Investigation of unexplained infant deaths in Jerusalem, Israel 1996-2003.
BACKGROUND
Sudden infant death syndrome (SIDS) is a diagnosis of exclusion that may be assigned only after investigations including a forensic autopsy are performed to exclude possible organic and environmental causes of death. Israeli society is influenced by the Jewish and Islamic faiths, which permit autopsy only under selected circumstances. Against this background, we carried out a study to determine what examinations are performed to investigate unexplained infant deaths in Jerusalem, Israel.


METHODS
We examined hospital, Ministry of Health and Ministry of Interior records of unexplained infant deaths in the Jerusalem district from the years 1996-2003.


RESULTS
Ninety six cases were identified from all sources. Forty nine (51%) infants were brought to a hospital at or near the time of death. Studies to determine the cause of death were performed in 54% of cases for which medical records were available for review. These studies included bacterial cultures (44%), skeletal surveys (12%), computerised tomography (3%) and metabolic studies (3%). Only one forensic autopsy was performed, and in no instance was the death site examined by medical personnel. There was a high rate of retrospective review by district health physicians. The most frequently assigned cause of death was SIDS.


CONCLUSIONS
: The capacity of public health officials and forensic pathologists to investigate unexplained infant deaths is strongly affected by the legal, religious and political milieu in which they work. Efforts should be made to develop socially acceptable methods of improving the quality of infant death investigations in Jerusalem.
Eisenstein
Eli M
EM
Department of Pediatrics, Hebrew University-Hadassah Medical Center, Mount Scopus, Jerusalem, Israel. eisenstein173@yahoo.com
Haklai
Ziona
Z
Schwartz
Shepard
S
Klar
Aharon
A
Stein
Nechama
N
Kerem
Eitan
E
D001344:Autopsy / Q000941:ethics / Q000331:legislation & jurisprudence; D002423:Cause of Death; D005554:Forensic Medicine / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008485:Medical Audit; D013398:Sudden Infant Death / Q000175:diagnosis* / Q000453:epidemiology