Investigation of Unexplained Infant Deaths in Jerusalem, Israel, 1996-2003

Eli M Eisenstein ^1*, Ziona Haklai ², Shepard Schwartz ³, Aharon Klar ⁴, Nechama Stein ² and Eitan Kerem ¹

¹ Hadassah Medical Center, Mount Scopus, Israel
² Ministry of Health, Israel
³ Shaare Zedek Medical Center, Israel
⁴ Bikur Holim Hospital, Israel

^* To whom correspondence should be addressed. E-mail: eisenstein173{at}yahoo.com.

Accepted 11 October 2006

Abstract

Background: Sudden infant death syndrome (SIDS) is a diagnosis of exclusion, which may be assigned only after investigations including a forensic autopsy are performed to exclude possible organic and environmental causes of death. Israeli society is influenced by the Jewish and Islamic faiths, which permit autopsy only under selected circumstances. Against this background, we performed this study to determine what examinations are performed to investigate SIDS in Jerusalem, Israel.

Methods: We examined hospital, Ministry of Health and Ministry of Interior records of unexplained infant deaths in Jerusalem district from the years 1996-2003.

Results: Ninety-six cases were identified from all sources. Forty-nine (51%) were brought to a hospital at or near the time of death. Among cases in which medical records were available for review, studies to determine the cause of death were performed in 54%. These studies included bacterial cultures (54%), skeletal surveys (14%), computerized tomography (3%), and metabolic studies (3%). Only one forensic autopsy was performed, and in no instance was the death site examined by medical personnel. There was a high rate of retrospective review by District Health Physicians. The most frequently assigned cause of death was sudden infant death syndrome (SIDS).

Conclusions: The capacity of public health officials and forensic pathologists to investigate unexplained infant deaths is strongly affected by the legal, religious, and political milieu in which they perform their work. Efforts should be made to develop socially acceptable methods of improving the quality of infant death investigations in Jerusalem.

Keywords: autopsy, forensic investigation, religion, sudden infant death syndrome

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