A previously healthy 2-month-old infant died unexpectedly during sleep. Post-mortem examination revealed aspiration of gastric contents with early aspiration pneumonia, rhinovirus infection, and trace amounts of fluoxetine metabolite (from maternal breastfeeding). The coroner found no strong evidence that maternal fluoxetine use was a contributory risk factor, noting expert consensus supports continuing this antidepressant during lactation when maternal mental health is stable. Parents had implemented all recommended safe-sleep practices. The death was classified as unexplained sudden infant death with multiple possible contributors but no preventable factors identified.
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Specialties
paediatricsmidwiferygeneral practiceforensic medicine
Drugs involved
fluoxetine
Clinical conditions
sudden infant death syndromerhinovirus infectionaspiration pneumoniagastric aspiration
Contributing factors
rhinovirus upper respiratory tract infection
aspiration of gastric contents with early aspiration pneumonia
possible extrinsic factor of fluoxetine exposure via breastmilk (though no strong evidence of causal contribution)
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