A large part of scientific research on forensic medico-legal institutes methodological. One always looks for new and better methods, for example, to prove more and more different and lesser amounts of molecules able to edit or other forensic issues. An example is the introduction of miRNA analysis in forensic science. Existing methods are continuously improved to be sensitive and specific, are extended to broader questions. An examples of this is our improved "bone" method, also with the DNA from freshwater exposed boneextract may be.
Biomedical research is rare, because in forensic institutions hardly one can build a collective case study sufficiently large. Unlike, for example, a Department of Gastroenterology, imagine where in a short time, tens of patients with the same stomach or intestinal disease, the composition of the "patient population" in the right medicine is necessarily extremely heterogeneous, since there are many different causes of death under the rubric of unnatural or unexplained cause of death is to enter into a forensic investigation.
But a few deaths that occur regularly and are well tested regularly quite medically to rule out foul play, there are. These include the sudden infant death syndrome and sudden cardiac death .
If the sudden and unexpected death of an infant is displayed, the prosecution often seized the corpse of the child and ordered an autopsy to exclude the child from abuse (eg after shaking caused injuries died). It happens, unfortunately, not rare, so that, after consideration of the legal interests affected, often severely traumatized parents the additional burden of an autopsy must be expected.
This also means that can accumulate in the forensic medical institutes collectives of SIDS cases that are sufficiently large for scientific investigations, so that the majority of SIDS research in Germany is done by legal medical institutions.
The Sudden Infant Death Syndrome (SIDS) is still a puzzling phenomenon in industrialized countries, he is still the leading cause of death in infants aged between 3 weeks and one year.
The currently most accepted and cited by many researchers definition is:
"SIDS is defined as the sudden unexpected death of an infant who is less than a year, with the onset of the dying process during sleep, with death * even after a thorough examination of the implementation of a complete autopsy and review of the circumstances of his death ** and including medical history, can not be explained. "
* Falls below as well as a toxicological screening for possible poisoning, overdose of drugs (eg, sedatives), etc. can discover
** that will also visit the place of death, so the sleeping accommodation, such as the bedding, etc., and meant a survey of parents
This definition is not binding or valid in general and to date no consensus exists on binding imperative criteria for SIDS or SIDS-like cases must be handled and examined. This ambiguity is also an existing problem for the research and many inconsistencies in the results between SIDS studies could be due to different applied definitions for inclusion in collectives and different methods for processing and evaluation of large cases.
It could be SIDS, therefore, as well as a generic term for a heterogeneous disease with more than one entity and many potential etiologies understand.
However, SIDS remains a diagnosis of exclusion. That is, if a child in the "age of SIDS" dies and the cause otherwise, it is SIDS. This also means that single factor never a real "cause" of SIDS can be defined, because if a cause of death can be clearly defined , there is just no SIDS.
The incidence of SIDS varies between countries, "layers", ethnicity and other subpopulations. Since in the 80's campaigns have been carried out, suggested in the context of those parents, doctors, nurses and midwives certain behaviors and relationships have been explained, the SIDS incidence has fallen dramatically.
However, according to a study was from 2008, the SIDS rate in Germany still at 0.43 per 1000 live births for the year 2005. With 204 cases in 682 514 live births in 2008 declined, according to the Federal Statistical Office, the rate to 0.3 cases per 1000 live births.
For the etiology of SIDS and the SIDS-associated mortality events involved pathomechanisms are many hypotheses that have been assigned different levels of evidence. Some much-discussed possible factors were identified:
genetic variants that "with the syndrome Long QT are "associated, the LQTS is a complex disease that occur in different variants and mutations in several different genes may be due to the gene as a subunit of the sodium ion channel.
Abnormalities in the brain stem, leading to loss-protective reactions in physiological disorders of self-regulation, the brain stem model is frequently on the neurotransmitter serotonin and its metabolic pathways in the medulla oblongata focused
non-physiological responses to light and really dangerous infections of the upper respiratory tract, eg sleeping in the prone position, to a self-reinforcing and ultimately fatal, "rapid reaction" with hyperthermia , hypotension, shock lead and preterminal
Despite the many hypotheses that circulate for a period of SIDS, there is a broad consensus that SIDS is a multifactorial phenomenon and widespread among researchers notion is the so-called "triple risk hypothesis", the triple risk hypothesis . It states that meet three factors need to enable it to come to SIDS. None of the three factors by itself is the cause, but only through their combination can SIDS be triggered and it takes all three factors.
The first factor is a can cause genetic predisposition. So one in the genome fixed investment, which is a particular susceptibility of a very young child whose breathing and autonomic nervous system or immune system is not fully developed, and for a grown man almost always imperceptible and harmless is.
The second factor is prenatal or neonatal influences on the child, such as smoking during pregnancy, maternal age and preterm birth, and generally the critical developmental period in which there is a child in the first year of life.
The third factor is the actual " trigger "that can initiate a by the first two factors, the vulnerable child SIDS events. These include, for example sleeping in the prone position and overheating of the child.
The figure shows how they fit together the three factors, initially through convergence of genetic predisposition and developmental factors that act before and shortly after birth, could create a vulnerable child, if there an environmental trigger, such as sleeping in the prone position, exposed, can succumb to SIDS.
If this model correctly describes the reality, then, must allow it to come to Sudden Infant Death Syndrome, a genetic factor present. If it succeeds in the future, these factors completely explain, it might in another routine investigation after the birth of a child (keyword: " a massive parallel sequencing ") targeted searches for all known factors. Should one or more are found, they would be warned, it could impact their drug and / or by special care and safety measures neutalisieren and prevent SIDS.
Our genetic makeup, we have not (yet) in the hand and can therefore also that of a newborn can no longer influence to reduce the risk for SIDS. We may very well limit the external risk factors and should do all parents. Therefore, in conclusion, some recommendations, compliance shown to reduce the risk for the occurrence of SIDS:
Before birth:
- Do not smoke during pregnancy
- if predictable: no pregnancy before the mother is 20 years old
After birth (up to the age of one year):
- the child should sleep in the supine position
- the child should not be packed too warm, especially the head must not be overheated room temperature at 18 ° C (do not worry, children not catch cold so fast)
- the child should be exposed to tobacco smoke
- the child should not sleep in the parental bed at the parents' bed is a perfect grown, but own cot
- the child should be breastfed for longer than 2 weeks
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