title: Investigation of unexplained infant deaths in Jerusalem, Israel 1996-2003.
abstract: 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.
authors.affiliation: Department of Pediatrics, Hebrew University-Hadassah Medical Center, Mount Scopus, Jerusalem, Israel. eisenstein173@yahoo.com
authors.forename: Eli M
authors.initials: EM
authors.lastname: Eisenstein
authors.forename: Ziona
authors.initials: Z
authors.lastname: Haklai
authors.forename: Shepard
authors.initials: S
authors.lastname: Schwartz
authors.forename: Aharon
authors.initials: A
authors.lastname: Klar
authors.forename: Nechama
authors.initials: N
authors.lastname: Stein
authors.forename: Eitan
authors.initials: E
authors.lastname: Kerem
mesh_terms: 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