Simultaneous sudden unexpected death in infancy of twins

Int J Legal Med (2010) 124:631–635 DOI 10.1007/s00414-009-0407-y

CASE REPORT

Simultaneous sudden unexpected death in infancy of twins: case report
Edwin A. Mitchell & Dawn E. Elder & Jane Zuccollo

Received: 24 November 2009 / Accepted: 16 December 2009 / Published online: 16 January 2010 # Springer-Verlag 2010

Abstract Simultaneous sudden infant death syndrome (SIDS) in twins is anextremely rare event. Some believe these are natural deaths, whereas others suggest they are unnatural. We report monozygotic twins dying at 12 weeks of age. Extensive investigation concluded that the cause of death was natural. Our case fulfilled the criteria of simultaneous SIDS in twins. However, thermal stress due to excessive thermal insulation, use of a pillow and placing twins in the samecot all represent a potentially unsafe sleeping environment. We recommend the term “simultaneous sudden unexpected death in infancy of twins” to describe such cases. Keywords SUDI . Simultaneous death . Twins . Thermal environment . Unsafe sleeping environment

Introduction Twins are at higher risk of sudden infant death syndrome (SIDS) than singletons [1]. However, this largely appears to be dueto lower birthweight of twins. After the “Back to Sleep” campaign in the US, twins continued to have a
E. A. Mitchell (*) Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland 1040, New Zealand e-mail: e.mitchell@auckland.ac.nz D. E. Elder Department of Paediatrics, University of Otago, Wellington, New Zealand J. Zuccollo Department of Obstetrics and Gynaecology,University of Otago, Wellington, New Zealand

higher SIDS rate (1.3/1,000 live births) compared with singletons (0.7/1,000) [2]. The risk factors for SIDS (male, small for gestational age, black, unmarried and maternal smoking) were similar for both singleton and twins. The risk of SIDS in twins is similar for both monozygous and dizygous twins [3, 4]. Simultaneous SIDS in twins has been reported but isextremely rare. The literature mainly deals with single case reports [5, 6]. The deaths are classified as either simultaneous sudden infant death syndrome in twins [7, 8], or due to injuries associated with environmental hazards [9] or “unascertained” [10]. The literature is limited and generates strong opinions. To quote one author: “The likelihood of twin infants dying suddenly andsimultaneously of SIDS, a natural disorder, defies credibility” [9]. The aim of this paper is to describe a further case of simultaneous unexpected deaths of twins and to discuss the possible causes of death in this case.

Case report There had been one previous child born to young Maori parents. That child was aged 3 at the time of the birth of the monozygotic twins and she was well. This pregnancy wascomplicated by pregnancy-induced hypertension. The mother smoked one to two cigarettes a day during pregnancy. Labour was induced at 36 weeks gestation. Both infants were delivered vaginally without complication. Twin 1 weighed 2,100 g (10th–15th percentile) [11], length was 43.1 cm (5th–10th) and head circumference 32 cm (25th). Twin 2 weighted 2,700 g (50th percentile), length was 46 cm (25th) andhead circumference 33 cm (50th). The infant girls were bottle fed from birth. They were discharged home at 7 days of age.

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Int J Legal Med (2010) 124:631–635

At 20 days of age both infants were admitted to hospital for 2 days due to an upper respiratory tract infection (URTI). Two weeks prior to death both infants had minor URTI which was treated in the community with antibiotics.Five days prior to death they had the 3 months immunisation (OPV, DTaP and HibHepB). The 6 weeks immunisation had also been given on time. Both parents smoked. On the evening prior to the death each infant was given a bottle between 9:30 and 10:00 pm and a dose of paracetamol for mild fever. Both infants were placed to sleep on their backs alongside each other in the same cot, which was in the...