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Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?

Background —The “Back to Sleep” cam- paign in 1991 resulted in a dramatic decrease in the incidence of sudden infant death syndrome (SIDS). The proportion of presumed SIDS deaths being actually suspicious deaths from airway obstruction is likely to have become relatively greater. There is usually little pathological evidence to suggest smothering, but intra- alveolar haemorrhage appears to be more prominent in cases where interference with the airway is suspected. Aim —To attempt to quantify intra- alveolar haemorrhage to see whether it could be used as a marker to distinguish between smothering/overlaying and SIDS. Methods —Intra-alveolar haemorrhage was quantiﬁed using digital image analysis on haematoxylin/eosin stained sections taken from the lungs of 62 consecutive infants who had died suddenly and unex- pectedly. Cases were initially classiﬁed according to the original cause of death. After quantitation, the case histories were critically reviewed. Three pathologists independently made microscopic assessments of the degree of intra-alveolar haemorrhage in the ﬁrst 24 cases to see whether these accurately reﬂected the quantitative results. Results of those infants with a history suggesting possible involuntary overlaying and 45% of those with a history suspicious of smothering had signiﬁcant intra-alveolar haemorrhage (> 5% of total lung surface area assessed). From the history, the cause of death in 11 cases initially classiﬁed as SIDS would better have been given as “Unascertained.” Simple micro- scopic assessments the true extent of the haemorrhage 33% (8/24). J Clin Pathol 1999; 52 :581–587)