Pneumonia and SIDS

My little cousin died about two months ago. At first, the medical examiner said that he died of SIDS. Last week he concluded that my cousin had Interstitial Pneumonia at the time of death. Since he didn't have a severe case of Interstitial Pneumonia, the medical examiner is stating that my cousin died of a combination of SIDS and Interstitial Pneumonia. Please give me your opinions and comments on this. (P.S. - When my cousin died, he was in a queen-size bed with his father and older brother.)

Date: Wed, 29 Jul 1998

Without knowing the details or having reviewed the records I can not comment specifically on this case, but I will say that a baby died of a combination of SIDS and interstitial pneumonia seems to defy logic. A diagnosis of SIDS is based fundamentally on not being able to define another cause of death, it is not an additive phenomenon as occurs in other situations well recognized by clinicians and pathologists alike,

Henry Krous
hkrous@health.ucsd.edu

December 1997

In regard to autopsy findings, there is a spectrum in the lung sections ranging from findings consistent with normal, findings associated with mild respiratory illness (cold, bronchitis, etc.) but not sufficient to explain sudden death, and finally findings suggestive of pneumonia (pneumonitis) as the cause of death.

If the history is indicative of a sudden and unexpected death, then minor evidence of lung inflammation, congestion or other evidence of infection should not be considered sufficient to explain the death, and SIDS is the appropriate final conclusion. Unfortunately, however, some pathologists are reluctant to conclude SIDS if there are any findings (regardless of how minor) and they thus conclude that pneumonia was the cause of death. Such infections are typically thought to be viral rather than bacterial, for which antibiotic treatment would not be effective; there thus should be no implication that such deaths could have been prevented, or that symptoms should have been recognized.

In summary, infants dying suddenly and unexpectedly are very likely SIDS and should be considered in the same context as all other sudden and unexpected infant deaths. The autopsy results change this conclusion ONLY when the findings are of sufficient severity to explain the fatal outcome.

I hope this is helpful.
Dr. Carl Hunt