Overview medical evidence of infanticide that examined in sanglah hospital forensic medical installation on year period 2010-2015

Background: Infanticide is intentional killing of newborns by their own mothers soon after they were born (< 24 hours) due to the fear of getting caught giving birth by other people. The evidence of infanticide can be found in some aspects such as the condition of the newborn (alive or dead), viability of the newborn, newborn’s sign of being taken care of, sign of abuse, and the cause of death. Objective: This research aims to know the evidence of infanticide investigated in Forensic Medicine Installation of Sanglah hospital in 2010-2015. Methods: The method used in this research paper is cross-sectional descriptive. This research is also a retrospective study due to the time the infanticide case occurs which is in the past. Secondary data used in this research paper is taken from the medical records and the visum et repertum of infanticide cases in Forensic Medicine Installation of Sanglah hospital occur in 2010-2015. Results: shows only 18 out from 51 samples are met the criteria of inclusion. From those 18 samples of dead newborns data, all of them were live birth and viable (able to live outside the womb), 88.9% of newborns were not taken care of, 38.9% of abuse were in the form of contusion, and the most common (72.2%) cause of death in newborn was blunt injury such as strangulation, smothering, and compression of the chest. Conclusion: Signs of violence in infants that most commonly found are bruises injury while the most common cause of death in baby are due to blunt violence.


INTRODUCTION
According to the Act Rule in Indonesia, infanticide is a murder that committed by a mother to her baby who carried out when was born or shortly after birth (less than 24 hours) because of fear discover having a baby 1 .In 1990, the prevalence of baby deaths World (from birth to age 4 years) because of the violence is 1.926 of 17.472 per thousand cases, and infanticide is 1/3 of all the number of that case 2 .The first report on baby murdered case was designed in 1969 by Resnick, which investigated approximately 131 cases between 1951 until 1967 3 .
Infanticide is a form of crime that are unique.The uniqueness is because the killer must be a biological mother and the reason is she was afraid of getting caught has given birth a baby.Reason of this fear is because the baby was born in the result of dark relationship with a unknown man 4 .
Babies who was killed as a infanticide case or not, can be seen from several things.Is the baby was born alive or dead, Is the baby's condition was viable or not, Is the baby get treatment or not, Is that any presence or absence signs of violence in baby, and what are the causes of death 5 .
According to the Italian data analysis from 2000 until 2005, shows that the prevalence of murder cases with asphyxia mechanism is 19% cases by drowning, 18% cases by smoothering, and 10% cases by strangulation.Only 4% of murder cases were found by using fireguns.About 80% of murder cases are usually done at home that was 64% cases in the bathroom and 20% cases in bedroom.In Jakarta, reported that 90-95% cases of 30-40 infanticide cases per year is accomplished by mechanical asphyxia.Other causes of death can be found by a blunt force to the head that was 5-10% cases and violence sharply on the neck or chest.
Infanticide without a plan was set in the Criminal Code Article 341 with the threat of jail maximum 7 years and if is done with the plan during pregnancy was threat of jail maximum 9 years in accordance with the Criminal Code Article 342 6 .
Medical Forensic Science that also called Medical Sciences of Justice is one of the compulsory subjects of science medical education in Indonesia.
The Act Rule require each general practitioner, specialist or forensic medicine specialist clinic to help forensic medical examinations for the judiciary if requested by police investigators.Thus, in upholding a justice that concerning human lives, the Forensic Medicine and Medicolegal Science is indispensable.
The research that related medical evidence of Infanticide is still rarely done in Bali so that important to doing this research as a benchmark reference as well as increase the wealth of knowledge in uncovering a case of infanticide.Given the importance of medical evidence in the disclosure of infanticide, the writer was interested to study about the profile of medical evidence cases of infanticide which includes that the baby is born is born alive or dead, the baby's condition that was viable or not, the baby get treatment or not, the presence or absence signs of violence in baby, and what cause of death.

METHODS
This research is a descriptive crosssectional study design.The purpose of this research is provide an overview medical evidence of infanticide.This research also a retrospective study because based on reports infanticide cases that was occurred in the past.Data that used in this research is secondary data, which was obtained from medical records and post mortem cases of infanticide in Sanglah Hospital Forensic Medical Installation on year period 2010-2015.
Sample in this research are all the baby's body death that sent and recorded in the registration book at the Sanglah Hospital Forensic Medical Installation on year period 2010 -2015.Total sample was 18 from 51 samples that have met the inclusion and exclusion criteria.The inclusion criteria is a baby's body death that allegedly killed at the time of birth or shortly after birth (less than 24 hours) and the baby's body death have a post mortem records or medical records and were been examined (outside and inside).The exclusion criteria is a baby's body death that allegedly killed at birth more 24 hours, the baby's body death has mortem records or medical records but not completed and only performed an external examination.
After data are obtained from a post mortem that have been collected, data will processed using SPSS 21 application, which begins with the data entry, data processing, fill in missing data, and checks back in univariate by calculating the percentage of each research variable.

