By THOMAS HARGROVE
Scripps Howard News Service

Nowhere is the confusion surrounding sudden infant death more apparent than in the 95 unique and often-contradictory statutes approved by state legislatures throughout the nation in recent years.

"The laws vary significantly in terms of scope and subject," concluded analysts for the National Conference of State Legislatures in a report updated in June.

Special rules for infant death investigations: This map shows the states that do not have special investigation procedures, called protocols, when infants die suddenly and mysteriously. (SHNS map by Thomas Hargrove)State lawmakers do not necessarily agree on the definition of Sudden Infant Death Syndrome, for example, even though the World Health Organization and the U.S. Centers for Disease Control and Prevention have agreed on a clear standard.

According to the definition set by the United Nations and the federal government, SIDS is "the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene and review of the clinical history" of the dead child.

But many states have decided the SIDS diagnosis may be used for children older than 1 year, although there is not legislative agreement as to how late in life SIDS may occur. There are no federal mandates to direct how states should investigate sudden infant deaths or how such investigations should be reviewed.

Among other patterns to recent legislation for the mysterious deaths of children:

-- States often provide guidance to coroners and medical examiners to follow specific protocols, to always conduct autopsies if cause of death isn't obvious, or to always inspect the scene of death.

-- Many states have created SIDS advisory councils and established educational or counseling programs to help police, paramedics, coroners and the families of victims.

-- Some states have mandated the creation of Child Death Review Boards and require that experts on SIDS participate in such reviews of the death investigations.

-- Six states require special training about SIDS for firefighters, paramedics and police. They are Arizona, Arkansas, California, Tennessee, Washington and West Virginia.

-- Five states specifically mandate that child-care workers must be educated about SIDS. They are California, Florida, Minnesota, Texas and Wisconsin.

How America investigates sudden infant death: This graphic shows how many states have special rules for infant-death investigations, how many follow standards set by the Centers for Disease Control and Prevention, and how many require that only medical doctors should investigate the deaths of babies.Among the states that produced the longest list of special legislative acts to combat SIDS are Arizona, California, Minnesota, New Jersey and Tennessee.

Arizona, for example, requires that basic training for all state firefighters and emergency medical technicians must include education "on the nature of SIDS." The state also created a Sudden Infant Death Advisory Council to develop training programs and to advise the governor and lawmakers. The state also mandates use of an "infant death investigation checklist" to be employed by medical examiners and police.

California requires that all state hospitals provide instructional materials about SIDS to its patients free of charge, and mandates that every licensed nurse and emergency medical technician in the state must "complete a course of training on the nature of SIDS."

When Mississippi passed a law ordering coroners and medical examiners to perform death-scene investigations for all unexplained infant deaths, the rate at which infant deaths were reported to be SIDS inexplicably soared. Lawmakers later ordered coroners to follow CDC investigation protocols and offered to compensate them $100 for each complete investigation.