Neonaticide

This can be defined as the deliberate killing of a child within 24 h of its birth. The perpetrator is usually the mother. She delivers the child and kills it. Occasionally, she is assisted by a relative or a friend, but usually neonaticide is an act committed by a single individual with no witnesses. Most of the perpetrators are young and unmarried. Some claim not to have realized they were pregnant until they went into labor. Their goal is either to conceal the fact that they gave birth to a child or to dispose of an unwanted child.

Finding dead infants in sewers, trash dumps, and public bathrooms is fairly common in large metropolitan areas. These infants are either victims of neonaticide or are stillborn. The mother is usually the individual who abandoned the child. If apprehended, her defense is usually that the child was stillborn; she panicked and disposed of the body. Thus, in cases of suspected neonaticide, the first fact to establish is whether the child was alive at the time of birth. This is often one of the most difficult things to do. The presence of milk or any food material in the stomach would indicate that the child was alive. Unfortunately, in cases of neonaticide, the killing usually occurs immediately after birth and one does not find milk or food material in the stomach.

The standard test to determine if a child has breathed has traditionally been the hydrostatic test. This consists of determining whether the lungs float in water. If they sink, the child is presumed to have been stillborn, and if they float, the child is presumed to have been born alive. There are problems with this test. If putrefaction has taken place, then, even in the stillborn, the lungs might float. Second, some children who are delivered alive take only a few breaths and do not aerate their lungs enough to float. Because of this, physicians have resorted to microscopic examination of the lungs. If the alveoli were collapsed, then it was presumed that the children had not breathed. If they were completely and uniformly distended (presumably by air), then the child obviously had breathed. Unfortunately, microscopic examination is even more inaccurate than the hydrostatic test. If there has been attempted resuscitation, there may be distention of the air passages and alveoli by air and it will not be possible to determine whether the child was alive or stillborn. One of the authors had a case of a child dead 10 h intrau-terine who, on microscopic examination of the lungs, showed uniform dis-tention of all alveoli, which is consistent with a child who has breathed for several hours. The lungs did not float, however.

At the present time, the authors place most reliance on the hydrostatic test. We determine if both lungs float in toto and then we attempt to float sections of the lungs. If all float, then in our opinion, the child breathed and was, therefore, alive. This, of course, assumes that there has been no attempt at resuscitation and that there is no decomposition. Other findings used to determine whether a child was alive include petechiae of the lungs or heart and air in the stomach on radiological examination. Neither of these criteria is valid. Petechiae are nonspecific and can occur from intrauterine stress, and gas in the stomach can be due to labored respiratory efforts as the infant is in transit through the birth canal.

Once it has been established that a child was born alive, then one has to determine how it was killed. The simplest, most convenient, and probably the most common method of killing infants of this age is by suffocation. This can be accomplished by the direct application of a hand over the face, by obstructing the nose and mouth with an object such as a pillow, or by placing the child in a plastic bag. Less common methods are strangulation, stuffing the mouth with rags or toilet paper, drowning the child in a toilet, throwing the child off a building, and abandonment, with death caused by exposure or lack of care.

Deaths following abandonment may be unintentional in that the mother places the child in an area where she expects it to be found, but for some reason it is not, or environmental conditions (such as temperature) change radically. Given moderate temperatures, newborns can survive 7-10 days without food or water. This was illustrated in the Mexico City earthquake of September 1985 where 44 newborns were buried beneath tons of debris when a hospital collapsed.2

The more violent methods of homicide used on older children are rarely used in neonates. People generally do not bash heads against the wall or stomp neonates. Unfortunately, suffocation of a neonate usually leaves no physical signs. Thus, the pathologist can make this diagnosis only if the mother leaves the baby in a plastic bag, leaves toilet tissue in the mouth, or confesses. If none of these occur, then one can only speculate as to the cause of death.

If the body of a newborn is placed in a warm dry atmosphere, it will frequently undergo mummification. This may be aided by the relatively bacteria-free condition of a newborn. Mummified infants are occasionally found in trunks in attics and beneath floorboards of old houses.

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Responses

  • Italo Romano
    How drugs create neonaticide?
    7 years ago

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