Autopsy Report Questions

26 Jul 1998

Well, I paid my $20 and got the autopsy today. Excuse the typos that will appear. My hands are shaking so badly I can't stop them. My baby's death was declared cerebral anoxia, whatever that means. I was confused about lots of stuff (our pediatrician said he'd translate for us), but maybe you can help for some of this. They wrote "In hospital 'brain dead' protocol and ventilator 40 hrs. Brain swollen 430 grams. Lungs markedly congested and edematous. No petechiae and no optic nerve sheath hemorrhages. Thymus small <5 grams. No congenital anomaly identified. Values for height and weight on growth charts are within 50th percentile." Manner of death (no big surprise): undetermined.

Why would my baby's brain be swollen? They said no hemorrhage or focal abnormality -- whatever that means. Should I have noticed that my baby's lungs/breathing were congested (or is that what happened from being dead and on the ventilator?????). I'm assuming the optic nerve stuff is looking for shaken baby syndrome. Is 50th percentile bad? Or is that just right?

Just responding to your questions about the autopsy report, without knowing any of the history, the findings are fully consistent with SIDS in an infant that was admitted brain dead and artificially supported for a brief period of time. All of the lung and brain congestion (edema) are secondary. 50th percentile means at the middle of the normal range. Since there were no areas of localized bleeding in the brain, this indicates that trauma was not the underlying cause of death.

It is confusing when the autopsy report focuses on the secondary findings and not the primary event, but that is why review of all sudden and unexpected infant deaths is necessary to correctly identify those that are indeed SIDS.

I hope these responses about my baby's autopsy results are helpful.

Dr. Carl Hunt
chunt@MCO.EDU

4/21/97

I have some questions pertaining to a few comments and the language used on my daughters death certificate.
a.) acute cerebral anoxia
b.) acute obstruction of airway (she had a bottle 1/2 hour before the sitter found her and when they did CPR on her she vomited)
c.) aspiration of post prandial vomitus
d.) viral pneumonitis, bronchitis, epiglottitia

The first three were listed as minutes of onset of death were the last one was 1-2 days before death. Is the medical examiner saying it was or was not SIDS since there is no indication on the death certificate? I have read in some articles that sometimes there is a virus in a number of SIDS cases and I was wondering if this might be one?

The diagnosis of epiglottitis seems extraordinarily unlikely given the rarity of the microorganism most commonly responsible for this disorder. This disorder virtually never occurs during the age when SIDS occurs. Since the Hemophilus influenza vaccine has become available, the disease is rare in children of any age.

Aspiration always deserves consideration. There is too little information to comment further other than to say that this diagnosis is too often confused with SIDS. Gastric contents can pass into the upper airway after death, especially if the body is moved around. The same is true in cases of cardiopulmonary respiration.

Airway obstruction requires a careful description of the death scene, at face value it seems like a rather dubious diagnosis.

Henry Krous
Children's Hospital - San Diego