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DOI: 10.1055/s-0041-1739741
Sudden unexpected death of two infants in baby carriers
Introduction In recent years, baby carriers with full or half buckles for easier handling have become popular in the Western countries. Sudden unexpected death in infancy (SUDI) associated with the use of full- or half buckle baby carriers as well as baby slings have been reported in the United Kingdom, France, Spain, Australia, and the US (Batra EK et al., 2015; Bergounioux J et al., 2015; Maqueda Castellote E et al., 2012). Here, we present two recent cases of SUDI in full buckle baby carriers, to our knowledge the first cases reported in Germany.
Case reports Both infants were healthy, full term babies at the age of 1 month and 2 ½ months, respectively (Table 1). They were carried in full buckle baby carriers by one of the parents, presumably asleep, when a cease of spontaneous breathing and cardiac arrest was realized. Both infants presented bloody nasal or mouth discharge. Medical emergency teams were successful in establishing return of spontaneous circulation after 50 and 45 minutes, respectively. Laboratory examination at hospital admission indicated multi-organ failure. Neurological investigations revealed loss of brain function and MRI scans showed signs of hypoxic-ischemic encephalopathy in both infants. There were no signs of child abuse in guideline-based examinations. A multidisciplinary panel recommended to withdraw life support, in mutual consent with the parents, considering the absence of spontaneous breathing.
Discussion Patients’ histories, clinical and apparative findings combined with post mortem examinations strongly suggest suffocation as mechanism of death and lead to the overall conclusion on SUDI. Reviewing previous case reports, the circumstances leading to suffocation in adult-worn full- or half buckle baby carriers and baby slings are similar. Airway obstruction and suffocation presumably occur when the infant falls into a chin-to-chest position. Furthermore, when the infant is fully contained by the baby carrier or baby sling, it may be forced into a C-shaped, curved positioning of the spine, which may aggravate airway obstruction. In addition, the infant’s nose or mouth might be obstructed by the adult’s body or the device itself, especially when the size of the carrying device is inadequate.
Conclusion Despite their growing popularity, baby slings and baby carriers may exhibit a significant risk for SUDI. These devices should be used with particular caution in infants below 4 months of age, until neurodevelopment allows complete head control. According to the age and weight of the infant, parents should focus on correct size and fitting of the strap-on device. Appropriate warnings and instructions need to be provided by manufacturers and health professionals, e.g. at the well-baby examinations scheduled for 3–10 days (U2) and 4–6 weeks (U3).


Publication History
Article published online:
26 November 2021
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