{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T17:01:11Z","timestamp":1765040471916,"version":"3.40.5"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,12,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE:<\/jats:title><jats:p>Sudden and unexplained death is a leading cause of infant mortality. Certain characteristics of the sleep environment increase the risk for sleep-related sudden and unexplained infant death. These characteristics have the potential to generate asphyxial conditions. We tested the hypothesis that infants may be exposed to differing degrees of asphyxia in sleep environments, such that vulnerable infants with a severe underlying brainstem deficiency in serotonergic, \u03b3-aminobutyric acid-ergic, or 14-3-3 transduction proteins succumb even without asphyxial triggers (eg, supine), whereas infants with intermediate or borderline brainstem deficiencies require asphyxial stressors to precipitate death.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We classified cases of sudden infant death into categories relative to a \u201cpotential asphyxia\u201d schema in a cohort autopsied at the San Diego County Medical Examiner\u2019s Office. Controls were infants who died with known causes of death established at autopsy. Analysis of covariance tested for differences between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Medullary neurochemical abnormalities were present in both infants dying suddenly in circumstances consistent with asphyxia and infants dying suddenly without obvious asphyxia-generating circumstances. There were no differences in the mean neurochemical measures between these 2 groups, although mean measures were both significantly lower (P &amp;lt; .05) than those of controls dying of known causes.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>We found no direct relationship between the presence of potentially asphyxia conditions in the sleep environment and brainstem abnormalities in infants dying suddenly and unexpectedly. Brainstem abnormalities were associated with both asphyxia-generating and non\u2013asphyxia generating conditions. Heeding safe sleep messages is essential for all infants, especially given our current inability to detect underlying vulnerabilities.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2013-0700","type":"journal-article","created":{"date-parts":[[2013,11,12]],"date-time":"2013-11-12T01:56:19Z","timestamp":1384221379000},"page":"e1616-e1625","source":"Crossref","is-referenced-by-count":29,"title":["Potential Asphyxia and Brainstem Abnormalities in Sudden and Unexpected Death in Infants"],"prefix":"10.1542","volume":"132","author":[{"given":"Bradley B.","family":"Randall","sequence":"first","affiliation":[{"name":"Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"Paterson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth A.","family":"Haas","sequence":"additional","affiliation":[{"name":"Departments of Pathology and Pediatrics, University of California, San Diego, La Jolla, California, and Rady Children\u2019s Hospital, San Diego, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin G.","family":"Broadbelt","sequence":"additional","affiliation":[{"name":"Department of Pathology, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jhodie R.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Othon J.","family":"Mena","sequence":"additional","affiliation":[{"name":"San Diego County Medical Examiner\u2019s Office, San Diego, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry F.","family":"Krous","sequence":"additional","affiliation":[{"name":"Departments of Pathology and Pediatrics, University of California, San Diego, La Jolla, California, and Rady Children\u2019s Hospital, San Diego, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia L.","family":"Trachtenberg","sequence":"additional","affiliation":[{"name":"New England Research Institutes, Watertown, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah C.","family":"Kinney","sequence":"additional","affiliation":[{"name":"Department of Pathology, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2013,12,1]]},"reference":[{"issue":"6","key":"2021120823372952500_B1","first-page":"1","article-title":"Deaths: leading causes for 2008.","volume":"60","author":"Heron","year":"2012","journal-title":"Natl Vital Stat Rep"},{"issue":"4","key":"2021120823372952500_B2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.semperi.2011.02.018","article-title":"Racial and ethnic disparities in infant mortality.","volume":"35","author":"Hauck","year":"2011","journal-title":"Semin Perinatol"},{"issue":"12","key":"2021120823372952500_B3","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/j.1440-1754.2005.00756.x","article-title":"Interpretation of recent sudden infant death syndrome rates in Western Australia.","volume":"41","author":"Freemantle","year":"2005","journal-title":"J Paediatr Child Health"},{"issue":"4","key":"2021120823372952500_B4","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/PAF.0b013e31819df760","article-title":"Observations on increased accidental asphyxia deaths in infancy while cosleeping in the state of Maryland.","volume":"30","author":"Li","year":"2009","journal-title":"Am J Forensic Med Pathol"},{"issue":"8","key":"2021120823372952500_B5","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1056\/NEJMra0803836","article-title":"The sudden infant death syndrome.","volume":"361","author":"Kinney","year":"2009","journal-title":"N Engl J Med"},{"issue":"4","key":"2021120823372952500_B6","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1111\/j.1556-4029.2007.00477.x","article-title":"Infant death scene investigation and the assessment of potential risk factors for asphyxia: a review of 209 sudden unexpected infant deaths.","volume":"52","author":"Pasquale-Styles","year":"2007","journal-title":"J Forensic Sci"},{"issue":"1","key":"2021120823372952500_B7","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1542\/peds.114.1.234","article-title":"Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach.","volume":"114","author":"Krous","year":"2004","journal-title":"Pediatrics"},{"issue":"5","key":"2021120823372952500_B8","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1542\/peds.93.5.814","article-title":"Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD.","volume":"93","author":"Willinger","year":"1994","journal-title":"Pediatrics"},{"issue":"4","key":"2021120823372952500_B9","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1136\/adc.70.4.291","article-title":"Reduction in mortality from sudden infant death syndrome in New Zealand: 1986\u201392.","volume":"70","author":"Mitchell","year":"1994","journal-title":"Arch Dis Child"},{"issue":"6","key":"2021120823372952500_B10","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1046\/j.1440-1754.2000.00563.x","article-title":"Sudden infant death syndrome in South Australia 1968\u201397. 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