{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:28:11Z","timestamp":1788496091789,"version":"build-2803163510"},"reference-count":13,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Health\u2019s Ministry"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objective: Sudden infant death syndrome (SIDS), sudden neonatal unexpected death (SNUD), and sudden intrauterine unexpected death (SIUD) are major unsolved, shocking forms of death that occur frequently and without warning. The body of literature on the anatomo-pathological substrates in the cardiac conduction system of SIDS-SIUD and their possible relationship with risk factors and triggers is fragmentary and scarce. The work aims is to analyze the cardiac conduction system findings collected at the national referral center for SIDS-SIUD. Methods: A total of 123 autopsied cases of SIDS (59.35% males, 40.65% females, mean age \u00b1 SD: 103.49 \u00b1 67.17 days), 36 cases of SNUD (61.11% males, 38.89% females, mean age \u00b1 SD: 8.4 \u00b1 9.17 days), and 127 cases of SIUD (45.67% males, 54.33% females, mean age \u00b1 SD: 36 \u00b1 4.59 gestational weeks) were analyzed. In-depth pathological examinations of the cardiac conduction system were performed on serial sections according to the Lino Rossi Research Center\u2019s protocol. Results: Among the studied cases, the following findings were observed: resorptive degeneration (SIDS: 88.7%, SNUD: 88.88%, SIUD: 56.69%), fetal dispersion (SIDS: 73.17%, SNUD: 91.66%, SIUD: 78.74%), Mahaim fibers (SIDS: 40.65%, SNUD: 44.44%, SIUD: 32.28%), cartilaginous meta-hyperplasia (SIDS: 56.91%, SNUD: 25%, SIUD: 33.07%), septated atrio-ventricular junction (AVJ) (SIDS: 21.14%, SNUD: 33.33%, SIUD: 38.58%), AVJ duplicity (SIDS: 6.5%, SNUD: 11.11%, SIUD: 2.36%), intramural bifurcation (SIDS: 3.25%, SNUD: 2.77%, SIUD: 4.72%). Conclusions: The prevalence of cardiac conduction findings was consistent across the SIDS, SNUD and SIUD groups. These findings provide valuable insights into the pathological characteristics of the cardiac conduction system in SIDS-SIUD that are potential morphological substrates for the development of cardiac arrhythmias. Further investigation and study of the conduction system are needed to understand the underlying mechanisms of these forms of death.<\/jats:p>","DOI":"10.3390\/diagnostics15131637","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T03:33:25Z","timestamp":1750995205000},"page":"1637","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Sudden Unexpected Infant and Perinatal Death: Pathological Findings of the Cardiac Conduction System"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6982-170X","authenticated-orcid":false,"given":"Giulia","family":"Ottaviani","sequence":"first","affiliation":[{"name":"Lino Rossi Research Center for the Study, Prevention of Unexpected Perinatal Death, SIDS, Anatomic Pathology, Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 Degli Studi Di Milano, 20122 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 Degli Studi Di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Lino Rossi Research Center for the Study, Prevention of Unexpected Perinatal Death, SIDS, Anatomic Pathology, Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 Degli Studi Di Milano, 20122 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 Degli Studi Di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7144-0984","authenticated-orcid":false,"given":"Massimo","family":"Del Fabbro","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 Degli Studi Di Milano, 20122 Milan, Italy"},{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1981-5248","authenticated-orcid":false,"given":"Simone G.","family":"Ramos","sequence":"additional","affiliation":[{"name":"Pathology and Legal Medicine, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref_1","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"},{"key":"ref_2","unstructured":"Centers for Disease Control and Prevention (CDC) (2023, August 01). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: Data and Statistics, Available online: https:\/\/www.cdc.gov\/sudden-infant-death\/data-research\/data\/index.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"677","DOI":"10.3109\/15513819109065465","article-title":"Defining the Sudden Infant Death Syndrome (SIDS): Deliberations of an Expert Panel Convened by the National Institute of Child Health and Human Development","volume":"11","author":"Willinger","year":"1991","journal-title":"Pediatr. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ottaviani, G. (2016). Defining Sudden Infant Death and Sudden Intrauterine Unexpected Death Syndromes with Regard to Anatomo-Pathological Examination. Front. Pediatr., 4.","DOI":"10.3389\/fped.2016.00103"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0140-6736(10)62233-7","article-title":"Major Risk Factors for Stillbirth in High-Income Countries: A Systematic Review and Meta-Analysis","volume":"377","author":"Flenady","year":"2011","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"F30","DOI":"10.1136\/adc.2010.208736","article-title":"Unexpected Collapse in Apparently Healthy Newborns\u2014A Prospective National Study of a Missing Cohort of Neonatal Deaths and near-Death Events","volume":"97","author":"Becher","year":"2012","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00414-024-03231-1","article-title":"Sudden Unexpected Postnatal Collapse and BUB1B Mutation: First Forensic Case Report","volume":"138","author":"Esposito","year":"2024","journal-title":"Int. J. Legal Med."},{"key":"ref_8","unstructured":"Ottaviani, G., Leonardi, P., and Alfonsi, G. (2023, January 7). Sudden Unexpected Infant and Perinatal Death: Pathological Findings of the Cardiac Conduction System. Proceedings of the ISPID International Conference on Stillbirth, SIDS and SUDI. Baby Survival: Global Achievements and Future Challenges, Florence, Italy."},{"key":"ref_9","unstructured":"Constitution of the Italian Republic Italian Law N\u00b0 31 (2006). Regulations for Diagnostic Post-Mortem Investigation in Victims of Sudden Infant Death Syndrome (SIDS) and Unexpected Fetal Death. Off. Gaz. Ital. Repub. Gen. Ser., 34, 4."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ottaviani, G. (2014). Crib Death\u2014Sudden Infant Death Syndrome (SIDS). Sudden Infant and Perinatal Unexplained Death: The Pathologist\u2019s Viewpoint, Springer International Publishing. [2nd ed.].","DOI":"10.1007\/978-3-319-08347-6"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1046\/j.1538-7836.2003.00409.x","article-title":"Intimal Preatherosclerotic Thickening of the Coronary Arteries in Human Fetuses of Smoker Mothers","volume":"1","author":"Matturri","year":"2003","journal-title":"J. Thromb. Haemost."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1097\/MLR.0000000000001129","article-title":"Years of Life and Productivity Loss Because of Adult Sudden Unexpected Death in the United States","volume":"57","author":"Mirzaei","year":"2019","journal-title":"Med. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1521\/psyc.2012.75.1.76","article-title":"Bereavement and Mental Health after Sudden and Violent Losses: A Review","volume":"75","author":"Kristensen","year":"2012","journal-title":"Psychiatry"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/13\/1637\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:59:42Z","timestamp":1760032782000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/13\/1637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":13,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15131637"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15131637","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]}}}