Evidence of brain ischemia in early neonatal sudden death syndrome

Ten early neonatal sudden death victims (ENSD) were selected for neuropathological and immunohistochemical examinations. The gestational ages of the victims ranged from 36 to 42 weeks, and the postnatal ages from 8 hours to 10 days of life. In 6 of 10 patients, softening with rarefaction was observed in the subcortical or intermediate white matter, which was associated with minimal astrogliosis in the whole white matter. In 7 of the 10 ENSD victims, the number of GFAP-positive glia was significantly greater in both the deep and subcortical white matter than in controls. The brainstem showed mild gliosis in the reticular formation and vagal nuclei of the medulla oblongata in 8 of the 10 ENSD victims. In 8 of the 10 ENSD victims, the number of GFAP-positive astrocytes was greater in both the dorsal vagal nucleus and the reticular formation of the medulla oblongata than in controls. The high incidence of leukomalacia and astrogliosis in the cerebral white matter and brainstem suggests the presence of brain ischemic insults before death, which may be prenatal in some cases.