SN7 SHORT NOTE 5M

Describe the examination of a dead newborn found in a public place.

Forensic Medicine · 2nd Professional — Para-Clinical

Nature and Recognition

A dead body of a newborn found in a public place — a drain, a well, a refuse heap, a field or a railway track — is among the commonest medicolegal presentations in India, and poses a defined sequence of questions which must be answered in order.

1. Is it human? — occasionally an animal fetus is brought → 2.
What is the maturity? — crown-heel length with HASSE’S rule, weight, external features, and the ossification centre in the lower femur for full term → 3.
Was it viable? — maturity, and the presence of any lethal malformation → 4.
Was it dead-born? — look for maceration first, which if present ends the enquiry into infanticide → 5.
Was it born alive? — the chest and diaphragm, the lungs, the hydrostatic test with compression, the stomach-bowel test and the middle ear → 6.
How long did it survive? — the cord and its inflammatory ring, gastrointestinal air, caput, meconium and milk in the stomach → 7.
What was the cause of death? — natural, accidental or homicidal → 8.
Was there care and was it withdrawn? — washed, dressed, cord tied, fed → 9.
Identity and maternity — preserve tissue for DNA, and examine any suspected mother for signs of recent delivery

What to Record and Preserve

At the scene — the exact place and position; the container, bag, cloth or newspaper in which the body was wrapped, which may carry a date, a shop name or fingerprints; the presence of the placenta; and photographs before anything is moved
External — length, weight and head circumference; the state of the umbilical cord, whether torn or cut, its length, and whether tied; vernix, meconium and blood on the skin, indicating an unattended birth; the caput; and every injury, described and photographed with a scale
Internal — a complete autopsy including the skull opened carefully to look for tentorial tears and intracranial haemorrhage; the neck dissected in a bloodless field; and the lungs, stomach and intestines removed after ligation for the floatation tests
Preserve — the cord and its stump; the stomach and its contents; blood and tissue for DNA; viscera for toxicology; and the wrappings and container, handed over to the police sealed
Radiograph the body — for the ossification centres, for fractures, and for any foreign body such as a needle introduced through a fontanelle

CLINICAL PEARL

Radiograph every dead newborn before dissecting it. It demonstrates the ossification centres that establish maturity, any fracture of the skull or long bones, and — crucially — a needle or pin introduced through a fontanelle, the nostril or the ear, which is a recognised method of infanticide and leaves almost no external mark. It costs a few minutes and cannot be done afterwards.

Applied Aspects

Work through the questions in order; maturity, then intrauterine death, then live birth, then survival, then cause. Beginning with the cause of death produces unsupportable opinions
Look for maceration before anything else; if present, the child was dead before birth and no question of infanticide arises
Radiograph before dissection, for the femoral centre, for fractures and for a concealed needle
Record the state of the cord; torn and ragged indicates an unattended precipitate delivery, and cut or tied indicates that somebody was present
State honestly where the findings are uninterpretable; decomposition destroys the evidence of live birth, and a report that says so allows the correct lesser charge rather than an unsustainable greater one
Preserve DNA in every case; establishing maternity is frequently the only way the investigation proceeds, and the body will be disposed of
Establish that the remains are human before anything else; animal fetuses are brought in and an investigation has been built on one
Open the skull carefully for tentorial tears and intracranial haemorrhage, which are the classical birth injuries and are easily destroyed
Look for signs of care and its withdrawal — washed, dressed, cord tied, fed — which show the child was attended and survived
Preserve the wrappings and container; a newspaper carries a date and a place, and a bag may carry fingerprints
Photograph at the scene before the body is moved; position and surroundings cannot be reconstructed and bear on the manner of death
Ligate the stomach and duodenum before removal, or the swallowed air escapes and the second life test is lost
Dissect the neck in a bloodless field as in any other body; strangulation of a newborn is easy and leaves little
Section the lower femur in every case; the ossification centre establishes full term and survives decomposition
Take the middle ear where the body is putrefied; it is protected and may answer the question of respiration when the lungs cannot

All questions in Infanticide & Abortion

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