RESULTS
According to the Table 1., based on 18 samples studied that obtained were born alive and viable.Babies must born in living conditions and viable so that it can be said these baby are victims of infanticide.Medical evidence in the sign of getting treatment, found that 88.9% of the babies do not get treatment, while 11.1% of other babies have been getting treatment before being killed.McMahan (2013) found that the baby who was killed immediately after birth generally have not given care to her mother because the killer will more likely to look for ways kill her baby that was didn't immediately known birth from another man 7 .
Appuranto (2010) mention that the violence sign of infanticide is often found on the babies with galling press injury as a result of smoothering, and abrasions injury is caused by pressure exerted tool trappers that used to strangulate the neck of victim. 8From the 18 samples that studied, approximately 38.9% is most have bruises injury, while abrasions and open injury are not much different that about 16% and 11.1% sample.Signs of violence in the form of finding a combination of two injuries have nearly the same frequency between one and the other that was 5.6%, but only the findings of the combination of abrasions and bruises injury proportion acquired approximately 11.1%.
According to the results, showed that 72.2% of the causes death are blunt violence.Meanwhile, the sharp violence that is generally using a sharp weapon by a combination of blunt and sharp force, have no differences significantly (16.7% and 11.1%).

DISCUSSION
In this study, the sign of baby that was born alive or dead can be seen from sign of live births include baby could breathe, cry, muscle movement, blood circulation, heart rate, changes in Hb, the contents of the stomach and intestines, and condition of umbilical cord from baby. 9 In case of infanticide, babies must be born alive because the terms that did infanticide is a live-born baby less than 24 hours.When the baby is born dead, that case is not a infanticide because the baby was dead before murdered.
Similarly with baby was born alive, that case is called infanticide if the baby was born in a viable condition.Sign of baby's viable can be seen from the infant's ability to live outside from mother's uterus without aid of special equipment 10 .Based on the results, obtained all of the sample born alive and viable.Praveen (2011) mention that in case of infanticide, other than babies born in the condition of the live-born infants are should able to live outside from mother's uterus without aid of special equipment.When the baby is born but not viable, baby can died as a result of inability to live outside from mother's uterus and not in case of murdered.Babies who are not able to live outside from mother's uterus can be caused by congenital diseases, thus requiring special equipment in order to help live outside from mother's uterus 11 .Sign of treatment in baby can be seen by the results of cutting the umbilical cord, vernik caseating in the folds of neck, armpits, and thighs, is that found food or milk that leftover in the baby's stomach during examination, and is baby when was found is using clothes or not.If appear sign of the care in baby, then a murder that committed by mother can not be regarded as infanticide, but an ordinary murder.However, if sign of care that provided in baby is still in a span of less than 24 hours after the baby is born, then can be regarded as infanticide.It is characterized by the presence of meconium in the large intestine (baby born less than 24 hours).
Signs of violence in baby can be seen from the medical findings during examination post mortem examination from inside and outside.Signs of violence can be bruises injury, abrasions injury, open wounds, broken bones, or combination of two or more of these injuries.From 18 samples study, approximately 38.9% most suffered bruises injury, while abrasions injury and open wound are not much different about 16% and 11.1%.Signs of violence in finding a combination of two injuries, have nearly the same frequency between one and the other is 5.6%, but only findings of the combination of abrasions injury and bruises injury acquired approximately 11.1%.Victims who are suffered smotherring, sores or blisters press in lips which are not uncommon crescent moon shape, bruised injury in lower lip that faced with the gums, and presence of foreign objects such as paper or cloth crumpled paper that fills in mouth.Victims of cases strangulation that presence galling press injury encircling all or part of neck which is an injury meshes as a result from pressure exerted by the tool trappers used, bruising blisters small injury which often form crescent shape is caused by pressure from the tip of nail-strangler, and their injuries were abrasions and bruises that occur irregularly as a result from pressure exerted by the fingertips strangler.Appuranto (2010) mention that sign of suffocation, include cyanotic lips and fingertips, spots of bleeding in the lining of eye, eyelids, and other loose tissues, dark bruising bodies and spacious, a fine white foam or white reddish out from nostrils or mouth, and also found on the victim who suffered smotherring 8 .
The cause of death in this case consists of blunt violence, violence sharply, and both (violence blunt and sharp).In general, the most frequent cause of death was blunt violence with smotherring which causes asphyxia.Based on results, the most cause of deaths in cases of infanticide are blunt violence with strangulation, smotherring, and emphasis on chest that is 72.2% of cases.All that conditions will generally cause baby can asphyxia because of difficulty breathing until suffocate.Meanwhile, sharp violence that was generally using a sharp weapon by a combination of blunt and sharp violences, showed that no differences were significantly that results is 16.7% and 11.1%.Hoediyanto (2010) mention that smotherring, strangulation and emphasis on chest also the way that often made to kill the baby so that can be asphyxia due to blunt violence 11 .

CONCLUSION
It can be concluded that 18 samples studied were all found to be born alive and viable, and most didn't reveal any sign of treatment.Signs of violence in infants that most commonly found are bruises injury while the most common cause of death in baby are due to blunt violence.

SUGGEST
Based on the research, the advice is that case of infanticide especially that occurred in Bali are a rare case, it is necessary to conduct further research with larger samples, longer periods as well as the addition of others variables that has not been discussed in this study so that will make it easier for Forensic Medicine's role in proving a infanticide case reveals.

DISCLOSURE
Authors would like thank you to Director Sanglah Hospital Bali.Authors also would like thank you to the Chief of Forensic Medicine Installation Sanglah Hospital Bali and thank you to dr.Ida Bagus Putu Alit, Sp.F, DFM as a mentor and dr.Dudut Rustyadi, Sp.F, SH, as a evaluator.