Forensic pathological criteria of sudden infant death syndrome (SIDS) diagnosis

收集日本31个法医学部门的307例婴儿猝死法医尸检病例，从死亡时间、死亡方式、死前临床症状、包括睡姿在内的死亡现场调查、尸检诊断和尸检结果等角度进行统计分析。死亡原因为婴儿猝死综合征（SIDS）的占39.7%，俯卧位死亡占61.5%。在这些分析结果的基础上，我们提出了诊断小岛屿发展中国家的法医病理标准或最低要求。根据这一标准，小岛屿发展中国家必须在对死者进行彻底解剖后进行诊断，同时完全否认因谋杀、虐待儿童、意外窒息等原因造成的外部死亡。当从死亡现场调查和睡眠姿势，特别是俯卧姿势怀疑是外部死亡时，我们不应该诊断小岛屿发展中国家。作为专题交流，我们研究了婴儿猝死病例的司法判例分析、婴儿猝死病例脑内转铁蛋白和铁蛋白的免疫组化分析、SIDS病例肺神经内分泌分布和杠杆细胞脂肪变化。

Three hundred and seven forensic autopsy cases of sudden infant death were collected from 31 departments of forensic medicine in Japan and statistically analysed from the various view points, such as time of death, mode of death, ante mortem clinical symptoms, death scene investigation including sleeping position, autopsy diagnosis and autopsy findings. Of total cases 39.7% were diagnosed the cause of death as sudden infant death syndrome (SIDS) and 61.5% of SIDS cases were found dead in prone position. On the basis of these analytical results, we proposed forensic pathological criteria or minimal requirements for diagnosis of SIDS.According to the criteria, SIDS always should be diagnosed after thorough autopsy of the deceased and simultaneously complete deny of the external death, caused by murder, child abuse, accidental asphyxiation etc. When external death is suspected from death scene investigation and sleeping position, particularly prone position, we should not diagnosed SIDS.As special communications we studied on analysis of judicial precedents about sudden infant death cases, immunohistochemical analysis of transferrin and ferritin in the brain from sudden infant death cases, pulmonary neuro endocrine distribution and fatty change of the lever cells in SIDS cases.