Nasal and intrapulmonary haemorrhage in sudden infant death syndrome

Background-Fresh intrapulmonary and oronasal haemorrhages in cases of sudde n infant death syndrome (SIDS) might be markers for accidental or intention al smothering inappropriately diagnosed as SIDS. Aim-To compare the incidence, epidemiological association, and inter-relati on of nasal haemorrhage, intrapulmonary haemorrhage, and intrathoracic pete chiae in infant deaths certified as SIDS. Methods-In SIDS cases from a large nationwide case-control study, a wide ra nge of variables were compared in cases with and without reported nasal hae morrhage and, in a subgroup of cases, in those with and without pathologica lly significant intrapulmonary haemorrhage. Results-Nasal haemorrhage was reported in 60 of 385 cases (15%) whose paren ts were interviewed. Pathologically significant intra-alveolar pulmonary ha emorrhage was found in 47% of 115 cases studied, but was severe in only 7%. Infants with nasal haemorrhage had more haemorrhage into alveoli and air p assages than age matched cases without nasal haemorrhage. In multivariate a nalysis, nasal haemorrhage was associated with younger infant age, bed shar ing, and the infant being placed non-prone to sleep. Intrapulmonary haemorr hage was associated with the same three factors in univariate analysis, but in multivariate analysis only younger infant age remained statistically si gnificant. There was no significant association between nasal or intra-alve olar haemorrhages and intrathoracic petechiae. Conclusions-Nasal and intrapulmonary haemorrhages have common associations not shared with intrathoracic petechiae. Smothering is a possible common fa ctor, although is unlikely to be the cause in most cases presenting as SIDS .