Homicidal commotio cordis: the final blow in a battered infant.

Objective: This report describes in detail the occurrence of inflicted commotio cordis (cardiac concussion) in a previously abused 7-week-old. Though inflicted commotio cordis has been reported in three toddlers, this is the first report in a young infant.

Method: Following documentation of abuse in a living child, the case of a death of a prior sibling--previously regarded as natural--was re-opened for further investigation. Original autopsy materials were reviewed, and the body of the deceased child was exhumed.

Results: Exhumation and second autopsy documented more than 50 fractures in the deceased child. When re-interviewed, the children's father admitted to causing the injuries in both children, and gave a textbook description of commotio cordis as the mechanism of death in the fatal case.

Conclusions: Commotio cordis is a rare event in which a fatal dysrhythmia--usually ventricular fibrillation--is precipitated by a blow to the precordial chest. Previous reports have indicated that homicidal commotio cordis can occur in small children. This report demonstrates that commotio cordis can occur even in the very young, previously abused infant.