At autopsy of a newborn suspected to be a victim of infanticide, both lungs sink completely in water (hydrostatic test negative), but the stomach and upper small intestine contain abundant air. The MOST appropriate conclusion is:

• A The infant was stillborn, since the lung test is the sole arbiter of live birth
• B The infant was born alive but died soon after, before achieving full pulmonary aeration ✓
• C Air entered the stomach passively during decomposition, so the finding has no value
• D The air proves artificial insufflation of the lungs during attempted resuscitation

Explanation

The lung floatation test requires sufficient aeration for buoyancy, so an infant who took only a few breaths may have lungs too poorly aerated to float while still having swallowed air into the stomach. A positive stomach-air test therefore supports live birth even when the hydrostatic test is negative. Decomposition gas forms late and is accompanied by general putrefactive change, and resuscitation air reaches the lungs and stomach together, so neither explains an isolated gastric finding.

Reference: The Essentials of Forensic Medicine and Toxicology, K S Narayan Reddy, 34th ed.

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Written and medically reviewed by the StethoPrep medical team.