Sudden infant death syndrome pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S[2]

Overview

The exact pathogenesis of Sudden infant death syndrome (SIDS) is not fully understood. It is thought that Sudden infant death syndrome (SIDS) may be caused by either genetic mutations, brainstem abnormality, airflow obstruction, maternal smoking, or infection.

Pathophysiology

Pathogenesis

Brain anomalies

Genetics

Cardiac dysfunction

Triggers

Prone position

  • The exact pathogenesis of prone position and the development of sudden infant death syndrome (SIDS) is not completely understood.
  • According to some new studies infant being in prone position increases the risk of infant to the following:
    • Suffocation of the baby
    • Decrease in arousal of the baby
    • Overheating of the baby

Gross Pathology

  • On gross pathology, the following features are characteristic findings of SIDS.
Hypertrabeculation
Left ventricular hypertrabeculation in a three month old infant, presenting as sudden infant death syndrome. It is postulated that the apical area of hypertrabeculation acted as the source of a fatal arrhythmia. Case courtesy by J. Ker et al[27]


Microscopic Pathology

Thick, pseudostratified ependymal layer of a 17-week human fetus
Thick, pseudostratified ependymal layer of a 17-week human fetus. (a) In the lining of the fourth ventricle (histological section of brainstem); (b) in the lining of the central canal (histological section of thoracic spinal cord). Klüver-Barrera stain; magnification, 20×. CAse courtesy by Anna M Lavezzi et al.[34]
  • Focal granule cell dispersion in the dentate gyrus can be seen on microscopy of the brain in SIDS.
Examples of focal granule cell dispersion in the dentate gyrus (DG) and associated abnormalities in infants with sudden unexplained in death. a Normal infant hippocampus with landmarks for reference at its mid-body [level of the lateral geniculate nucleus (not shown)]. The DG forms the shape of a “C” at this level. Hematoxylin and eosin (H&E), ×4. b Control DG in a 4-month-old infant with explained cause of death. The DG consists of densely packed granule cells in a linear structure in its straight limbs. H&E, ×20. c Hippocampus of an infant with sudden unexplained death with focal granule cell bilamination (arrow) in the DG. H&E, ×4. d Hippocampus of a second infant with sudden unexplained death with focal granule cell bilamination (arrow) in the DG. H&E, ×10. e Hippocampus of a third infant with sudden unexplained death with focal granule cell bilamination (arrow) in the DG. H&E, ×10. f Hippocampus of a fourth infant with sudden unexplained death with focal granule cell bilamination (arrow) in the DG. H&E, ×10. g Granule cell duplication at the bend (hook) of the DG (arrow), associated with FGCB along the straight limb, in an infant with sudden unexplained death. H&E, ×20. h There are single, ectopic granule cells in the molecular layer (arrowheads). In the DG, there are immature cells, suggestive of immature neurons (Fig. 2), present in the subgranular layer. H&E, ×20. i There are immature cells in the DG (arrowheads), as well as clusters of granule cells in the molecular layer (arrow). H&E, ×20. DG dentate gyrus, ML molecular layer. Case courtesy by Hannah C. Kinney et al[35]


References

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