The singular and combined appearance of conjunctival petechiae, of acu
te pulmonary emphysema and of signs of aspiration was evaluated in res
uscitated and non-resuscitated children dying of SIDS (n = 115), of ot
her causes of natural death (n = 17), of severe head injury (n = 10) a
nd of asphyxiation/strangulation (n = 7). Conjunctival petechiae occur
red in all of the asphyxiated victims and in five out of 10 children d
ying of severe head injury, but were exclusively found in four resusci
tated babies and one baby with questionable resuscitation trials of th
e SIDS-group (4%), furthermore in one resuscitated child dying of a co
ngenital heart defect. Acute pulmonary emphysema was detected in six o
ut of the seven children of the asphyxiation/strangulation group, in t
wo resuscitated children with head injury and in five resuscitated bab
ies dying of SIDS. Both parameters were observed exclusively in the as
phyxiation/strangulation group (71% of the cases) but not in the contr
ol cases. Therefore, it can be concluded that the simultaneous appeara
nce of conjunctival petechiae and of acute pulmonary emphysema strongl
y indicates death by asphyxiation, (C) 1998 Elsevier Science Ireland L
td.