Post-neonatal sudden unexplained death in a California community

To gain further insight into the problem of infant sudden death, a study was undertaken to investigate a complete series of cases of infant sudden unexplained death that occurred during a seven-year period in Sacramento County. Needed information was abstracted from autopsy records, Medical Examiner's records and death certificates. The average death rate for the seven-year period was 1.7 for 1,000 live births. Average age at time of death was 2.8 months. There were no records of sudden death among infants over the age of eight months. Higher than average death rates were observed within many of the low socioeconomic areas of Sacramento County. Also, sudden unexplained deaths appeared to occur more frequently in the winter months than in the spring, summer or fall. In over half the cases the infants had a cold, the sniffles, or other respiratory tract congestion within two weeks of the date of death, which seems to support the oft-quoted contention concerning the possibility of nasal obstruction which could initiate the fatal apnea. An additional notable finding was the very frequent occurrence of petechial hemorrhage in the thymus, heart, and lung tissues. The unique age distribution of these deaths in combination with the high frequency of low socioeconomic groups and the frequency of minor respiratory ailment would suggest approaches that can be taken to identify infants at high risk and thus initiate effective community health programs for prevention.