department of
Obstetrics and Gynaecology, University of Auckland, Claude Road,
Auckland 1003, New Zealand, b Department of Paediatrics, University of
Auckland, Private Bag 92019, Auckland, New Zealand
Correspondence to: Dr Thompson j.thompson{at}auckland.ac.nz
Accepted 28 February
2001
BACKGROUND
Fresh intrapulmonary and
oronasal haemorrhages in cases of sudden infant death syndrome (SIDS)
might be markers for accidental or intentional smothering
inappropriately diagnosed as SIDS.
AIMTo compare the incidence,
epidemiological association, and inter-relation of nasal haemorrhage,
intrapulmonary haemorrhage, and intrathoracic petechiae in infant
deaths certified as SIDS.
METHODSIn SIDS cases from a large
nationwide case-control study, a wide range of variables were compared
in cases with and without reported nasal haemorrhage and, in a subgroup
of cases, in those with and without pathologically significant
intrapulmonary haemorrhage.
RESULTSNasal haemorrhage was
reported in 60 of 385 cases (15%) whose parents were interviewed.
Pathologically significant intra-alveolar pulmonary haemorrhage was
found in 47% of 115 cases studied, but was severe in only 7%. Infants
with nasal haemorrhage had more haemorrhage into alveoli and air
passages than age matched cases without nasal haemorrhage. In
multivariate analysis, nasal haemorrhage was associated with younger
infant age, bed sharing, and the infant being placed non-prone to
sleep. Intrapulmonary haemorrhage was associated with the same three
factors in univariate analysis, but in multivariate analysis only
younger infant age remained statistically significant. There was no
significant association between nasal or intra-alveolar haemorrhages
and intrathoracic petechiae.
CONCLUSIONSNasal and
intrapulmonary haemorrhages have common associations not shared with
intrathoracic petechiae. Smothering is a possible common factor,
although is unlikely to be the cause in most cases presenting as SIDS.
Keywords: sudden infant death syndrome; infanticide; nasal haemorrhage; pulmonary haemorrhage
© 2001 by Archives of Disease in Childhood
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