Carpenter R G, Waite A, Coombs R C, Daman-Willems C, McKenzie A, Huber J, Emery J L
Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Lancet. 2005;365(9453):29-35. doi: 10.1016/S0140-6736(04)17662-9.
There have been suggestions that when two or three unexpected unexplained infant deaths occur within a family they are more likely to be unnatural than natural. We aimed to estimate the probability that a second infant death is natural versus unnatural.
The Care of Next Infant programme (CONI) supports parents who have previously had an unexpected and apparently unexplained infant death and is currently available in over 90% of health districts in England, Wales, and Northern Ireland. We studied all deaths in 6373 infants who had completed the CONI programme by December, 1999. After a CONI death, we made detailed enquiries into the previous death and the CONI death, including a family interview, a review of autopsies, and case discussion.
57 (8.9 per 1000) CONI infants died. Nine deaths were inevitable, and 48 were unexpected. 44 families lost one child, and two families lost two children. Of the 46 first CONI deaths, 40 were natural; the other six were probable homicides, five committed by one or both parents (two criminally convicted). The ratio of 40 natural to six unnatural deaths is 6.7 (95% CI 2.8-19.4). Enquiries identified 18 families with two SIDS(sudden infant death syndrome) deaths and two families with probable covert double homicides (ratio 9.0 [2.2 to 80.0]). There were no convictions in 13 incomplete cases. Families with three deaths are reported.
Repeat unexpected infant deaths are most probably natural.
有观点认为，当一个家庭中发生两例或三例意外的不明原因婴儿死亡时，这些死亡更有可能是非自然原因而非自然原因导致的。我们旨在估计第二例婴儿死亡是自然原因还是非自然原因的概率。
“照顾下一婴儿”计划（CONI）为那些之前经历过意外且明显原因不明的婴儿死亡的父母提供支持，目前在英格兰、威尔士和北爱尔兰超过90%的卫生区都有该计划。我们研究了截至1999年12月已完成CONI计划的6373名婴儿的所有死亡情况。在CONI婴儿死亡后，我们对之前的死亡和CONI死亡进行了详细调查，包括家庭访谈、尸检复查和病例讨论。
57名（每1000名中有8.9名）CONI婴儿死亡。9例死亡是不可避免的，48例是意外死亡。44个家庭失去了一个孩子，2个家庭失去了两个孩子。在46例首次CONI死亡中，40例是自然死亡；另外6例可能是他杀，其中5例是由父母一方或双方实施的（2例被刑事定罪）。自然死亡与非自然死亡的比例为6.7（95%可信区间2.8 - 19.4）。调查确定了18个有两例婴儿猝死综合征（SIDS）死亡的家庭和2个可能存在隐蔽双重他杀的家庭（比例为9.0 [2.2至80.0]）。13例未完成的案件中没有定罪情况。报告了有三例死亡的家庭。
反复出现的意外婴儿死亡很可能是自然原因导致的。
