No abstract

Sudden infant death syndrome (SIDS) is an unexpected non-violent death of apparently healthy child aged 7 days to 1 year, in which the anamnesis and autopsy data do not allow to find out the cause of the fatal outcome. Researchers have not come to a consensus on the thanatological role of morphological changes in the brain. Aim. To determine pathomorphological changes in the brain in the case of sudden death syndrome in children. Material and methods. Forensic medical studies of 118 deaths of healthy children who died suddenly for the period 2008-2017 were carried out and analyzed on the territory of the Stavropol region. Autopsy material was divided into groups: the main group (1) consisted of 74 observations (62.8%), where SIDS was the main final sectional diagnosis. The comparison group (2) consisted of 44 (37.2%) observations; the children died suddenly at home as a result of viral-bacterial pneumonia. For control, the third group was formed (3), which included 45 observations, where the death of children occurred as a result of drowning and carbon monoxide poisoning. Results and its discussion. A histological examination of pieces of the brain in the case of sudden death syndrome revealed the foci of angiomatosis of the vessels of the pia mater and brain matter with the normal structure of the elastic membrane of the arteries, the effects of glial proliferation in the subependymal region of the lateral ventricles and subcortical formations. In the medulla oblongata, in a detailed study of the posterior (vegetative) nucleus of the vagus nerve, degenerative changes in neurons were detected in the form of chromatolysis and karyolysis, a glial reaction of the type of neuronophagy. Conclusion. Pathomorphological changes in the brain stem may be due to combined intrauterine hypoxic and intrapartum traumatic factors, which, potentiating each other, lead to dysregulation of the respiratory rhythm with the development of a fatal outcome during sleep.

The objective of the present study was to evaluate the contribution of intrauterine infections to the loss of fetuses and newborn babies and to elucidate the cause-and-effect relationships between the unfavourable outcomes of pregnancies and the actions of the attending medical personnel. The main group of the patients included in the study was comprised of 28 women whose pregnancy ended in stillbirths (13 cases) and infant death during the neonatal period (15 cases) in the association with intrauterine infections (IUI). The control group consisted of 11 practically healthy women with the physiological course of pregnancy and parturition matched to those of the main group in terms of age, parity, and social status. Special attention was given to the possibilities of prevention of neonatal deaths and the severity of harm to the health of mother and child. Examination of the patients of the main group revealed multiple infectious foci in the body affecting various organs and their systems including the urogenital tract. The premature birth occurred in 46.4% of the women presenting with fetal-placental insufficiency. They gave birth to the babies with a low weight for gestational age in the state of asphyxia that required the application of the resuscitation procedures and intensive therapy. The present study has shown that the immediate cause of fetal and neonatal deaths was multiple organ dysfunction associated with intrauterine infections. No direct relationship between the unfavourable outcomes of pregnancy and the actions of the medical personnel was documented in the majority of the cases (89.3%). It is concluded that the main factors responsible for tanatogenesis were the character and severity of the difficult to diagnose pathological process.