Infant death in San Francisco 1989-1990

This paper examines all of the unexplained and violent deaths of children less than one year of age in the City and County of San Francisco during the years 1989-1990. A total of 62 cases were collected and analyzed retrospectively. Among the cases we examined, 34 deaths were determined as SIDS, while seven were moded as accidents and two as homicides. The deaths were examined with respect to the following parameters: sex, race, age, height and weight, cause and manner of death, significant autopsy and microscopic findings; circumstances of death including place, the person discovering or reporting the death, the presence of siblings or previous child death in the family and previous illness in the same child. A particular stress is given to the definition and diagnosis of SIDS, according to the international literature, and to the criteria adopted to distinguish SIDS cases from accidents and homicides. A review of both the American and European literature shows that most articles do not include comparisons of data from both the autopsy and the scene. Additionally there is little standardization in the investigation and the extent of postmortem examinations performed. An international standardization of these methods appears necessary and the use of protocols to assure complete investigation and postmortem examination will allow more intensive evaluation of data. Here we give a brief presentation of the necropsy protocol for Sudden Unexpected Infant Death recently written and approved by the California Department of Health Services and used in the Chief Medical Examiner's Office in San Francisco.