Investigation of Sudden Investigation of Sudden and Unexpected - PowerPoint PPT Presentation

Investigation of Sudden Investigation of Sudden and Unexpected Infant and Unexpected Infant Deaths Deaths Melanie Newbould Melanie Newbould Paediatric and Perinatal Paediatric and Perinatal Pathologist Pathologist RMCH RMCH

Every year in England Every year in England and Wales… … and Wales • Around 600 babies die suddenly Around 600 babies die suddenly • and unexpectedly in the first and unexpectedly in the first year of life year of life • In Lancashire and greater In Lancashire and greater • Manchester we see around 90- - Manchester we see around 90 100 each year 100 each year

We have become We have become increasing aware… … increasing aware • That we simply cannot distinguish That we simply cannot distinguish • deaths due to some natural cause deaths due to some natural cause from those due to asphyxia – – the the from those due to asphyxia asphyxia can be accidental or in asphyxia can be accidental or in some cases deliberate some cases deliberate • We get occasional cases in which a We get occasional cases in which a • parent confesses to deliberately parent confesses to deliberately smothering the child and we know smothering the child and we know that without the confession we really that without the confession we really would not identify these cases would not identify these cases

So for the past 8 years So for the past 8 years • We have in this region stopped using We have in this region stopped using • the term “ “SIDS SIDS” ” because this implies because this implies the term a natural disease a natural disease • We now use the term We now use the term • “unascertained unascertained” ” for the cause of for the cause of “ death and use the term “ “Sudden Sudden death and use the term Unexpected Death in Infancy” ” or or Unexpected Death in Infancy SUDI to describe the typical to describe the typical SUDI presentation presentation

Because we give “ “Unascertained Unascertained” ” Because we give as the cause of death as the cause of death • It means that there will be an It means that there will be an • inquest inquest • This is because in order to do This is because in order to do • any investigations such as any investigations such as histology, microbiology, histology, microbiology, metabolic studies, toxicology metabolic studies, toxicology the Coroner must open an the Coroner must open an inquest – – this is the Law this is the Law inquest

At the Inquest… … At the Inquest • The Coroner takes evidence The Coroner takes evidence • from the pathologist(s) and from the pathologist(s) and sometimes other clinicians sometimes other clinicians • He/she then gives a decision as He/she then gives a decision as • to whether the death is natural to whether the death is natural or not on the balance of or not on the balance of probabilities probabilities

The Kennedy Report The Kennedy Report • Published in 2004 Published in 2004 • • Was set up following the release Was set up following the release • from prison of Sally Clark in Jan from prison of Sally Clark in Jan 2003 2003 • She was convicted of killing her She was convicted of killing her • two infant sons who it was two infant sons who it was claimed had died suddenly and claimed had died suddenly and unexpectedly unexpectedly

The Kennedy Report The Kennedy Report • Suggested a multi Suggested a multi- -agency agency • approach to the investigation of approach to the investigation of SUDI SUDI • It is suggested that all It is suggested that all • personnel dealing with the death personnel dealing with the death should have some specialised should have some specialised experience experience

It is suggested… … It is suggested • That the baby is taken That the baby is taken • immediately into A&E immediately into A&E department department • It is suggested that some It is suggested that some • specimens are taken specimens are taken immediately from the body immediately from the body

Initially Initially • There should be a strategy for There should be a strategy for • investigation decided between the investigation decided between the paediatric department and the police paediatric department and the police • As soon as possible the parental As soon as possible the parental • home should be visited home should be visited • A key part of the Kennedy Report is A key part of the Kennedy Report is • the instigation of a specialised the instigation of a specialised paediatrician who will visit the paediatrician who will visit the parental home in the first 24 hours parental home in the first 24 hours following the death and investigate following the death and investigate such matters as sleeping such matters as sleeping arrangements arrangements

The paediatrician then… … The paediatrician then • Complies a report for the Coroner Complies a report for the Coroner • and the pathologist and the pathologist • The Coroner orders the post mortem The Coroner orders the post mortem • examination usually to take place examination usually to take place within 2- -3 days of death 3 days of death within 2 • This will usually be carried out by a This will usually be carried out by a • pathologist with a special interest in pathologist with a special interest in paediatric examinations, sometimes paediatric examinations, sometimes with a forensic pathologist – – who is who is with a forensic pathologist an expert in injury an expert in injury

Unless there is an Unless there is an obvious cause… … obvious cause • The pathologist(s) must give the The pathologist(s) must give the • cause of death as “ “Unexplained Unexplained” ” cause of death as or “ “Unascertained Unascertained” ” at this stage at this stage or • The Coroner will then open an The Coroner will then open an • inquest following which the inquest following which the funeral can usually be held (not funeral can usually be held (not if any injuries have been found) if any injuries have been found)

The Post mortem report is The Post mortem report is confidential until the inquest confidential until the inquest • It must not be disclosed to a third It must not be disclosed to a third • party without Coronial consent (that party without Coronial consent (that includes the paediatrician! – – however however includes the paediatrician! in most cases this is a formality only in most cases this is a formality only • As soon as possible it is As soon as possible it is • recommended that the paediatrician recommended that the paediatrician goes through the post mortem goes through the post mortem findings with the family findings with the family

The Kennedy report… … The Kennedy report • Recommends that all professionals Recommends that all professionals • involved meet 2- -3 months after the 3 months after the involved meet 2 death (GP, Paediatrician, police, death (GP, Paediatrician, police, social workers etc) and discuss their social workers etc) and discuss their findings. The report generated by findings. The report generated by this meeting should then be made this meeting should then be made available to the Coroner before the available to the Coroner before the inquest inquest • The paediatrician should also write a The paediatrician should also write a • detailed letter to the parents detailed letter to the parents explaining all the findings of this explaining all the findings of this report and offer to meet them report and offer to meet them

At the inquest… … At the inquest • At the inquest (held when all At the inquest (held when all • statements and results are available) statements and results are available) the Coroner decides the Cause of the Coroner decides the Cause of death and the death certificate is death and the death certificate is issued issued • The inquest is public The inquest is public – – the press are the press are • usually there – – (there may issues of (there may issues of usually there interest to the public involved). The interest to the public involved). The Kennedy report recommends that it Kennedy report recommends that it is held in private if at all possible is held in private if at all possible

The Kennedy Report … … The Kennedy Report • Recommends that two terms Recommends that two terms • should be used … … should be used – SIDS SIDS – – for those cases that fulfil for those cases that fulfil – the criteria exactly the criteria exactly – SUDI SUDI for other deaths where there for other deaths where there – are no post mortem findings and are no post mortem findings and where the police are not where the police are not conducting an investigation conducting an investigation