Sudden infant death syndrome appears to have killed the 6-month-old identical twins who stopped breathing in their Northeast Baltimore home Feb. 21, the chief state medical examiner said yesterday.
Dr. John E. Smialek said that while all autopsy results aren't yet in, "many of the features of the boys' deaths seem consistent" with SIDS. No foul play is suspected, Dr. Smialek said.
Brandon and Todd Blair apparently died from a medical rarity -- and suspicions aroused early in the case by misread X-rays were groundless, according to a person close to the investigation.
It is such a medical rarity for twins to stop breathing simultaneously that there have only been about a dozen cases reported worldwide, medical experts said.
The boys stopped breathing in their crib about noon Feb. 21 at their home in the 2800 block of Hamilton Ave. Their mother, Kim Panufka, was able to revive them but they later died at the Johns Hopkins Children's Center.
Afterward, concerned social services officials ordered that the twins' 3-year-old sister be taken out of the custody of the immediate family. The child has been living with a relative for the past week, but will be allowed to go back to her mother in a day or two, according to investigators.
The twins were born two months prematurely in August. While in the hospital, doctors studied the infants' sleep patterns and spotted abnormalities associated with SIDS, Dr. Smialek said.
The boys were sent home from the hospital with a specially designed monitor that would sound an alarm if they stopped breathing, a standard warning device for babies in a SIDS-risk category, Dr. Smialek said.
Family members reported to police that on three occasions prior to Feb. 21, one or both of the boys stopped breathing.
Sudden infant death syndrome, also known as crib death, occurs in healthy babies who are laid down to sleep and are found inexplicably dead some time later. No cause has been determined, although some researchers say immaturity in the brain may shut down the baby's breathing functions.
According to the American Medical Association, SIDS is slightly more common among boys, particularly those born premature. Three quarters of all cases occur in babies between one month and six months of age, and infants who have survived an apparent SIDS episode are at considerable risk for another episode. All these criteria fit the Blair twins.
The odds of SIDS occurring in twins is so remote, the early days of the investigation into the boys' deaths looked at possible abuse in the family household, according to investigation sources.
The possibility of abuse surfaced more strongly when a hospital lab technician told police that X-rays of the babies showed some fractured ribs, and the infants' faces appeared to have bruises, investigators said.
But according to medical examiners, the fractured ribs don't exist and were reported because of an erroneous reading of the X-ray by the lab technician. Also, the facial bruises appear to have been caused when the babies were being desperately given mouth-to-mouth resuscitation by their mother.
Bonita Blair, the twins' great-aunt, said the family "is still grieving from a terrible tragedy. They've suffered three blows -- the loss of the twins, and the taking of their daughter."
She said the suspicion cast upon the family by investigators and TV news has added more trauma to the ordeal. "It's been one horrendous blow after another," Ms. Blair said.
The twins had remained on the breathing monitor until about two months ago, when it appeared they were developing normally and had gained weight, Ms. Blair said.
"We thought they were out of the woods. They were just checked about three weeks ago by a pediatrician, and they seemed to be fine and up to par," Ms. Blair said.
Dr. Smialek, the medical examiner, has researched nine cases of twins dying from SIDS and wrote a medical abstract about how families are often the subject of suspicion following the deaths. "The occurrence of the simultaneous deaths of infant twins is a phenomenon that still evokes bewilderment and suspicion," he wrote in the 1986 abstract. In many cases, the deaths of twins "results in an atmosphere of intense suspicion of the parents."
He added that in the past, SIDS deaths have been wrongfully attributed to the negligence of parents, a myth perpetuated by those who are misinformed about the subject.