Diagnosing milk aspiration as a cause of death in sudden unexpected infant death: forensic insights from post-mortem analysis impacting criminal investigations

Sudden unexpected infant death (SUID) encompasses both explained and unexplained infant fatalities. When a comprehensive investigation yields inconclusive results, the case is classified as sudden infant death syndrome (SIDS). On the other hand, the most frequent non-SIDS diagnoses may be attributed to specific causes of death including a heterogeneous spectrum of conditions and disorders (e.g., trauma, asphyxia, suffocation, infection and metabolic diseases). Although rare, milk aspiration is a recognized cause of SUID that can lead to acute respiratory failure. This case report describes the death of a three-month-old infant found unresponsive in a traditional African baby carrier. Gross examination revealed no significant anomalies other than increased lung weight and the presence of milk-like material in the airways, alveoli, and stomach. Histological and ultrastructural analyses identified granular brownish material with birefringent globules in the lungs, consistent with aspirated milk. Immunohistochemical staining was positive for beta-lactoglobulin, confirming formula milk aspiration. This evidence was crucial in excluding maternal negligence as a cause of death, instead supporting an ante-mortem aspiration event resulting from regurgitation. This case highlights the diagnostic challenges associated with fatal milk aspiration and emphasizes the critical importance of a multidisciplinary approach. The integration of clinical history, autopsy findings, and advanced histopathological techniques is essential for accurately determining the cause of death and ensuring a sound legal assessment within the Courtroom setting.