A Series of 8 Illicit Fentanyl Intoxication Deaths in Infants and Toddlers.

ABSTRACT: We report 8 children younger than 2 years who died from acute illicit fentanyl intoxications in Connecticut between 2020 and 2022.The Connecticut Office of the Chief Medical Examiner (CT OCME) investigates all unexpected, violent, and suspicious deaths in Connecticut. The CT OCME's electronic database was searched for fentanyl deaths by age. All underwent autopsies and toxicology testing.The ages ranged from 28 days to 2 years (mean age, 12 months). The causes of death involved acute fentanyl intoxications with 1 having xylazine, 1 having para-fluorofentanyl, and 1 having cocaine and morphine. All the manners of death were certified as homicide. The postmortem fentanyl blood concentrations ranged from 0.40 to 46 ng/mL. Most of the children were found unresponsive after being put to sleep. Three were co-sleeping with adults (2 in bed; 1 on a recliner). There was a known history of parental/caregiver drug abuse in 7 of 8 of the fatalities.We summarize the key investigative, autopsy, and toxicological findings. As illicit fentanyl use increases, there is a potential for infant exposure and death. The investigation and certification of these deaths and the role of intentional administration versus inadvertent exposure due to caregiver neglect in the context of the certification of the manner of death are described.

Impact of statewide safe sleep legislation on hospital practices and rates of sudden unexpected infant deaths.

BACKGROUND: Sudden Unexpected Infant Death (SUID) is the leading cause of death in the post-neonatal period in the United States. In 2015, Connecticut (CT) passed legislation to reduce the number of SUIDs from hazardous sleep environments requiring birthing hospitals/centers provide anticipatory guidance on safe sleep to newborn caregivers before discharge. The objective of our study was to understand the barriers and facilitators for compliance with the safe sleep legislation by birthing hospitals and to determine the effect of this legislation on SUIDs associated with unsafe sleep environments. METHODS: We surveyed the directors and/or educators of the 27 birthing hospitals & one birthing center in CT, about the following: 1) methods of anticipatory guidance given to parents at newborn hospital discharge; 2) knowledge about the legislation; and 3) barriers and facilitators to complying with the law. We used a voluntary online, anonymous survey. In addition, we evaluated the proportion of SUID cases presented at the CT Child Fatality Review Panel as a result of unsafe sleep environments before (2011-2015) and after implementation of the legislation (2016-2018). Chi-Square and Fisher's exact tests were used to evaluate the proportion of deaths due to Positional Asphyxia/Accident occurring before and after legislation implementation. RESULTS: All 27 birthing hospitals and the one birthing center in CT responded to the request for the method of anticipatory guidance provided to caregivers. All hospitals reported providing anticipatory guidance; the birthing center did not provide any anticipatory guidance. The materials provided by 26/27 (96%) of hospitals was consistent with the American Academy of Pediatrics (AAP) Guidelines. There was no significant change in rates of SUID in CT before (58.86/100,000) and after (55.92/100,000) the passage of the legislation (p = 0.78). However, more infants died from positional asphyxia after (20, 27.0%) than before the enactment of the law (p < 0.01). CONCLUSIONS: Despite most CT hospitals providing caregivers with anticipatory guidance on safe sleep at newborn hospital discharge, SUIDs rates associated with positional asphyxia increased in CT after the passage of the legislation. The role of legislation for reducing the number of SUIDs from hazardous sleep environments should be reconsidered.

An Underestimation of Heroin Deaths Due to the Use of "Acute Opiate Intoxication" on Death Certificates.

INTRODUCTION: Deaths due to drug intoxications in the United States have increased. Public health agencies track the specific intoxicants using death certificate data in order to develop and focus prevention strategies. Criteria used to decide what deaths need toxicological investigation and how these deaths are certified will affect this data. METHODS: We retrospectively reviewed the investigative, autopsy, and toxicology reports of 118 fatal intoxications that were certified as "acute opiate intoxication." RESULTS: Of the 113 decedents in whom morphine was detected, 84 were determined to involve heroin. For 61 of 84 heroin deaths, the heroin diagnosis was based upon the detection of diacetylmorphine, 6-acetylmorphine, and/or a lower blood codeine to morphine concentration. For 23 of 84 deaths, the determination was based upon morphine detection and illicit substances and/or paraphernalia at the scene. Of the 61 of 84 heroin deaths diagnosed by direct toxicology results, 33 of the 61 (54%) did not have illicit substances or paraphernalia at the scene. Toxicology identified 33 of 84 (39%) heroin fatalities that would not have been distinguished from morphine intoxication by the scene investigation. CONCLUSIONS: The majority of deaths due to opioids can be further classified based upon the toxicological analysis and scene investigation. As heroin deaths may have no illicit substances/paraphernalia at the scene, investigators should not solely base their decision to perform an autopsy/toxicology on the scene absence of illicit drugs/paraphernalia. In our study sample, if toxicology testing were to be only performed when illicit substances/paraphernalia were found at the scene, a high portion of heroin deaths (39%) would have been missed.

Pseudotetraploid clone with structural chromosomal rearrangements in a chondromyxoid fibroma: a case report.

Chondromyxoid fibroma is a rare benign tumor accounting for 1-2% of primary bone tumors. Most of the patients are young males in the 2nd and 3rd decades of life. Metaphyses of long bones are predominantly affected. The histology of this tumor is well established, but its genetic mechanism remains poorly characterized. To our knowledge, only 22 abnormal cytogenetic analyses have been reported, and all contained diploidy or near-diploidy karyograms as their primary event, and inv(6)(p25)(q13) and rearrangements involving regions 6p23-25, 6q12-15, and 6q23-27 constituted a recurrent observation. In this report, a pseudotetraploidy tumor clone with multiple numerical and structural aberrations involving 6p23 as well as other chromosomal loci was identified in a chondromyxoid fibroma from the metaphysis of the left fibula of an 18-year-old male, which has not been reported. The finding may relate to the atypical-looking large cells often seen in this benign tumor.