INFANT DEATHS

Infanticide: refers to killing of a child below one year

In Indian law there is no separate law on infanticide. It is equivalent to murder. In certain

western countries (UK, Germany) infanticide is less serious charge than murder if it is
committed by a mother due to stress associated with pregnancy, childbirth and lactation

Foeticide: Killing of a fetus before it is born

Neonaticide: Killing a newborn infant

Filicide: It is infanticide wherein parent/s is the assailant

Medico legal considerations

Following questions need to be answered when a dead fetus is recovered

 Has the woman recently delivered a child?

If yes,

 Was the child viable?

 Was it born alive?
 If born alive, how long did it survive?
 What was the cause of death?
 Was death due to criminal act?
 When did it die? (time since death)

Viability

Physical ability of a foetus to lead a separate existence after birth apart from its mother,
by virtue of certain degree of development

Minimum duration required to make a fetus viable is 210 days (28 weeks)

Factors which help in assessing viability include the following:

 Weight 1.3 kg
 Crown heel length 35 cms
 Ossification centers at tibia, calcaneum, talus, cuboid

Rule of Haase

It is a method of estimating the gestational age of the fetus.

It uses crown heel length in estimating the gestational age of the fetus

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 1

If the crown heel length is less than 25cms, then square root of crown heel length gives
the gestational age in months.

If the crown heel length is more than 25cms, then crown heel length divided by 5 gives
the gestational age in months (Morrisons rule).

Still birth

birth of a baby born after 28 weeks of gestation, and which did not breathe or show any
other signs of life, at any time after being completely born

Causes of death are:

Prematurity

Anoxia

Birth trauma

Dead born

is one which has died in utero, and shows one of the following signs after it is
completely born

Rigor mortis at delivery: fetus in rigor is difficult to deliver out

Maceration

Mummification: seen when there is scanty liquor

Fetus is dried and shriveled

Putrefaction: if there is rupture of membranes, air enters and putrefaction starts

Maceration

It is a process of aseptic autolysis

Signs of maceration become evident in 24 hours after death

This is generally seen if there is exclusion of air after death of the fetus

Skin slippage is the earliest manifestation which is seen 6-12 hours after death

Findings:

- Red/Purple skin

- There is accumulation of gas in great vessels (Roberts sign)

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 2

- Collapse of vertebral column

- Fetus is soft, flaccid, flattens out

- It has got a sweetish disagreeable odour

- Blebs (serosanguineous fluid)

- Organs softened

- Shrinkage of brain leads to loosening of skull bones and overriding of cranial vault

when seen in a X ray (Spalding’s sign)

Live birth

child has showed signs of life, even if only a part of the child was out of the womb,
though the child may not have breathed or been born completely.

Signs of live birth

RESPIRATORY SYSTEM

Shape of the chest: Chest is flat if the baby has not respired and will be barrel or drum
shaped when the baby has respired

Diaphargm: It will be at the level of 6th or 7th rib if respiration has taken place, otherwise
it will be at the level of 3rd or 4th rib

Lungs

Before respiration:

Lungs will be firm, small, with sharp margins

Non crepitant, with liver like consistency

After respiration:

It would be voluminous, rounded margins

Mottled appearance

Spongy in consistency and crepitant

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Weight:

Ploucquet’s test: Before respiration lungs are smaller weighing 1/70th of body weight,
but after respiration they increase in weight due to circulation forming 1/35 th of body
weight.

Static test or Fodere’s test: Before respiration lungs are smaller weighing 30-40 gms,
but after respiration they increase in weight due to circulation weighing 60-70 gms.

Hydrostatic test: This test is based on the principle that if the baby has respired then
the lungs will float in water. Each lung is cut into pieces and put in water to look for
floatation. If the lungs sink then respiration has not taken place. If they float then
pressure is applied over these pieces to drive out tidal air and then it is retested again. If
it still floats that means it is a respired lung. It is also known as Breslau’s first life test.

False positive hydrostatic test is seen in:

Putrefaction

Artificial respiration

False negative hydrostatic test is seen in:

Pulmonary oedema

Pneumonia

Atelectasis

Hydrostatic test not necessary when:

Fetus is <180 days

Macerated fetus

Fetus is a monster

Presence of milk in stomach

Histological appearance

Un respired lung: Non distended alveoli with columnar lining epithelium

Respired lung: Expanded alveoli with flattened epithelium

Breslau’s second life test (Stomach bowel test): Presence of air in stomach and
intestine which float in water after double ligation indicates live birth

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 4

Food or milk in the stomach: indicates live birth

Disappearance of gelatinous tissue from the middle ear after respiration may point to
maturity of the infant (Wredin’s test).

