Cerebellar hemorrhagic injury (CHI) is being recognized more frequently in premature infants. However, much of what we know about CHI neuropathology is from autopsy studies that date back to a prior era of neonatal intensive care. To update and expand our knowledge of CHI we reviewed autopsy materials and medical records of all live-born preterm infants (<37 weeks gestation) autopsied at our institution from 1999-2010 who had destructive hemorrhagic injury to cerebellar parenchyma (n = 19) and compared them to matched non-CHI controls (n = 26). We favor the possibility that CHI represents a primary hemorrhage arising due to the effects of impaired autoregulation in a delicate vascular bed. The incidences of neuronal loss and gliosis in the inferior olivary and dentate nuclei, critical cerebellar input and output structures, respectively were higher in CHI compared to control cases and may represent a transsynpatic degenerative process. CHI occurs during a critical developmental period and may render the cerebellum vulnerable to additional deficits if cerebellar growth and neuronal connectivity are not established as expected. Therefore, CHI has the potential to significantly impact neurodevelopmental outcome in survivors.
This collection of literature attempts to compile many of the classic works that have stood the test of time and offer them at a reduced, affordable price, in an attractive volume so that everyone can enjoy them.
It stands to reason that the most difficult cases to investigate are those in which the individuala (TM)s death was sudden, unexpected, and unexplained. Very few deaths occur where the deceased has no significant medical history, no trauma, no significant autopsy findings, and very little social history in which to investigate. Infant deaths almost always fit this category, making them consistently the most complicated and challenging deaths to investigate.
Investigating Infant Deaths draws on the expertise of a forensic nurse and member of the CDC core team for the Sudden Unexpected Infant Death Investigation Reporting Form to provide medicolegal death investigators and law enforcement personnel with investigative techniques applicable to sudden unexpected infant deaths. Beginning with a general state-of-the-field, the author defines the role of the investigator and explains the benefits of a oedouble-teaminga an investigation. The book emphasizes the importance of timing and gives crucial tips for examining the incident scene and performing an initial post-mortem external exam. Specific instruction regarding the a oearta of interviewing the grieving parents and how to follow up with families gives investigators an important edge when autopsy findings are slim. Additional chapters cover how to use a doll re-enactment and how to review medical records, social service records, and criminal histories. It also illustrates how to set up task forces including State Child Fatality Teams and an Investigative Child Death Review at the local level. ACase studies are used throughout the book to give investigators real-life examples of the techniques at work.
Presenting a workable approach that may facilitate a re-evaluation of current protocols, Investigating Infant Deaths provides the tools for continued improvement that will ensure all infant deaths are investigated thoroughly and thereby help prevent future premature infant deaths from occurring.
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