Bron: Pubmed

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Ned Tijdschr Geneeskd. 2007 Apr 7;151(14):838; author reply 838-9.
Das C, Duijst-Heesters WL, Rutgers RA.
[Efforts to gain further insight into unexplained deaths among children]
[Article in Dutch]

Comment on:
Ned Tijdschr Geneeskd. 2007 Feb 3;151(5):284-6.

Ned Tijdschr Geneeskd. 2007 Feb 3;151(5):284-6.
Ploem MC.
[Efforts to gain further insight into unexplained deaths among children]
[Article in Dutch]

Child abuse can be overlooked as a cause of death, particularly in cases in which there is initially no known cause of death and the death remains unexplained. To rectify this serious situation, both the government and member of parliament Arib have developed proposals to amend the procedures found in the Burial and Cremation Act regarding the deaths of minors. The government hopes to promote closer post-mortem examination for those paediatric cases, including sudden infant death syndrome, in which the cause of death remains unexplained by requiring further investigation into the cause of death (the so-called NODO procedure). Arib proposed a bill in May 2006 that would require all deceased minors to be examined by a forensic expert. Arguments against the latter proposal include the unnecessary burden it would place on surviving relatives of children who die of clearly natural causes. At this time, the NODO procedure proposed by the government appears to be the more rational choice. At the same time, training for medical professionals, particularly general practitioners and paediatricians, should give ample attention to identifying injuries caused by child abuse and how best to deal with the parents.

Ned Tijdschr Geneeskd. 2007 Feb 3;151(5):305-9.
de Bruin KH, de Keijzer JC, Rutgers RA, Das C.
Unexplained deaths in minors in the Amsterdam-Zaandam region in 1990-2004 and the estimated number that will be considered for further investigation into the cause of death (the NODO procedure)
[Article in Dutch]

OBJECTIVE: To determine how often deceased minors are examined by a forensic physician and the rate of unexplained deaths, and to estimate how often further investigation into the cause of death (the so-called NODO procedure) would be initiated.
DESIGN: Descriptive, retrospective study.
METHOD: Statistics Netherlands (CBS) provided the number of deceased minors and the manner as well as cause of death for the Amsterdam-Zaandam region in the period 1990-2004. Data regarding residence, age, year of death, manner of death and cause of death were collected for all post-mortem examinations performed on minors during the same period using the registration system of the Department of Forensic Medicine of the Amsterdam Municipal Health Services.
RESULTS: A total of 2134 minors living in the Amsterdam-Zaandam region died in the period 1990-2004, according to the CBS. In this 15-year period the CBS registered 140 deaths (7%) that remained unexplained after post-mortem examination: 91 were registered as natural deaths due to unknown or unclear causes and 49 were registered as sudden infant death syndrome. In 306 cases (14%) the post-mortem examination was performed by municipal forensic physicians. Of these cases, 61 (20%) remained unexplained after post-mortem examination. In the remaining cases, post-mortem examination was performed by the treating physician.
CONCLUSION: The estimated annual number of cases that will be referred for the NODO procedure in the Amsterdam-Zaandam region is at least 10: 4 based on unexplained deaths after examination by a municipal forensic physician and 6 based on natural deaths with no known cause of death according to the treating physician. Nationwide, at least 125 of the expected 1800 childhood deaths will be referred annually.

Ned Tijdschr Geneeskd. 1998 Nov 14;142(46):2515-8.
Kuyvenhoven MM, Hekkink CF, Voorn TB.
Vakgroep Huisartsgeneeskunde, Universitair Medisch Centrum Utrecht.
[Deaths due to abuse for the age group 0-18 years; an estimate of 40 cases in 1996 based on a survey of family practitioners and pediatricians]
[Article in Dutch]

OBJECTIVE: To determine the number of cases of death of children and youths (0-18 years) in 1996 in which the doctor suspected maltreatment as a possible cause of death and whether the death was declared the result of natural causes.
DESIGN: Questionnaire.
SETTING: Department of General Practice Medicine, University of Utrecht, the Netherlands.
METHOD: In co-ordination with the Dutch College of General Practitioners and in consultation with the Dutch Society of Pediatricians a questionnaire was sent to all general practitioners (n = 6957) and pediatricians (n = 971) in the Netherlands. The definition of maltreatment was left to the respondents. The questionnaire included questions regarding some characteristics of the children and the motivation of the doctor to notify or not to notify the municipal coroner. It referred to 1996 but it also asked for cases in 1992-1995 to determine whether the earlier data supported the 1996 ones.
RESULTS: The overall response was 83% (6583/7928). The doctors mentioned a total of 33 cases in which they suspected that the death was the result of some kind of maltreatment. 'Death from natural causes' was noted on the death certificates of 6 of these cases and the coroner was not notified. The estimated number of deaths due to mistreatment in the age group 0-18 years for 1996 was 40 (1.14 per 100,000; 95% confidence interval (95%-CI): 0.79-1.50) and 24 in the age group 0-2 years (4.13 per 100,000; 95%-CI: 2.48-5.79), with an estimate of 7 certificates stating death from natural causes. CONCLUSION: The Dutch figures are rather similar to the minimum estimate for the United States in the youngest age groups: 4-11 cases per 100,000 and lower than for other European countries.

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