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PAPERS: Malcolm Brodlie, Ian A Laing, Jean W Keeling, and Kathryn J McKenzie Ten years of neonatal autopsies in tertiary referral centre: retrospective study BMJ 2002; 324: 761-763 [Abstract] [Full text]

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SIDS autopsies

John Fryer   (2 April 2002)

Immediate cord clamping may cause neonatal deaths

David JR Hutchon   (26 June 2007)

SIDS autopsies 2 April 2002
John Fryer, Researcher Sheffield Send response to journal: Re: SIDS autopsies	The autopsy rate for infants after 8 weeks is 100%. There is an increasing tendency to treat all such deaths as "suspicious" in a desire to eliminate the diagnosis of SIDS. Some eminent doctors already subscribe to this belief that there is no such thing as a cot death. The deaths of infants in hospital however apparently has a falling rate of autopsy. This seems to be helping the cause of doctors who do not want the inconvenient signs in hospital deaths which will be the same as those in infants who they claim have been suffocated deliberately. There is at present no way to prove a death is suffocation and those doctors and paediatricians who obtain such convictions for murder in the courts are doing themselves and the profession no good whatsoever. The consequences to the family is catastrophic. We need more proof as to why babies are still dying, not less research and using Lynch Law, Witch Hunting to "prove" some pet theory of the "dirty" thinkers. John Fryer Chemist
Immediate cord clamping may cause neonatal deaths 26 June 2007
David JR Hutchon, Consultant obstetrician and gynaecologist Memorial Hospital, Darlington. DL3 6HX Send response to journal: Re: Immediate cord clamping may cause neonatal deaths	The authors state that "In 145 (74%) there was complete concordance between the clinical cause of death and the findings at autopsy." I find this hard to believe as a high proportion were withdrawal of life support. At least, it depends on how definititive one considers the diagnosis. For example the clincal diagnosis may be irreverible brain damage with intracranial haemorrhage which is confirmed on postmartem examaination. Does this count as concordance especially when life support is withdrawn? Further it does not tell us why the neonate had such extensive brain damage and intracranial haemorrhage in the first place. If a postmortem were able to confirm that the neonate was hypoxic at birth, that immediate cord clamping then rendered the neonate hypovolaemic and hypotensive and that this then resulted in cerebral ischaemia which together with the hypoxia resulted in ireversible HIE, we would have enough information to avoid this cause of death in the future. We have the cord blood gas result at delivery which confirms the neonate was hypoxic in labour and the result may or may not implicate the obstetrician in the outcome. Unfortunately the recommendation for immediate cord clamping for a valid cord blood gas result will have already limited the neonates potential for recovery. With less of a placental transfusion, the healing potential of the stem cells will be trapped in the placenta. Ironically it is the test which may have led to the problem in the first place. Competing interests: None declared