Infanticide: Causes, Implications and Prevention

Infanticide

The Killing of a child under the age of 1 year is known as infanticide.

• Neonaticide - Killing a child within 24 hours of birth. 
• Feticide - Killing a fetus 
• Felicide - Killing a child by its own parents. 

IPC

There are few Indian penal codes that punish people who commit these heinous crimes. These are mentioned below. It is important to know that there is no separate IPC for infanticide. Infanticide is punished under 302 IPC, which is the same as murder. 

S. 315 IPC 

• Related to causing death. 
• With intent to prevent the child from being born alive or to cause it to die just after birth 
• Usually, gestational age >28 weeks 

S. 316 IPC 

• The aim was to kill the mother, but the death of her unborn child was caused.
• This amounts to culpable homicide. 

Viability of Fetus 

• The age of the fetus after which it is capable of survival outside is known as the viability of the fetus.
• Killing a fetus before the age of viability is called abortion. 
• 28 weeks of gestation is the age after which fetus can survive outside the womb. It is roughly 210 days 
• At 28 weeks the
  • Length - 35 cm 
  • Weight - 900g -1200g
  • Fingernails - thick
  • Meconium - in the large intestine 
  • Eyelids - open and pupillary membrane - disappeared. 
  • Testes are found at the external inguinal ring. 
  • Ossification Centers Appear in
    • 2nd and 3rd pieces of the sternum.
    • Talus 

After 28 weeks

This fetus can fall in any of the categories given below: 

1. Dead born 
   • The fetus died inside the uterus. 
   • IUD - intrauterine death 
2. Stillbirth
   • The fetus died during the process of delivery.
   • In birth passages 
3. Live birth 
   • Fetus came out. 
   • Expulsion of the fetus and shown signs of life 

Fetal/Newborn/Infant Autopsy 

When there is misconduct in the death of the baby. The doctor is the one who has to check if any foul play was involved or not. For checking the autopsy has to be done.

• When conducting fetal/newborn/infant autopsy
  • The first cavity to be opened is the Abdominal cavity to see the position of the diaphragm
• the method employed is ROKITANSKY
  • in-situ method
  • No organ is taken out. 
• Other methods that can also be used are:
  • Virchow’s 
  • Ghon’s 
  • Letulle’s
• Cranial cavity can be examined in the fetus by two methods:
  • BENEKE’S METHOD 
    • The cranial cavity is divided into two parts.
  • BARR’S METHOD 
    • The cranial cavity is divided into four parts in this method.

Dead Born

A dead born baby will have these signs, evidently seen on autopsy:

Signs 

These can be remembered using the mnemonic SHORMA:

• S - SPALDING SIGN 
• H - Hyperflexion of Spine - DEUEL'S HALO SIGN 
• O - Overcrowding of ribs
• R - Rigour Mortis
  • Stiffening of muscles 
• R - ROBERT SIGN 
• M - Mummification 
• A - Aseptic autolysis
  • Also called Maceration. 

Maceration

• Most important sign 
• Also called aseptic autolysis
  • No bacteria are involved. 
  • Self-lysis 
• Conditions required for maceration to occur are:
  • Intact Amniotic Sac.
  • With plenty of amniotic fluid. 

Changes in Maceration

• Skin slippage/Reddening of skin/Peeling of skin
  • When pressure is applied to the skin - The skin will peel off
  • After 12 hours 
  • Earliest sign of maceration 
• Skin blister/Blebs
  • 24 hours 
• Softening of joints
  • Flaccid body 
  • 48 hours /2 days 
  • Hypermobile joint 
• Swedish/disagreeable odour 
• Subcutaneous edema
  • 5th day 
  • Thickness >5mm
• Abdominal distension

In Maceration

• Skin slippage/Skin peeled off. 
• Reddening of the skin.

