Oronasal secretions are observed frequently in
sudden infant death syndrome (
SIDS), but overt blood is uncommonly reported. The literature on oronasal blood in
sudden infant death is limited. The goal of this study was to determine the frequency of oronasal blood in sudden
infant deaths and to examine possible causative factors. Oronasal blood was described in 28 (7%) of 406 cases of
sudden infant death. Oronasal blood could not be attributed to
cardiopulmonary resuscitation in 14 cases, including 10 (3%) of 300 cases of
SIDS, 2 (14%) of 14 accidental
suffocation cases, and 2 (15%) of 13 undetermined cases. Eight of the 10 infants in cases of
sudden infant death were bedsharing: 5 with both parents, 2 between both parents. The infant in 1
SIDS case was from a family that had had three referrals to Child Protective Services. Oronasal blood not attributable to
cardiopulmonary resuscitation occurs rarely in
SIDS when the infant is sleeping supine in a safe environment. Bedsharing may place infants at risk of
suffocation from overlaying. Oronasal blood observed before
cardiopulmonary resuscitation is given is probably of oronasal skin or mucous membrane origin and may be a sign of accidental or inflicted
suffocation. Sanguineous secretions that are mucoid or frothy are likely of remote origin, such as lung alveoli. The use of an
otoscope to establish the origin of oronasal blood in cases of
sudden infant death is recommended.