Diagnostic Protocol

Guidelines

in pathologic and forensic-medical diagnostics of sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death syndrome (SIUDS)

SAMPLING METHODS

The procedure for the accurate anatomo-clinical study of SIDS and SIUDS cases includes the examination of the clinical history data, of the scene of death in case of SIDS, as well as the anatomo-pathological investigations.

Thus, the guidelines include: 

a) dispatch of the clinical history, together with the clinical and pathological information form opportunely filled; 

b) dispatch of the organs and tissues, according to the anatomo-pathological protocol described below.

The anatomo-pathological protocol includes in particular the in-depth study of the autonomic nervous system. The morphological study is completed by investigations of molecular genetics.

Send the samples and all the informations to:

Centro di Ricerca "Lino Rossi"

Università degli Studi di Milano

Via della Commenda 19 – 20122 Milano, Italy

Tel. 02-+39-02-50320821; Fax: 02-+39-02-50320823

Neuropathological protocol 

As regards the examination of the central nervous system, if sampling is to be carried out and the samples to be analyzed are sent directly, the methods of sampling the most significant ones are indicated below. Alternatively, it is possible to send the brain en masse in containers with buffered formalin of less than 10%.

The anatomopathologic study of the central autonomic nervous system includes an in-depth study of the brainstem, cerebellum, and spinal cord, where the main structures participating in control of the vital functions are located.

Brainstem sampling

Examination of the brainstem includes sampling of four specimens, as shown in figure 1. The first specimen, ponto-mesencephalic, extends from the upper third of the pons to the adjacent portion of mesencephalon. The second includes the caudal portion of the pons. The third specimen takes as reference point the obex and extends 2-3 mm above it and below it. A fourth sample  includes the lower limit of the medulla oblongata and the rostral portion of the spinal cord.

Figure 2 shows the histological sections obtained from the four fragments, indicating the main nuclei and structures to be examined.

Figure 1 - Brainstem sampling: ventral (left) and dorsal (right) surface

Cerebellum

In order to examine both the cerebellar cortex and the nuclei (dentate, etc.), a specimen of hemisphere extending all along the major diameter should be sampled, as shown in the figure 3.

Alternatively, it is possible to send the brain in toto in containers with buffered formalin of less than 10%.