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HD 2 > Pathology of Death in Childhood > Flashcards

Pathology of Death in Childhood Flashcards

1
Q

What is meant by infant mortality?

A

death <1 year of age

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2
Q

A baby may die…? (3)

A 
Before leaving hospital (congenital malformations, complications of pregnancy &amp; delivery)
After admission for recognised illness
At home (sudden unexpected deaths)
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3
Q

What is SUDI?

A

Sudden unexpected death in infancy - an unexpected death in a child under 1 year of age.

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4
Q

How is SIDS diagnosed?

A

All unexpected deaths in infancy should be referred to the Coroner for autopsy. If autopsy fails to demonstrate an abnormality = SIDS

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5
Q

What are the top 3 causes of infant mortality?

A

Congenital anomalies
Disorders relating to short gestation
SIDS

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6
Q

What does infant death vary depending on? (2)

A

Ethnic background - e.g. Caribbean with immaturity related conditions
Parents’ job/SES

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7
Q

What other causes of infant mortality are there? (2)

A

Infections

Asphyxia/trauma

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8
Q

What types of sudden unexplained death are there? (3)

A

Baby is found dead in the cot/bed
Baby dies in parents/carers arms (instantaneous death) - obvious cause or not apparent
Rapid death due to a recognised illness

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9
Q

Why might the baby be found dead in the cot? (8)

A 
Congenital heart disease
Respiratory infections
CNS infections
Septicaemia
Intoxication
Seizure disorders
Unexplained (SIDS)
Suffocation and NAI
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10
Q

What might cause instantaneous death (obvious cause)?

A

Accident or trauma

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11
Q

What might cause instantaneous death (cause not apparent)?

A 
Cardiac malformation
Coronary arteritis or myocarditis
Cardiomyopathy
Arrhythmia
Respiratory foreign body or laryngeal cyst
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12
Q

What are the causes of rapid death due to a recognised illness?

A 
Respiratory infections
CNS infections
Gastroenteritis
Other infections
Reye’s syndrome
CNS haemorrhage
Congenital adrenal hyperplasia
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13
Q

Why doing a post-mortem in sudden unexpected infant death? (4)

A

To establish whether death was natural or not
To elucidate the cause of death
To provide basis for counselling
Accurate certification of death for epidemiological and research purposes

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14
Q

Current definition of SIDS?

A

The sudden unexpected death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the clinical history.

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15
Q

When is SIDS most common?

A

Between 4 and 20 weeks

  1. 1% 1-3 months
  2. 3% 4-6 months
  3. 5% <1 month
  4. 1% 7-12 months
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16
Q

When is SIDS most common (season)?

A

Winter

17
Q

What types of SIDS are there? (3)

A

Death occurs silently during sleep
SIDS while awake
Resuscitated SIDS

18
Q

What are the risks for SIDS?

A 
Social class IV or V
Unmarried mother
Young mother
High parity
High birth order
Short inter pregnancy interval
City dweller
Co-sleeping
Maternal smoking
Maternal opiate addiction
Maternal infection in pregnancy
Low birth weight 
Preterm 
IUGR
Twins
Minor malformations
19
Q

What is the triple risk hypothesis for SIDS?

A 
Vulnerable infant (physiologic responses)
Exogenous stressor (environment)
Critical developmental period (age)
20
Q

What is meant by critical developmental period?

A
  • Developmental immaturity
  • Rapid changes between 1 and 5 months
  • Abnormalities in arcuate nucleus of brainstem suggests delayed development of arousal, cardio-respiratory control or cardiovascular control and thermal regulation
  • Laryngeal spasm with GOR
  • Autoresuscitation from apnoea
21
Q

What is meant by a vulnerable infant? (3)

A

Long QT syndrome
Abnormality of the serotoninergic network (including arcuate nucleus)
Slower responses to changes (increase in heart rate or breathing)

22
Q

What is meant by external stressors?

A 
Minor URTI
Prone position
Bed-sharing
Overheating
Hyperthermia
23
Q

What are the typical external findings? (3)

A

Body apparently well developed and well nourished
Frothy fluid around nose (often blood-tinged)
Cyanosis of lips and nail-beds

24
Q

What are the typical internal findings? (7)

A 
“Large” thymus with petechiae
Petechiae pleura
Epicardial petechiae
Full expansion of lungs
Liquid heart blood
Empty bladder
Prominent LN &amp; Peyer’s patches
25
Q

What is seen microscopically?

A

Pulmonary congestion and oedema
Mild inflammation of upper respiratory tract
Focal fibrinoid necrosis of vocal cords
Persistent haemopoiesis in the liver

26
Q

SIDS or suffocation?

A

Impossible to distinguish at PM

Better to call “unascertained” if not sure

HD 2 (25 decks)

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