"Back to sleep" and unexplained death in infants.
OBJECTIVE
Investigation of body position in infants with sudden and apparently unexplained death. Determination of the upper airway space of the infants in different positions by computed tomography (CT) scan. Comparison of the CT scan, the body position at death scene, and the autopsy results.


METHODS
Prospective investigation on all infants referred to a specialized center investigating abrupt and apparently unexplained death of infants.


METHODS
Full-term infants with sudden and clinically unexplained death. Four extra infants studied at different postmortem times to verify absence of change in measurement in postmortem CT scan over time.


METHODS
Position of infant when found dead. CT scan of upper airway in 3 positions (prone face down, prone head rotated, supine nose up), presence or absence of upper airway obstruction, level and length of the obstruction, presence or absence of cause of death, and presence or absence of small maxillomandibular complex at autopsy.


RESULTS
Twenty-seven children had unexpected crib deaths (17 of them determined to be sudden infant death syndrome at autopsy). Fourteen children were found dead in the prone position; for 8 of them, this was their normal sleeping position. Airway occlusion behind the base of tongue was seen on CT scan in 24 of the 27 infants (89%) when placed prone head down; in 13 (48%) when placed prone with the head rotated to the side, and in 5 (18%) infants in the supine position. Four infants had mild facial dysplasia and had been found dead in the supine position; in 3 of them, sudden infant death syndrome was found to be the cause of death. The stability of CT scan findings over time was demonstrated after death in 3 different body positions.


CONCLUSIONS
Supine sleeping position may not be necessarily protective when small jaws are present, and sleeping position may also be a factor in abrupt deaths in infants even if "explained by autopsy."
Rambaud
Caroline
C
Centre "mort subite du nourrisson " Hopital Antoine Beclere, Clamart, France.
Guilleminault
Christian
C
D000402:Airway Obstruction / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D006928:Hyoid Bone / Q000000981:diagnostic imaging / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008844:Micrognathism / Q000000981:diagnostic imaging* / Q000473:pathology; D010159:Palate / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D016684:Prone Position / Q000502:physiology*; D012137:Respiratory System / Q000000981:diagnostic imaging / Q000473:pathology; D012307:Risk Factors; D013398:Sudden Infant Death / Q000209:etiology* / Q000473:pathology; D016683:Supine Position / Q000502:physiology*; D014057:Tomography, X-Ray Computed