Umbilical cord changes

12-24 hrs: Dries and shrinks

36-48 hrs: zone of inflammation at the base

2-3 days: Shrivelling and mummification

5-6 days: falls off

10-12 days: scar

Caput Succedaneum

Oedematous swelling in the presenting part of the scalp formed during delivery seen in
obstructed labor

Contains blood and serous fluid

Does not cross the midline as it is limited by the attachment of pericranium to the cranial
bones

Disappears by 2-4 days

Cephal haematoma

Accumulation of blood b/w periosteum of scalp and bone

It is limited to suture lines

Disappears by 10-15 days and shows colour changes similar to that of a contusion

Changes in circulation

Umbilical arteries: obliterates by 2-3 days

Umbilical vein: obliterates by 4-5 days

ductus venosus: closes by 4-5 days

ductus arteriosus: closes by 7-10 days

Foramen ovale: closes by 2-3 months

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 5

Meconium: it is the excretory product of the fetus. It is excreted completely by 2-3 days
after birth

Vernix caseosa: Cheesy material secreted by sebaceous glands of the fetus found
coating the skin surface. Presence indicates the baby is not washed. It does not say
whether it is live born or not

Duration of Survival

It can be determined based on the following:

Meconium

Umbilical cord changes

Circulatory changes

Fetal haemoglobin: It is 80% at birth, completely replaced by the adult type by 6

months

Skin changes:

At birth: Bright red

2-3 days: Dark

3-6 days: Physiological jaundice

7-10 days: Original colour (Pinkish)

Causes of infant deaths

It could be natural or unnatural

Natural causes could be immaturity, malformations etc

Unnatural may be accidental or criminal

Accidental causes may be cord twisting round the neck, trauma due to falling of fetus
in cases of precipitate labor etc.

Criminal causes may be due to acts of omission or acts of commission

Acts of omission: failure to:

Protect the child from heat or cold

Provide assistance during labor

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 6

Clear air passages

Cut umbilical cord

Feed the child

Acts of commission:

Smothering

Strangulation

Burns

Drowning

Poisoning

Concealed puncture wounds in axilla, inner canthus of eye, inguinal region etc

Precipitate labour: it is a type of labor in which all the 3 stages of labor are merged
and the delivery occurs very fast

Commonly seen in multiparous woman or in woman with roomy pelvis and a small fetus

The pregnant woman may get a sensation of micturition or defecation and when she
goes to the toilet, she may suddenly deliver the child which may fall into the lavatory
pan and sustain fatal head injuries

Caput succedaneum will not be present

Battered baby syndrome

(Non accidental injury of childhood, Caffey’s syndrome, Child abuse syndrome,

Mal treatment syndrome)

A battered child is one that suffers repetitive physical injuries inflicted by parent or
guardian, which are non-accidental in nature

Common in broken families

Illegitimate or unwanted child is more often the victim

The physical findings will not corroborate the history of accident given by the parents

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 7

Manifestations:

Bruises: are common in wrist, forearm, thighs and ankles. The child is held at these
places and swung

Burns, whip marks are common in buttocks

Face and lips show bruising and lacerations

Six penny bruises: characteristic circular bruises seen due to firm poking of chest,
thighs and abdomen of the baby by fingers of adults

Bruises of different periodicity on the same child with history inconsistent with the
findings

Skull fractures

Intra cranial haemorrhages

Multiple rib fractures

Limb fractures

Shaken baby syndrome

Extreme rotational cranial acceleration induced by violent shaking or shaking and

impact

Triad of findings:

 Retinal haemorrhages
 Sub dural haemorrhages
 Sub arachnoid haemorrhage

Little or no evidence of external cranial trauma

Investigations

CT scan

MRI

Fundoscopy

X ray

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 8

Autopsy findings

Sub dural haemorrhage

Cerebral oedema with sub arachnoid haemorrhage

Retinal haemorrhages

Multiple fractures of skull, long bones and ribs

Sudden Infant death syndrome

(SIDS, Crib death, Cot death)

Sudden death of an infant which remains unexplained after a thorough case

investigation, including autopsy, examination of the death scene and review of the
clinical history

Maximum cases occur between 3-7 months

More common during night time

Prior history of running nose in observed in such infants

Etiology:

Overlaying of infants by drunk parents sleeping by the side of the baby

Sleeping in prone position

Inadvertent smothering by soft cloth or pillow

Sleep apnoea

Dust mite allergy

Cow milk allergy

Autopsy findings:

Blood stained froth

Laryngitis,tracheitis, tracheo bronchitis

Petechial haemorrhages in heart, lungs and thymus

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 9

 Age related changes in foetus

Ossification centers

5 months:

Calcaneum
manubrium
1st segment of body of sternum
7 months:

Talus
2nd and 3rd segments of body of sternum
9 months:

Cuboid
Lower end of femur
Nails

3 months: Membranous form

7 months: Tip of finger

9 months: Beyond the tip of fingers

Testes

6 months: Psoas

7 months: Near the internal ring

8 months: Inguinal canal

9 months: Scrotum

Hair

4 months: Lanugo appears

5 months: Scalp hair appears

7 months: Scalp hair 1cms

9 months: Scalp hair 2cms

Dr Vikram Palimar, Professor of Forensic Medicine, KMC, Manipal Page 10