Coroner stresses safe sleeping practices for babies, records open verdict in death of 7-week-old boy

Source: CNA

SINGAPORE: The State Coroner has reiterated the importance of safe sleeping practices for infants while giving an open verdict into the death of a seven-week-old boy who was found face down on a pillow.

While State Coroner Adam Nakhoda said it could not be conclusively determined if the baby died from asphyxia or a natural cause of death, he emphasised the importance of safe sleeping arrangements.

An expert had previously highlighted that accidental suffocation of a sleeping infant was a preventable cause of sleep-related infant deaths.

Guidelines include: Not placing loose items like pillows, blankets, beddings, toys or mattresses around or under a sleeping infant; allowing the infant to sleep alone in a baby cot; and using a firm mattress with a fitted bedsheet with no gaps between the mattress and cot rail.

Infants should be placed on their backs when sleeping and not on their stomach or side until they are a year old. However, babies above four months old who can roll from their backs to their stomachs and back again can be allowed to remain in the sleeping positions they assume.

The baby boy was born on May 17, 2023, at KKH Women's and Children's Hospital to a couple who already had a five-year-old daughter and a one-year-old son.

The boy was pre-term at 35 weeks due to placental abruption. He weighed only 2.14kg and was transferred to the special care nursery and later neonatal intensive care unit.

He was discharged from KKH at two weeks of age.

His mother said he may have caught a cough from his brother in the week he went home but had no fever.

The baby was cared for primarily by his mother and was bottle-fed every two to three hours.

Initially, the baby slept in a cot in the same room as his mother and older brother, who was a one-year-old toddler.

However, as the baby woke up frequently to feed, this affected his brother's sleep.

The baby was then moved to sleep in another bedroom with his father. In this bedroom, there was an elevated bed and a mattress next to it on the floor.

The baby was first put to sleep on the bed, while his father slept on the mattress.

However, the parents became concerned that the baby might fall off the bed and put him to sleep on the mattress instead, while his father slept on the bed.

When the baby slept on the mattress, he was usually placed slightly on his side, with most of his back still on the mattress.

His head would be placed on a small pillow in a side-lying position, because milk tended to leak out of his mouth.

His head was tilted to the side because of his slight runny nose and congestion.

The parents would then cover the baby with a weighted bean bag to prevent him from moving while he slept.

On Jul 3, 2023 at about 10pm, the boy's father fed him milk and placed him in his usual sleeping position on the mattress. The baby was likely to be swaddled, the court heard.

The father then went to sleep on the bed next to the baby.

At about 5.30am the next morning, the father woke up and panicked when he realised the time.

This was because the baby should have woken at around 1am to feed, but he had not.

The father checked on the baby and saw him face down on the pillow, unresponsive. The weighted bean bag was still on the baby.

The father picked the infant up and tried to wake him but found that he was stiff and cold.

The man then woke his wife, who saw that the baby's face and lips were purplish.

She was trained in infant first aid and began to administer cardiopulmonary resuscitation to the baby while her husband called for an ambulance.

Paramedics at the scene estimated that the baby had likely died for some time. The child was pronounced dead later that morning.

An autopsy could not ascertain the final cause of death. Although asphyxia could not be totally excluded as a cause of death, it was also possible that the boy had died due to a natural disease process, the medical officer performing the autopsy found.

Photos taken of the scene showed that the mattress the baby slept on was a thin adult-sized mattress that appeared to be meant for a single bed.

While a fitted sheet was placed on the mattress, it was clear it did not fit snugly as there were creases and ridges made by the loosely fitted sheet, the coroner said.

The mattress was placed against the elevated bed, with soft toys, small pillows and a packet of wet wipes placed on the mattress.

The pillow was rectangular with a depression in the middle, possibly caused by the weight of the baby's head.

The parents of the child did not raise any issues or concerns during the coroner's inquiry and the police did not suspect foul play.

The coroner said "losing a child is always a devastating event, perhaps more so when the child is a very young infant that was otherwise thriving".

Although the boy had some medical issues at birth, he had overcome these and there was no evidence he had any other issues at the time of his death.

The coroner found that it was likely the baby had died before 5.30am when his father found him.

While it was unclear how the baby ended up lying prone, it was possible that his nose and mouth were covered by the pillow, resulting in asphyxiation.

This could have resulted in the redness seen around the baby's nose and mouth and a small bruise on his nose. However, the coroner said these could also have been a result of the CPR.

He extended his condolences to the boy's parents on their tragic loss.