Open verdict on death of 3-week-old boy who fell asleep in arms of confinement nanny

SINGAPORE: A coroner said on Thursday (Oct 28) that the cause of death of a three-week-old boy who fell asleep in the arms of his confinement nanny could not be ascertained.

Coroner Kamala Ponnampalam wrote in her inquiry findings that she was constrained to record an open verdict as forensics experts could not determine if the baby died due to suffocation or sudden infant death syndrome.

The evidence does not suggest foul play, she added.

In her findings, Ms Kamala wrote that the baby was born healthy in October last year. He had no known medical conditions apart from neonatal jaundice and a hoarse voice because of acid reflux a few days prior to his death.

The family hired a 57-year-old confinement nanny, Madam Sien Yem Leng, to look after the boy.

Mdm Sien did not have formal training, but had worked as a confinement nanny for almost 20 years and had gained her experience from caring for her younger siblings and her previous job where she worked with children.

DIED AFTER SLEEPING IN ARMS OF NANNY

During her time with the baby's family, Mdm Sien occupied and slept in the same room as the baby, where the family had set up a portable camera to monitor the infant.

On Nov 19, 2020, Mdm Sien fed the baby at about 1am. After feeding, the baby made some noises which indicated to Mdm Sien that he was in some discomfort, according to the findings.

The baby had been uncomfortable throughout the night as he kept making noises and seemed to be crying and fidgeting in his cot, according to the findings. Mdm Sien carried him several times in different positions to get him to fall asleep.

"At some point, Mdm Sien sat on her bed leaning against the wall behind her, with (the baby) in her arms. He was held against her chest with his face resting on her shoulder. Mdm Sien dozed off," according to the findings.

At about 4.15am, the baby’s mother woke up, went into his room and found him asleep in Mdm Sien's arms.

According to the mother, the baby’s face was "facing directly" into Mdm Sien’s chest. She also said that a yellow cloth - which had been placed on Mdm Sien's chest and used a barrier between nanny and baby for hygiene purposes - was on the baby's face when Mdm Sien carried him to the cot.

She said that Mdm Sien removed the cloth after placing the baby in his cot and and then left the room to wash some breast pump accessories.

Mdm Sien, in her account, said that the right side of the baby’s face was on her shoulder area and not buried into her chest or shoulders. She explained that she would turn his head to face away from her shoulders whenever she held him in this position.

The view of the baby and Mdm Sien was obstructed by cushions in the portable camera footage.

After Mdm Sien left the room, the baby’s mother noticed that the left side of his face appeared darker. She took him out of the cot and called out to him, but he was unresponsive.

The baby's father heard his wife's shouts and rushed to the infant's room, where he saw his wife trying to wake their son up. He found the baby's body cold to the touch, according to the findings.

They subsequently took the baby to KK Women’s and Children’s Hospital (KKWCH), where doctors found the baby to be pulseless with no signs of life. The infant did not respond to resuscitation and was pronounced dead at 5.18am.

An autopsy by forensic pathologist Associate Professor Teo Eng Swee from the Health Sciences Authority concluded that the baby’s cause of death was unascertained, but asphyxia and sudden infant death syndrome could not be ruled out. There was also no evidence of any inhalation of milk into the airways that may have caused asphyxia due to choking.

Assoc Prof Teo noted that based on Mdm Sien’s statement, there was no obvious information that the baby was facing or buried into her chest or shoulder area. He also commented that it was possible that baby’s nose and mouth were obstructed by the yellow cloth that had been placed on the nanny’s chest but added that there was no definitive objective autopsy evidence for this.

There was also no evidence of any imprint marks or injuries on the baby’s face.

POOR SLEEP PRACTICES

“We are once again confronted with a case involving poor sleep practices which may have led to infant death,” wrote coroner Kamala Ponnampalam in her report.

“The cases before this Court have shown that an infant who falls asleep in a prone position is more likely to fall victim to accidental suffocation. Paediatricians and those involved in infant care regularly emphasise the importance of baby sleeping on its back.”

She listed the ABCs of safe sleep – Alone (the infant should not sleep in the same bed as others), Back (the infant should always be put to sleep on their backs) and Crib (a well-built crib, free of loose bedding, pillows and toys).

She also wrote of the fatigue that can set in as parents and caregivers care for an infant through the night.

“It is best not to cradle the infant in the arms for long periods of time and risk baby falling asleep in an unsafe sleep position when the caregiver dozes off even briefly. In cases where the baby is unable to settle, caregivers must adopt other strategies or hand over to another adult than risk baby falling asleep prone.”

She gave her condolences to the family for the “tragic loss of their beloved son”.