With the goal of educating families and saving babies' lives, North Carolina's new chief medical examiner is going to re-examine how the state diagnoses the unexpected deaths of sleeping infants.
Dr. Deborah Radisch says she plans to consult with path ologists statewide about how the medical-examiner system should handle the deaths that are now usually labeled sudden infant death syndrome.
She also wants to discuss a federal project under way in five states that aims to better investigate and diagnose these deaths. Those states are finding they record fewercases of SIDS, and more often label the deaths suffocation, cause unknown, neglect or even homicide.
It's the first time since she took office in late June that Radisch has said she'll study SIDS deaths and related cases. She expects to start after she finishes hiring her staff.
The hope is to "establish consistency in diagnosis of all infant deaths that come through the medical examiner's system," Radisch said in an interview this week. "We want to continue to encourage families to be aware of preventive measures such as safe-sleep practices."
A Charlotte Observer series in June showed that N.C. medical examiners often have applied the SIDS ruling tobabies even when evidence showed they might have suffocated. They were often found sleeping in unsafe situations: with adults on beds or couches, for example, or facedown among pillows and fluffy blankets.
The investigation found that two-thirds of SIDS autopsies in North Carolina between 2004 and 2008 listed risks that raised the possibility of suffocation. The newspaper also found that law enforcement agencies were sometimes frustrated by the SIDS ruling if they thought the case involved neglect or - rarely - homicide. A SIDS ruling, they said, made successful prosecution of infant deaths almost impossible.
About 100 North Carolina infants each year die from SIDS. After years of research, those deaths are still a medical mystery. The label means that doctors don't know why a baby died and that the death was unpreventable. In North Carolina, SIDS also is considered a natural manner of death.
Advocates of safe-sleep practices for infants worry that SIDS diagnoses can be misleading. They want parents to understand that the risk of SIDS goes down when babies are put to sleep on their backs, alone in their cribs, without blankets or pillows that could suffocate them.
Georgia's medical-examiner system is taking part in the federal project coordinated by the Centers for Disease Control and Prevention in Atlanta.
Beoncia Loveless, a medical investigator with the Georgia system, says some people think of the SIDS label as merely an issue of semantics. "But it's important, if you're trying to get a message out to the community," she says. People once thought SIDS deaths "were unpreventable. But many appear to be preventable. It changes your message."
Although doctors still don't know what makes some infants vulnerable to dying in their sleep, they do know that sleep conditions are related, Loveless said. "The chances of that death go up significantly if the baby is in an unsafe environment."
Loveless said that in Georgia, very few sleep-related deaths are labeled SIDS. The term is reserved for a baby that dies unexpectedly in a safe-sleep situation.
Radisch says she won't start the process of examining infant deaths and other issues until she has a full staff, and she's still working to fill three open jobs forforensic pathologists in her Chapel Hill office. She says the pool of qualified applicants is small - about 40 graduate each year, and about 30 pass board examinations. Several states and jurisdictions are trying to hire.
The medical examiner's office is charged with investigating suspicious, unusual or unnatural deaths. North Carolina's Office of the Chief Medical Examiner oversees about 11,000 cases per year and about 4,500 autopsies.
