La  muerte posneonatal en domicilio diez años después: Montevideo, 2006

Hugo Rodríguez Almada; Ana María Ferrari; Lucía Arzuaga; Mario Echenique; Domingo Mederos

Authors

Hugo Rodríguez Almada Universidad de la República, Facultad de Medicina, Departamento de Medicina Legal, Profesor Agregado
Ana María Ferrari Universidad de la República, Facultad de Medicina, Clínica Pediátrica, Profesora
Lucía Arzuaga Universidad de la República, Facultad de Medicina, Clínica Pediátrica, Ex Médica Residente
Mario Echenique Uruguay, Poder Judicial, Instituto Técnico Forense, Médico Patólogo
Domingo Mederos Uruguay, Poder Judicial, Médico Forense

Keywords:

SUDDEN INFANT DEATH, POSTNEONATAL MORTALITY, CAUSE OF DEATH, URUGUAY

Abstract

Introduction: studies carried out at national level in 1996 evidenced a high prevalence of postneonatal deaths without medical assistance. Infant mortality rate decreased in the following 10 years at the expense of the postneonatal component. Within the new epidemiological framework, we aim to find out whether the attributes of postneonatal household death have changed.
Objectives: 1. To learn about postneonatal household death in Montevideo in 2006, describing some of the features of the affected population and their environment.
2. To learn about the causes of these deaths and the diagnostic procedures used.
3. To Compare the new results with those corresponding to 1996.
Method: a descriptive, retrospective study was conducted for all postneonatal household deaths occurring in Montevideo in 2006. Death certificates, police reports, autopsy reports and anatomopathological studies were used as research sources. The form used for the collection of data in the present study was the same one used in 1996. The initial cause of death was revised in those cases where Anatomopathological Reports were available.
Results: In 2006, there were 84 postneonatal deaths in Uruguay, 39 (0.46%) of which were household deaths. Most infant deaths were male (0.64%). Average death age was 3 months fifteen days. Female and male weight/age ratios were obtained in 34 cases: eight of which were equal to or lower than percentile 5. Except for malnutrition and preterm birth, in most cases (0.67%) there was no pathological history. Six of them carried known diseases and a further seven presented respiratory complications in the week prior to death. In terms of season distribution, winter prevailed (0.36%). Almost all deaths were natural deaths and certified by a forensic doctor. In 24 out of 38 deaths complementary anatomopathological studies were required. Judicial autopsy findings, anatomopathological studies and pediatric history reveal the main cause of death are respiratory infections (0,42%).
Most deaths occurred (FR=0,56) in three police districts of Montevideo, characterized by low socioeconomic indicators. Upon comparing new results to those obtained in 1996, we found proportional household postneonatal deaths remained constant, the same as the deceased’s profile.
Conclusions: 1. Household death still represents almost 50% of infant mortality in the postneonatal term in Montevideo, it is a significant public health issue and it is avoidable.
2. It occurs in neighborhoods with low socioeconomic level. The deceased’s profile is the same as that of 1996.
3. Forensic doctors who certify these deaths have evidenced a change in attitude, showing a tendency to request more anatomopathological studies and to avoid attributing deaths to incidental autopsy findings.
4. Information regarding causes of death is not enough. This could be reverted by systematically requesting the necessary complementary studies, especially anatomopathological studies and verbal autopsies, as well as by organizing multidisciplinary committees to discuss the issue.

