Some sudden unexpected deaths in infancy may be avoidable

Over half of investigated, sudden, unexpected deaths in infancy with an identifiable cause could be avoided, according to the fifth annual report of the confidential inquiry into stillbirths and deaths in infancy, published this week.

The study first reviewed all 456 deaths in infants aged 1-52 weeks that occurred in five English regions in 1993-6. In 363 cases no adequate explanation for death was found, and these were classified as the sudden infant death syndrome. In 93 cases the cause of death, usually infection, was identified. Of these, 67 cases were then examined by the confidential inquiry's regional panels. The panels concluded that 35 of the deaths “might have been avoided if those involved had acted differently” and noted that “extrapolating this to … England and Wales suggests that each year about 60 deaths might be avoided by better care.”

Both professionals and carers were implicated in providing suboptimal care. general practitioners sometimes failed to recognise the severity of illness, and the report recommends that general practice training should always include hospital experience of acute paediatrics. Suboptimal care also occurred after referral to specialist units, and the report recommends that continuing education of consultant paediatricians should include the best current management of acute severe illness in infancy. Inadequate supervision of junior doctors is also highlighted: three babies died after being assessed by a junior doctor and discharged without the opinion of a consultant.

The value of education for parents is noted, both to reduce harmful behaviours such as smoking and to help with recognising illness. Almost half the babies showed detectable signs and symptoms of illness.

Fifth Annual Report of the Confidential Enquiry Into Stillbirths and Deaths in Infancy is published by the Maternal and Child Health Research Consortium, 188 Baker Street, London NW1 5SD, price £6.

CHARLOTTE MACPHERSON/EPL

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