The trail of an infant's death begins with questions

It starts with a call about a small life suddenly ended. A baby found lifeless, unable to be revived.

Most of the more than 4,000 sudden and unexpected infant deaths in this country each year prompt a detailed investigation and an autopsy.

Whether an infant is pronounced dead at a hospital, home or some other setting, the need for investigators to quickly begin gathering facts inevitably intrudes on grieving families.

Rachel Yerbich, whose son, Benjamin, died suddenly in Granite Falls, Minn., in September 2006, recalls spending much of the night holding her son in a family room off the ER. 'They unhooked him from all the machines and let me carry him in there and say goodbye, let my family gather with me to say goodbye.'

Yet there were questions waiting for Yerbich and her husband, Jesse.

Typically, investigators attempt to interview parents and others familiar with the care of the infant at the hospital, separately, even though many families want to cling together at such a time.

'It was awful, not having any support when the investigator is asking all these questions, and you've just lost a baby, and you begin wondering what you did wrong,' Yerbich said. 'I know some people kill their babies, but you wish there was some other way for them to get the information.'

'Although painful for the family, a detailed investigation may shed light on the true cause of death,' wrote FBI Special Agent Ernst Weyand in a 2004 article on sudden infant death investigations published in the FBI Law Enforcement Bulletin. ' Without a complete investigation, the circumstances of a baby's death will remain a mystery.'

Investigators often go to both the hospital and the home where the baby was found. They may ask the parent or other person who found the child to demonstrate the position using a life-sized doll. They'll note the type and arrangement of bedding, and may take sheets, blankets and pillows for tests.

A long checklist of questions should be run through about the health history of the child and relatives, about the home and daily routine.

'The treatment of parents is still a work in progress,' concedes Dr. Deborah Kay, assistant chief medical examiner for the Virginia Office of the Chief Medical Examiner's Central Region in Richmond. 'They may be puzzled by getting asked those types of questions, about things they may never have imagined happening. It's a most emotionally disturbing thing, but it is the most important thing, too.'

Early on, investigators photograph the body, noting how blood has pooled as an indicator of position and length of time from death, as well as any bruises or other signs of trauma to the body.

When the infant's body arrives at the morgue, it is weighed and labeled. The protocol in Virginia and many other jurisdictions calls for a full-body X-ray to be done, so pathologists can be aware of congenital abnormalities, fractures or other injuries.

On the autopsy table, the baby is laid out for an external exam. The team notes details a mother would know by heart — the color and length of hair, the color and condition of the eyes, the fingernails, the arms and legs. They also look for signs of illness or violence.

Then, the internal examination begins, the surgical opening of the body and the checking of each vital organ. Typically, an autopsy report from a sudden infant death may note congestion and fluid in the lungs or small burst blood vessels on the surface of the lungs, but no evidence of trauma, no malformation or disease that could have led to death.

'Medically, there's really nothing specific that separates an infant who accidentally suffocated and one that died from SIDS,' Kay said. 'The determination has to come from the scene investigation, the circumstances in which the baby was found.'

In most cases, no more than 24 to 48 hours pass from an infant's death to the release of the body, but autopsy and test results can take weeks, even months.

A little more than half the time in recent years nationwide, the investigation simply rules out any medical cause of death, and the cause is attributed to SIDS — Sudden Infant Death Syndrome. In a growing number of cases, though, investigators find some confounding factor that doesn't match the SIDS diagnosis.

Either way, the lack of a definitive reason for a baby's death after a long, anxious wait leaves many parents frustrated.

'They told me an autopsy was the only way they could tell me why he died,' said Brandy Hazel, who lost her 3-month-old son, Cole, to SIDS in July 2006. 'But really, all it did was tell me that it was SIDS. With SIDS, the autopsy can't tell you why they died.'