Maceration Stages 

• Mild - only skin slippage
• Moderate - skin slippage + softening of organs
• Severe - skin slippage + softening of organs + hypermobile joints 

Mummification

• Conditions required for mummification are:
  • Intact amniotic sac 
  • With a deficient blood supply of the fetus.
  • Scanty amount of amniotic fluid.
  • No air
  • Dehydrated fetus.

Putrefaction 

• Kind of decomposition 
• The amniotic sac not intact 
• Ruptured amniotic sac.
• Bacterial entry 

Radiological Signs of Dead Born 

• ROBERT‘S SIGN 
  • Gas
    • In aorta
    • In the pulmonary artery.
    • In the cardiac chamber.
    • In the umbilical artery.
  • 12 hours after death
  • Earliest radiological sign 
• SPALDING SIGN
  • 4-7 days after death
  • Overriding of cranial bones. 
  • Loss of alignment of cranial bones.
  • Because of liquefaction of the brain.
    • Support of cranial bones is lost. 
  • More common in vertex presentation.
  • Pathognomonic sign.
• Hyperflexion of Spine
  • Hypermobile joint 
  • Ball sign 
  • Vertebral column collapses 
• Overcrowding of ribs
  • Softening of organ 

• Halo sign - DEUEL'S HALO SIGN 
  • Halo in fetal head 
  • Separation of subcutaneous fat from the skull.

Live birth

• Any sign of life after the complete birth of a child. 
• Or the complete expulsion of the product of conception. 

Signs of live birth:

• Breathing 
• Cry of baby
• Movements of baby
• Pulsations
• Cardiac activity 

Given in the Registration Of Birth And Death Act 1969

Live Birth Tests 

1. Wreden’s test 
   • Air in the middle ear 
   • wrEdEn’s - EE - air in the ear 
   • No respiration - middle ear shows gelatinous tissue. 
2. Fodere’s test/static
   • Lung weight becomes two-fold. 
   • Fodere - two-fold
3. Plocquet test 
   • Proportion of lung weight by body weight.
   • Without respiration - 1/70. 
   • Respiration - 1/35 of body weight  
4. Breslau's 1st life test 
   • Air in the lung
5. Breslau's 2nd life test
   • Air in the stomach or intestine.
   • Stomach/ bowel test 
   • Double ligate the stomach and cut between two ligatures. 
   • Put stomach in water. 
   • Open the stomach inside the water.
   • If air is present → Bubbles will form. 

Breslau's 1st life test

• It is also known as the Lung float test/ RAYGAT’S test/ Hydrostatic test
• Based on specific gravity. 
• Based on the residual volume. 
• Residual volume
  • Volume of air that cannot be expired even with forceful expiration. 

To know the steps of Breslau's 1st life test in detail, watch our video on infanticide on the PrepLadder app. 

Few More Signs of Live Birth 

• Caput succedaneum 
  • Edema or congestion of the scalp. 
  • Crosses suture line. 
  • Compression of the scalp.
• Cephalhematoma
  • Hematoma between periosteum and skull
  • Does not cross the suture line. 
  • Subperiosteal hematoma 
• Umbilical structures
  • The umbilical artery closes on 3rd day.
    • Form medial umbilical ligament. 
  • Vein closes on 4th day.
    • Form ligamentum teres 
  • Cord - falls by 5-6 days. 

Criminal Abortion

• It is punishable under Section 312-316 IPC 

Section 317 IPC

• Abandoning the child at any place below 12 years of age. 

Section 318 IPC

• Concealment of birth. 
• 2-year 士 fine. 
• If child is unborn
  • Vagitus uterinus - intrauterine cry of unborn child. 
  • Vagitus vaginalis - Intravaginal cry. 

