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Drowning accounts for more accidental deaths in children and adolescents than all other causes except motor vehicle accidents. 1 – 3 Many of these fatalities are attributed to lack of supervision, trauma, alcohol or drug use, or seizures. However, an appreciable number of drownings have no satisfactory explanation. In these situations, cardiac arrhythmias, particularly those associated with the long-QT syndrome, may be an important consideration. The long-QT syndrome comprises a group of genetically distinct arrhythmogenic cardiovascular disorders, each resulting from a mutation in one of five genes encoding cardiac ion channels or auxiliary ion-channel subunits: KVLQT1 (at the LQT1 locus), HERG (at . . .

Case report of a newborn baby who developed respiratory distress due to aspiration after an underwater birth. The implications of the case are discussed in relation to dangers of aspiration of water in birthing pools. [(BNI unique abstract)] 14 references

To clarify the risks of drowning for children with epilepsy we have studied the records of the 306 children who drowned or nearly drowned in the UK in 1988 and 1989. Ten children with incidents related to epilepsy presented over the study period, four of whom drowned. Children with epilepsy had a higher incidence of submersion accidents but no child participating in supervised swimming drowned. Two children died in the bath. Five children had special needs. We conclude that children with epilepsy can enjoy swimming with a friend in a lifeguard supervised swimming pool. They should be encouraged to shower in a non-glass cubicle rather than have a bath. The bathroom should remain unlocked. Children with poorly controlled epilepsy or associated learning difficulties are at a higher risk from all accident trauma. They need a very high level of supervision while swimming and advice should be given on an individual basis according to what is considered realistic for that child.

Neurologically, he was stuporous, pupils were equal and reactive, and motor function on limbs was absent even with painful stimuli. Because of the critical status of the patient, cardiopulmonary resuscitation was performed and he was intubated, sedated, and transferred to intensive care unit. Because the accident was not witnessed, there were no signs of trauma and the initial cervical x-rays were normal; none of this information was present in our patient. [...]the coma status secondary to brain hypoxia did not allow an adequate neurological examination.

Near-drowning syndrome depends on the duration of submersion, the amount of fluid aspirated, and the severity of hypoxia. We report a case in which a patient developed ARDS shortly after undergoing a left upper lobectomy and a chest wall resection for a lung carcinoma. On further investigation, the ARDS was caused by near-drowning in a basin of freshwater: the patient’s face was submerged by the patient’s companion as part of a cultural tradition of trying to clean his lung. We believe that this case presents the etiology of freshwater near-drowning syndrome due to an ethnogenic practice not previously reported.

Non-accidental bath drowning is an infrequently reported form of child abuse. Details of 44 children who suffered from drowning or near drowning in the bath were analysed from a two year (1988-9) UK study to investigate factors that might point to abuse. Cases of near drowning were notified through the British Paediatric Surveillance Unit inquiry system and drowning cases from the Office of Population Censuses and Surveys, the Scottish Government Record Office, and the Northern Ireland Office. In 28 cases the story was of accidental submersion with a baby of modal age 9 months being left unsupervised in a bath. Two other neonates briefly slipped from the parents arms while having a bath. Four bathtub drownings were related to epilepsy. In contrast 10 cases (six drowning and four near drowning) had stories very suggestive of abuse with inconsistent histories, previous history of abuse, and late presentation for medical care. A diagnosis of abuse should be considered in the differential diagnosis of atypical bathtub immersions in the absence of epilepsy and developmental delay.

To the Editor: Ackerman et al. (Oct. 7 issue) 1 describe extensive molecular analyses in a young woman who died suddenly as a result of the long-QT syndrome. They discovered a mutation in a gene encoding a cardiac ion channel that led to the correct diagnosis and treatment of an 18-year-old sibling who had a borderline prolongation of the QT interval corrected for heart rate (QTc). Even though the authors acknowledge that molecular testing is available only as a research tool, a reader might have the mistaken impression that it should now be part of routine evaluation on the basis of . . .