A case of respiratory unexpected death

Introduction. The borderline Sudden Infant Death Syndrome (SIDS) or «gray zone» cases have been described as those cases in which anatomo-pathological findings alone might not have accounted for the sudden deaths, if it had not been for the concomitant presence of additional abnormalities which could have had a triggering role. Material and Methods. A female baby with a history of episodes of gastro-esophageal reflux and pneumonia was found unresponsive in her crib. At the age of one month she presented an episode of apnea which required resuscitative maneuvers. The baby was administered wide spectrum antibiotic therapy and was discharged six days later in good general conditions. The baby continued well until the day of her sudden death. A complete autopsy was performed, including examination on serial sections of the central and peripheral autonomic nervous structures. Results. The postmortem study of the brainstem revealed hypoplasia and neuronal immaturity of the hypoglossus nucleus. Discussion. The congenital abnormalities of the hypoglossus nucleus seem to have been responsible for the baby's symptoms of deglutition impairments with subsequent episodes of recurrent pneumonia. Milk aspiration can be attributed to functional swallowing disturbances caused by congenital alteration of the hypoglossus nucleus. Conclusions Our case acquires an unique interest about the role the abnormalities of the hypoglossus nucleus might have played in the lethal outcome. A concomitant diagnosis of pneumonia does not exclude that of SIDS or borderline SIDS.