Table 2 Case histories and relevant data

1

Infant co-sleeping between parents on a standard bed. Father had a pillow on his stomach and placed infant on top of it. Infant found lifeless on its side facing father’s back.

Undetermined

2

Infant breastfeeding in mother’s bed. Mother awoke 1 h later and found infant wedged under her breast.

Accidental suffocation

3

Infant breastfeeding in mother’s bed. Mother fell asleep and 20 min later she finds baby ‘blue and not breathing.’

SIDS

4

Breastfeeding in hospital room, fell asleep 5 to 10 min, infant found cyanotic with mouth on nipple. Partially resuscitated. Survived 12 days then taken off life support.

Undetermined

5

Infant breastfeeding in hospital bed. Nurse found mother asleep with infant wedged under ‘large pendulous’ breast and axilla.

Accidental suffocation

6

Swaddled infant fell asleep on pillow while breastfeeding. Then mother fell into a ‘deep sleep’. 15 min later, mother passed baby to grandmother who found baby limp and not breathing.

Undetermined

7

Mother fell asleep with infant beside her in bed. Later mother awoke and found infant lifeless. Mother fears ‘she might have rolled over on her baby’.

Asphyxia accidental overlay

8

Mother pretreated during labor with antibiotics for prolonged rupture of membranes and positive group B Streptococcus. After breastfeeding, she did not return infant to crib because infant ‘was congested.’ She fell asleep, 2 h and 30 min later nurse finds baby ‘latched on’ to breast but ‘blue and floppy.’

Sudden unexplained infant death

9

Mother had C-section due to hypertension and pre eclampsia treated with MgSO₄. Mother said to be ‘intellectually challenged,’ and ‘obese and large breasted.’ Mother breastfeeding when infant ‘became quiet’ and unresponsive. Mother believed baby had gone to sleep, 5 min later mother calls nurse who finds the baby lifeless.

Accidental suffocation

10

Labor was complicated by prolonged rupture of membranes and positive group Strep B Streptococcus treated during labor with IV antibiotics. Labor lasted 30 h. Mother stated ‘she had never been so tired in (her) life.’ Mother asked the nurse to take the baby to the nursery so she could sleep. Nurse said she might not have time to. Mother then breast fed briefly and fell asleep with her infant latched on to the breast. She awoke in the darkened room believing her swaddled infant to be sleeping. Neither parents noted whether baby was breathing or not. Father laid baby supine in bassinette for 90 mins. Father awoke and the infant found lifeless.

Undetermined

11

Labor complicated by prolonged rupture of membranes and positive group Strep B Streptococcus and prolonged labor (24 h). Treated with IV antibiotics. Mother complaining of ‘extreme exhaustion’ breast fed her infant lying on its side on a pillow with the baby rolled toward her. Nurse entered room and found lifeless infant lying beneath her sleeping mother.

Overlay

12

Mother fell asleep while breast feeding. 45 min later, mother awoke in the dimly lit room and found the infant unresponsive lying next to her facing her breast. Believing infant to be sleeping she called the nurse to take baby to nursery. Nurse discovered the infant flaccid and cyanotic.

Undetermined

13

Mother fell asleep 7 h after C-section with infant nursing on her breast. Mother awoke 13 min later and found her infant cyanotic and limp still on her breast.

Undetermined

14

Nurse entered mother’s dimly lit room. Awake mother reports infant just breastfed vigorously for 20 min but is now limp and assumes she is now sleeping. Nurse finds the infant grey and not breathing and begins CPR. Infant survives but with severe permanent brain damage. Extensive medical evaluation fails to reveal cause of the infants collapse. Father in the room at the time of the incident. A friend was also in the room.

Clincal Dx-apnea of undetermined etiology

15

Labor complicated by maternal fever. Both mother and baby treated with prophylactic antibiotics. After breast feeding, the mother placed her infant between her and the father in a ‘tiny’ fold out sofa bed. At some point, the mother then placed the infant behind her and continued talking with the father. After some min, she turned over to check her infant and found him cold and unresponsive. Both parents were noted to be obese.

Compression asphyxia

16

Infant noted to be ‘grunting’ immediately after delivery and as a precaution was taken to the NICU where he was kept briefly, evaluated and returned to the mother’s room after the grunting subsided. A blood culture was obtained. Mother was propped on her side using rolled towels and pillows for breast feeding her infant after which she fell asleep. She awoke, found the infant’s head cool and placed a hat on its head. Mother then noted face to be ‘partially blue’ and called for a nurse who found the infant to be deceased. Father was present in the room.

Probable positional asphyxia

17

Mother was breast feeding her infant in the delivery room lying supine on delivery bed. Father at mother’s side. About 2 h after delivery, the mother noticed that the baby’s chest was not moving and called the nurse who found the infant to be apneic and cyanotic and began CPR with intratracheal intubation and mechanical ventilation. Extubated on arrival at the NICU. Normal neurological exam 3 days later

Clinical DX-apnea of undetermined etiology+

18

Maternal pregnancy and delivery were uncomplicated. Soon after delivery the infant was given to the mother for ‘skin-to-skin’ contact. Minutes later, he was observed to be successfully breast feeding. Then about an hour later, a nurse found him lifeless lying on his mother’s chest with his face into her chest and shoulder. He was successfully resuscitated but suffered severe, lasting brain injury.

Clinical DX-apnea of undetermined etiology+