Inquest into the deaths of Kayla EWIN and Iziah O'SULLIVAN (Annexure to finding)

3.SUDI Classification

Classification

Definition

SUDI 0

Post-death investigation is not sufficient, and a cause of death cannot be determined or excluded with certainty because of lack of information:

e Death scene examination is undocumented or insufficient e No or insufficient review of medical history of the child/family, including family interview (as per protocol) and review of

clinical records

e Autopsy not in compliance with the SIDS protocol, or missing test or screens necessary to confirm or exclude a cause

SUDI 0+

As above AND one or more intrinsic and/or extrinsic risk factor (s) were able to be identified

SUDI 1

The infant was found in a safe environment with no evidence of accidental death, unexplained trauma, or abnormal presentation prior to death. Following thorough investigation, all other possible causes have been excluded.

Safe environment in this context means that the infant was: e Placed to sleep on their back — not on their front or side e For the first six months after birth, placed on their own safe infant -specific bedding that, where standards exist, is compliant with those standards.

e Inn environment free from tobacco smoke

e Dressed appropriately for the conditions(not overdressed) and their head and face are uncovered

e In an environment free from pillow or other soft objects that pose a suffocation risk — such as adult blankets or quilts, pillows and soft toys.

Thorough investigation includes a minimum of: e Sufficient and documented death scene examination

e Review of medical, social and family history of the child/family, including family interview with protocol and review of birth and clinical records

e Autopsy sufficient and in compliance with the SIDS protocol

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Classification

Definition

SUDI 2 As above, with the exception that non-modifiable (intrinsic) risk factors are identified:

« Low birth weight (less than 2500g)

e Pre-term birth (less than 37 weeks)

e Small for gestational age (less than 10" percentile weight for age at birth) or small for age on relevant intergrowth 21 or WHO charts respectively

e Preceding infectious illness (within the last two weeks)

e Maternal smoking during pregnancy

SUDI 3 The infant was found in an unsafe environment with modifiable (extrinsic) risk factors present, and following thorough investigation, mechanical asphyxia or suffocation cannot be determined or excluded with certainty.

Unsafe environment in this context means the infant was:

e Placed to seep prone or on their side

e Bed-sharing with an adult (if aged less than 6 months), or bed sharing with an adult at any age if the adult is under the influence or likely influence of alcohol or other drugs.

e Placed on their own in bedding not specifically designed for infant sleep(eg: adult mattress, pram, sofa), in infant —specific bedding that was non-compliant with existing standards or was otherwise unsafe

e Exposed to tobacco smoke after birth

e Dressed inappropriately for the conditions (over dressed) and/or their head and/or face was covered

e Placed in an environment with pillow or other soft objects that pose a suffocation risk

SUDI Regardless of sufficiency of post death investigation, a cause of

explained death can be determined with certainty

SUDI _ A cause of death can be determined with certainty AND post — death

explained + investigation identified one or more intrinsic and/or extrinsic risk

factor(s)

Undetermined

A finding of undetermined should only be applied in a SUD! context where the above classifications are insufficient. This would include where there was abnormal acute presentation prior to death (for example, sudden onset illness) but this is not sufficient to explain a cause of death.