Causes of Death in Children Dying at Home and While Being Treated in Hospital

Zusammenfassung

Die vorliegende Arbeit befaßt sich mit der vergleichenden Analyse der Todesursache eines Kollektivs von 2872 Kindern bis zum 14. Lebensjahr, von denen 1559 plötzlich zu Hause, 1313 während eines Krankenhausaufenthalts verstorben waren. Bis zum 1. Lebensjahr standen akute entzündliche Prozesse, vorwiegend Pneumonien, im Vordergrund. Jenseits des 1. Lebensjahres waren die Mortalitätsrate und die Anzahl der plötzlichen Todesfälle 5mal geringer als im 1. Lebensjahr. Die Autoren erörtern den Mechanismus funktioneller Störungen des respiratorischen Systems als wichtigste Ursache des plötzlichen Kindstodes. Daneben wird besonders auf folgende andere wichtige Todesursachen hingewiesen: angeborene Entwicklungsstörungen des Aortenbogens, primäre pulmonale Hypotension und Hypoxie des Zentralnervensystems. Es wird unterstrichen, daß die sorgfältige Obduktion bei der Klärung solcher Todesfälle entscheidende Bedeutung hat.

Summary

The causes of death were studied in a group of 2872 children up to 14 years of age. Of these, 1559 infants and children died suddenly at home, and 1313 in the course of hospitalization. The main causes of death in infants up to the 1st year of age were inflammatory states and pneumonias. In the group older than 1 year old the mortality rate and number of sudden deaths were five times lower than in infants.

Factors in functional insufficiency of the respiratory system were discussed, these being the main cause of sudden death among infants. Apart from the factors described attention should be paid to other factors: congenital malformations of the aortic arch, primary pulmonary hypertension, and hypoxemic state of central nervous system. Nontypical and nonevident clinical symptoms can be revealed by a thorough autopsy.

The present study on the problem of sudden and unexpected deaths among infants and children up to the 14th year of life was based upon clinical and postmortem findings from 2872 cases.

The material collected was divided into two study groups: group I comprised 1559 cases of children who died at home after short-term or non-evident symptoms of disease, and whose hospitalization had been found unjustified. These cases were examined as unexpected or sudden deaths at the Institute of Forensic Medicine. As comparison group II comprised 1313 children of the same age treated at the Institute of Pediatrics who died during the course of hospitalization. Apart from nine cases of sudden death the children died from a gradual worsening of the clinical State.

From the evaluation of the age, the mortality rate of possible causes for sudden and unexpected deaths was significantly higher in infants than in older children (Fig. 1).

Male cases were prevalent (59% boys and 41% girls).