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Am J Perinatol 2019; 36(05): 460-471
DOI: 10.1055/s-0038-1669398
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neuropathology of Early Sudden Infant Death Syndrome—Hypoplasia of the Pontine Kolliker-Fuse Nucleus: A Possible Marker of Unexpected Collapse during Skin-to-Skin Care

Anna M. Lavezzi
1   Department of Biomedical, Surgical and Dental Sciences, “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, University of Milan, Milan, Italy
,
Stefano Ferrero
1   Department of Biomedical, Surgical and Dental Sciences, “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, University of Milan, Milan, Italy
2   Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
,
Beatrice Paradiso
1   Department of Biomedical, Surgical and Dental Sciences, “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, University of Milan, Milan, Italy
3   Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
,
Liliya Chamitava
4   Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
,
Francesco Piscioli
5   Institute of Pathology, Hospital of Rovereto, Trento, Italy
,
Teresa Pusiol
5   Institute of Pathology, Hospital of Rovereto, Trento, Italy
› Author Affiliations Funding None.

Ethical Approval Permission from the Ethics Committee was not required for this study as our research center (“Lino Rossi” Research Center of the Milan University) is the national referral center for sudden unexplained fetal and infant death, in accordance with the aforementioned Italian Law no. 31. Study approval was anyway granted by the Institutional Review Board of Milan University.
Further Information

Publication History

22 February 2018

21 July 2018

Publication Date:
31 August 2018 (online)

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Abstract

Objective To find a possible pathogenetic mechanism of the early sudden infant death occurring in newborns during the skin-to-skin care (SSC), through the examination of neuronal centers regulating the vital activities.

Study Design This is an in-depth examination of the brain stem in 22 healthy term newborns, suddenly died in the first hour of life without the identification of a cause at autopsy (early sudden infant death syndrome [eSIDS]), 12 of them concomitantly with SSC, and 10 with age-matched controls died of known pathology.

Results Developmental alterations of neuronal structures of the brain stem were highlighted in 19 of the 22 eSIDS, but not in control. The hypoplasia of the pontine Kölliker-Fuse nucleus (KFN), an important respiratory center, was diagnosed at the histological examination, validated by morphometric quantifications, in 11 of the 12 eSIDS while they were placed on the mother's chest and in 2 of the 10 SSC unrelated neonatal deaths.

Conclusion The delayed development of the KFN could represent a specific finding of eSIDS occurring during SSC. Therefore, it is necessary to point out that the SSC represents a further risk factor that must be added to others already known for sudden infant death syndrome. Then this practice needs appropriate monitoring strategies of the infant's conditions.

Keywords

skin-to-skin care - sudden unexpected postnatal collapse - sudden infant death syndrome - early sudden infant death syndrome - risk factors - neuropathology - brain stem - Kölliker-Fuse nucleus

Note

Parents of all the infants included in the study provided written informed consent to autopsy and related research.


 

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