Unexplained stillbirth versus SIDS: common congenital diseases of the autonomic nervous system--pathology and nosology

Objective: To contribute to a more balanced assessment of the morphological substrates underlying unexplained perinatal death and SIDS. Methods: In-depth histological, immunohistochemical and genetic examinations were performed on the autonomic nervous and cardiac conduction systems in 95 unexpected perinatal deaths, 140 SIDS and 78 controls (44 infants and 34 perinatal death victims). Results: The study revealed the localization and the nature of a variety of specific congenital abnormalities of the autonomic nervous system, central and peripheral, and of the cardiac conduction system that represent the morphological substrates of the pathophysiological mechanism of sudden fetal death and SIDS. Conclusions: The observation of similar anomalies of the autonomic nervous and the cardiac conduction systems in both unexplained perinatal deaths and SIDS indicates their common congenital nature. Therefore, the definitions of these deaths, currently nosographically distinct, should be unified. © 2010 Elsevier Ireland Ltd. All rights reserved.