BANGOR, Maine — It will be three to four months before authorities know what happened to three Central Maine infants who died last week while sharing beds with their parents.
The result of the autopsy process could range from specific diagnoses such as asphyxiation to a complete mystery. Investigators are trying to avoid the latter.
“When we can’t determine the cause of death for an adult, it gets listed [on the death certificate] as unknown,” said Margaret Greenwald, the state’s chief medical examiner. “When we can’t determine the cause of death for an infant, it gets listed as sudden infant death syndrome. We don’t like that.”
A news release Tuesday from the state Department of Public Safety, which detailed the unrelated deaths of infants in Canaan, Madison and Windsor, raised the possibility that they died of suffocation because they were sharing beds with their parents. Medical experts used the unrelated tragedies as an opportunity to remind the public about safe sleeping practices for infants — including that they should not sleep with adults.
But the director of a national group called The Natural Child and a Notre Dame University researcher, both of whom advocate that nursing mothers sleep with their children, told the Bangor Daily News that authorities here should not assume bed sharing was the cause of death until everything else is ruled out.
“It’s critical for the coroner to actually determine whether everything else can be excluded, rather than concluding very quickly that the deaths had to do with bed sharing,” said Dr. James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at Notre Dame. “What I worry about is that when sweeping public health recommendations like this come out, what happens to those parents who choose to routinely bed share with their babies?”
Greenwald agreed about the importance of arriving at the correct cause of death, which is why the autopsy process and battery of tests associated with it take so long. She said Maine has always been diligent about investigating infant deaths, but that new directives from the National Centers for Disease Control in the past five years have urged medical examiners and law enforcement officers nationwide to redouble their efforts. The goal is to avoid settling on diagnoses of “sudden infant death syndrome” as much as possible.
“Nothing in the investigation becomes excluded,” said Greenwald. “That’s basically the way we operate.”
In the course of investigating an infant’s death, Greenwald and her staff look for a variety of infections; poisoning caused by medications or substances in the home; microscopic clues that indicate cancer or a mutation; problems in any of the body’s fluids; and metabolic disorders, among other things.
“All of that takes a lot of time to be processed,” she said.
Just as important to a medical examiner is information that comes from police investigations, such as the environment the baby lived in, whether he or she was exposed to cigarette smoke, sleeping arrangements and a range of other factors.
The CDC and National Institutes of Health are so serious about finding the right diagnosis that they urge use of the term “sudden unexplained infant death” instead of “sudden infant death syndrome” until everything else can be ruled out.
“We’re trying to take people away from the mindset that babies just die for no apparent reason,” said Greenwald.
Dr. Stephen Meister, medical director for the Maine Center for Disease Control’s family health division, said in addition to helping researchers understand the causes of SIDS, policy shifts like the CDC’s have the long-term side effect of educating parents.
“As we focus on the risk factors, such as parents not smoking and babies sleeping in their own beds, we hope the rate of SIDS goes down as close to zero as possible,” said Meister. “For now we have a better understanding of certain risk factors. We can really help to decrease the risks with some really simple steps.”
But there’s a long way to go. The national SIDS rate has been declining since the early 1990s, due in large part to the revelation that infants should sleep on their backs, not their stomachs, but SIDS still ranks as the leading cause of death among infants age 1 month to 1 year. More than half of the 4,500 sudden unexplained infant deaths each year in the United States end up with a SIDS diagnosis, according to the CDC’s Web site. That’s why the CDC in 2003 began pushing for standardized data collection nationwide, including a training initiative for investigators and standardized forms for use by medical examiners.
Greenwald said those efforts have helped a lot.
“Every time we get more information, we look at these cases differently,” she said. “Still, there remain some that we just don’t have answers for.”