References

(1) Mederos D, Rodríguez H, Díaz Roselló J, Ferrari A. Peritajes judiciales en menores de un año. Rev Méd Uruguay 1998; 14: 28-33.
(2) Rodríguez H, Mederos D, Díaz Roselló J, Ferrari A. Muerte en domicilio en el período neonatal. Montevideo, 1996. Rev Méd Uruguay 1998; 13: 147-53.
(3) Gutiérrez C, Palenzuela S, Rodríguez A, Balbela B, Rubio I, Lemes A, et al. Muerte inesperada del lactante. Diagnóstico de situación de la ciudad de Montevideo. Arch Pediatr Uruguay 2001; 72: 185-97.
(4) Rodríguez H, Mederos D, Echenique M, Vilas R, Ferrari A. Muerte posneonatal en domicilio y accesibilidad a los servicios de salud. Las Piedras, La Paz, Progreso; lº/7/96-30/6/98. Rev Méd Uruguay 1999; 15: 22 1-9.
(5) Ferrari A, Ferreira A, De Leonardis D, Fernández A, Imbriaco J. Mortalidad hospitalaria en un hospital pediátrico de referencia nacional: Centro Hospitalario Pereira Rossell. Rev Méd Uruguay 2002; 18: 59-65.
(6) Alberti M, Fernández A, Ferrari AM, Gutiérrez C, Hackembruch C, Montano A, et al. Informe del Comité de Auditoría de Fallecidos. Hospital Pediátrico. Centro Hospitalario Pereira Rossell. 2000-2006. Arch Pediatr Uruguay 2007; 78(1): 48-53.
(7) Fernández A, Rodríguez A, Sosa G, Palenzuela S, Beltramo P, Gutiérrez C, et al. El valor de la autopsia en una unidad de cuidados intensivos pediátricos. Arch Pediatr Uruguay 2006; 77(2): 103-9.
(8) Rubio I, Santoro A, Alberti M, Pizorno E, Fernández A, Gutiérrez C, et al. Mortalidad evitable en pediatría. Un aporte a la planificación de la atención a la salud de los niños. Rev Méd Uruguay 2007; 23: 145-52.
(9) Krous H, Becwtih B, Byrad R, Rognum T, Bajanowski T, Corey T, et al. Sudden infant death syndrome and unclassified sudden infant death: a definitional and diagnosis approach. Pediatrics 2004; 114: 234-8.
(10) Beckwith J. Discussion of terminology and definition of sudden infant death syndrome. In: Bergman A, Beckwith J, Ray C, eds. Sudden infant death syndrome: proceedings of the second international conference on causes of sudden death in infants. Seattle: University of Washington, 1970: 14-22.
(11) Willinger M, James L, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol 1991; 11(5): 677-84.
(12) Rognum T, Arnestad M, Bajanowski T, Banner J, Blair P, Borthne A, et al. Consensus on diagnostic criteria for the exclusion of SIDS. Nord Rettsmedisin 2003; 9: 62-73.
(13) Bajanowski T, Brinkmann B, Vennemann M. The San Diego definition of SIDS: practical application and comparison with the GeSID classification. Int J Legal Med 2006; 120: 331-6.
(14) Bajanowski T, Vege A, Byard R, Krous H, Arnestad M, Bachs L, et al. Sudden infant death syndrome (SIDS)–stan-dardised investigations and classification: recommendations. Forensic Sci Int 2007; 165: 129-43.
(15) Sawaguchi T, Sawaguchi A, Matoba R. Comparative evaluation of diagnostic guidelines for sudden infant death syndrome (SIDS) in Japan. Forensic Sci Int 2002; 130S: S65–S70.
(16) Malloy M. Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the "Back to Sleep" program. Pediatrics 2002; 109: 661-5.
(17) Byard R, Beal S. Gastric aspiration and sleeping position in infancy and early childhood. J Paediatr Child Health 2000; 36: 403-5.
(18) Alex N, Thompson J, Becroft D, Mitchell E. Pulmonary aspiration of gastric contents and the sudden infant death syndrome. J Paediatr Child Health 2005; 41: 428-31.
(19) Kruos H, Masoumi H, Haas E, Chadwick A, Stanley C, Thach B. Aspiration of gastric contents in sudden infant death syndrome without cardiopulmonary resuscitation. J Pediatr 2007; 150(3): 241-6.
(20) Barbato A, Porta G, Falcone R, Cuello B, Ávalos C, Logarzo D. Muertes en domicilio por infección respiratoria aguda en el partido de La Matanza, Buenos Aires, Argentina. In: Benguigui Y, Valenzuela C. Investigaciones operativas sobre el control de las infecciones respiratorias agudas (IRA) en niños en América Latina y el Caribe. Buenos Aires: OPS-OMS-AIEPI, 1998: 231-9.
(21) Silva L, Girardi G, Lezama V, Abara S, Benveniste S, Croxatto H, et al. Mortalidad infantil inesperada en domicilio. Revisión de antecedentes clínicos y anátomo-patológicos en Santiago de Chile. In: Benguigui Y, Valenzuela C. Investigaciones operativas sobre el control de las infecciones respiratorias agudas (IRA) en niños en América Latina y el Caribe. Buenos Aires: OPS-OMS-AIEPI, 1998: 241-61.
(22) Vejar L, Navarrete P, Lecerf P. Prevenir muertes por neumonía en los domicilios. Educación a las madres. Qué signos enseñar. In: Benguigui Y, Valenzuela C. Investigaciones operativas sobre el control de las infecciones respiratorias agudas (IRA) en niños en América Latina y el Caribe. Buenos Aires: OPS-OMS-AIEPI, 1998: 273-6.
(23) Valdés-Dapena M, McFeeley P, Hoffman H, Damus K, Franciosi R, Allison D, et al. Histopathology atlas for the sudden infant death syndrome. Washington: Armed Forces Institute of Pathology, 1993.
(24) Rodes S. Muerte inesperada del lactante. In: Sociedad Uruguaya de Pediatría. Congreso Uruguayo de Pediatría, 21. Montevideo: SUP, 1997.