Sudden Infant Death Syndrome 

• Sudden Infant Death Syndrome 
  • Infant was healthy. 
  • Unexplained sudden death. 
• It is also known as Crib death/ Cot death.
• Predisposing factors
  • Common in males 
  • 2 weeks to 2 years 
  • Commonly seen  in infants less than 6 months 
  • Incidence - 0.2 -0.4%
  • If 1st twin has problem, 2nd twin has more chance. 
  • Usually - Early morning 
  • If mother or parents are smokers or alcoholic 
  • Prematurity 
• Autopsy is Negative in such cases
  • All gross, Histopathologic, and laboratory tests are done.  
  • No findings 
• Face - Cyanosis 
• Milk or blood-stained froth from the oral cavity and nostrils
• Petechial hemorrhages in organs. 
• Cause of death
  • Deficiency of calcium, magnesium, selenium
  • Most common accepted theory - prolonged sleep apnoea
  • Viremia → respiratory depression.
  • Cow milk allergy. 
• Medico Legal implication
  • Presumed to be case of infanticide. 

Two Syndromes Related to Infanticide Are

1. Munchausen Syndrome Of Proxy 

Child abuse 

• Parents have psychological problems. 
• Repeated frivolous complaints by the parents. 
• Unnecessary investigations and treatment. 
• May be produced or alleged by parents. 

Examples of Child Abuse

• Parents give laxative and complain of diarrhoea.
• Parents give emetics and complain of vomiting.
• Prick finger and mix with urine to cause hematuria.
• Give Insulin → hypoglycemia 

Criteria of Child Abuse 

ROSENBERG Criteria 

1. Illness produced for alleged by parents. 
2. Repeated medical procedures and treatments. 
3. Denial of knowledge of cause of symptoms 
4. Regression of symptoms when child is separated from parents. 

2. Battered Baby Syndrome

• Also called CAFFEY SYNDROME / CAFFEY KEMPE SYNDROME / Maltreatment syndrome / Parent Child Stress Traumatic Syndrome 
• There is Inflicted physical injury by parents or guardian.
• It is done when there is:
  • Discrepancy in injuries in body and history given by parents. 
  • Delay in production of injuries and seeking medical attention. 
  • Different stages of healing of injuries.
    • Some injuries are 1 day old.
    • Some 1 week 
    • Some 1 month
• Predisposing factors 
  • Common in children < 3 years 
  • Male child 
  • Eldest or youngest child. 
  • Unwanted or illegitimate child. 
  • In parents of low socioeconomic status.
  • In illiterate parents. 
  • Unemployed parents. 
  • Unmarried parents.
  • If parents are Smokers, alcoholics, or drug abusers.
  • Same history in parents - Parent was a battered baby. 

Injuries

• Most common method of injury
  • Direct manual violence - Direct hitting 
• Most characteristic lesion
  • When you close your mouth while crying or slap the child.
  • Causes Tear inside upper lip near frenulum. 
• Others
  • Eye injuries 
  • Retinal hemorrhage or detachment. 
  • Patterned bruises.
    • Pinch marks → Butterfly bruises. 
    • Fingertip pressure → coins shaped bruises or six-penny bruises. 
  • Burns or scalds.
    • Hands, legs, or feet in hot water. 
    • Glove and stockings pattern of injuries. 
    • It is also known as Shaken baby syndrome. It is caused by Frequent shaking of the baby.
    • Causes Subdural hematoma.
      • Due to rupture of bridging veins 
    • Retinal detachment 
    • Periocular bleeding
      • Dot and blot haemorrhages
    • Encephalopathy 

Infantile Whiplash Syndrome 

• Skull fracture - linear fracture or fissure fracture.
  • Eggshell fracture 
• Multiple rib fractures
  • Anteroposterior compression → lateral fracture of ribs in midaxillary line
  • If lateral compression → ribs are fractured at posterior angles.
    • Paravertebral gutter formation - called nibbling fracture. 
  • X-ray - Formation of a callus - String of bead appearance. 
• Metaphyseal fracture
  • The lower end of the tibia
  • The upper end of the femur
  • Corner fracture or bucket handle fracture 
• Traumatic alopecia - Subgaleal hematoma 

Cause of Death

• The most common cause of death is head injury 
• Followed by blunt trauma to abdominal organs. 

Investigation 

• A single X-ray of the whole body - Babygram 

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