Confidential inquiry into 226 consecutive infant deaths.

Among 226 consecutive infant deaths (occurring after the first week), the leading causes were: congenital malformation (62 deaths), sudden infant death syndrome (47), pneumonia (36), gastroenteritis (26), and aspiration of gastric contents (16). In only one-third of the deaths was there a known predisposing organic disease. The study confirms the well-known relation between infant mortality and low birthweight, illegitimacy, poor social conditions, and low standards of parental care. Of particular interest was the finding of a long interval in many of the cot deaths' between the child last being seen alive and the discovery of the death. Half the deaths occurred at home, the leading causes of mortality in 103 cot deaths' being: sudden infant death syndrome (47), pneumonia (25), and aspiration of gastric contents (14). In at least one-third of the deaths from sudden infant death syndrome, there had been an illness in the previous week, usually an upper respiratory tract infection; peak mortality was in the first quarter of the year (January-March) and occurred in the second and third months of life. Many of the infants dying in hospital were very critically ill on admission. There was a high prevalence of `avoidable factors' in the group of deaths with no known predisposing organic disease, and the case histories suggest that deficiencies in both parental and medical care—often in combination—played an important role in many of the deaths investigated.