[The differential diagnosis of sudden infant death or child abuse--a case of fatal hyperthermia].
During summer-like outdoor temperature, a seven-month old female infant was put into a sleeping bag, wrapped up with a blanket and tied up by her mother and a friend of hers because of unrest and continuous screaming. Prior to that, between 0.30 a.m. and 0.45 a.m., occurred the rectal measurement of temperature: 37.5 degrees C. The infant died one to two hours later. At 10.00 a.m., about 8 hours after death, in the criminal investigations of the police measurements of temperature were made: rectal 38.1 degrees C; in the pharyngeal cavity 29.5 degrees C; surrounding temperature 22.2 degrees C. In the forensic autopsy, symptoms of maltreatment were noticed: hematoma of the skin at buttock and legs, no essential change of organs. The histological investigation showed an interstitial pulmonary oedema, an acute catarrhal tracheobronchitis and hyperaemic inner organs. Concerning the complete investigation results, an acute cardiac insufficiency and circulatory failure due to hyperthermy after wrapping up and immobilisation of the child were assumed to be the cause of death. In consequence of the avowal of the maltreater they were accused of murder and convicted for bodily injury with death. The difficulties of the differential diagnosis SIDS by hyperthermy and mortal hyperthermy due to maltreatment will be discussed. The necessity of a close cooperation between police and forensic physicians is emphasized as prerequisite to clarify such events.
Joachim
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Miltner
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D001831:Body Temperature; D002649:Child Abuse / Q000331:legislation & jurisprudence*; D003937:Diagnosis, Differential; D005260:Female; D006359:Heat Exhaustion / Q000473:pathology*; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology; D011180:Postmortem Changes; D013398:Sudden Infant Death / Q000473:pathology*
Zur Differentialdiagnose plötzlicher Säuglingstod oder Misshandlung--ein Fall von tödlicher Hyperthermie.