Infantile Death by Overlaying: Report of Seven Autopsy Cases

Overlaying refers to mechanical asphyxia caused by an adult sleeping on an infant due to deep sleep or external intoxication. We analyzed seven cases (6.6%) of overlaying death out of 106 sleep-related infantile death autopsy cases from January 2018 to March 2021. They were all boys, with an average age of 132.3 (63-244) days, and were sleeping with their inebriated parents. In autopsy, only non-specific findings such as facial congestion, pressure marks, scratches, and froth in the nose and mouth were noted. In the sleep-related infantile death investigation, thorough investigation of the death scene and the previous history are essential for diagnosis, because autopsy findings are minimal or non-specific in most cases. Victims of overlaying and sudden infantile death syndrome show similar clinical and autopsy findings. Therefore, special attention are required for the differential diagnosis.