Although brainstem serotonergic (5-HT) systems are involved in the protective responses to hypoxia, abnormalities of 5-HT function are strongly implicated in SIDS, and the neurochemical mechanisms by which 5-HT receptors influence brainstem cardiorespiratory responses to hypoxia remains unclear. This study focuses on the role of excitatory neurotransmission, including 5-HT3 signaling, to cardiac vagal neurons (CVNs) that dominate the control of heart rate. Excitatory synaptic inputs to CVNs, located in the nucleus ambiguus (NA), were recorded simultaneously with respiratory activity in in vitro brainstem slices. During control conditions excitatory inputs to CVNs were blocked by application of NMDA and AMPA/kainate glutamatergic receptor antagonists, whereas the 5-HT3 and purinergic receptor antagonists ondansetron and pyridoxalphosphate-6-azophenyl-2Ј,4Ј-disulfonic acid (PPADS), respectively, had no effect. However, during hypoxia ondansetron inhibited excitatory neurotransmission to CVNs. In recovery from hypoxia, spontaneous and respiratory-related excitatory events were blocked by glutamatergic and purinergic receptor blockers, respectively, whereas ondancetron had no effect. These results demonstrate that hypoxia recruits a 5-HT pathway to CVNs that activates 5-HT3 receptors on CVNs to maintain parasympathetic cardiac activity during hypoxia. Exaggeration of this 5-HT neurotransmission could increase the incidence of bradycardia and risk of sudden infant death during hypoxia. (Pediatr Res 65: 625-630, 2009) E pisodes of apnea and bradycardia are common in infants who succumb to SIDS (1,2). Although a specific cause in a majority of SIDS death is unknown, developmental abnormalities of serotonin (5-HT) function in the ventral medulla have recently been closely correlated with SIDS (3). These abnormalities involve multiple elements of 5-HT function including increased number of 5-HT neurons, reduction of 5-HT1A receptor binding, and relative reduction of 5-HT transporter function (4). In agreement with these findings, the study of cerebrospinal fluids of SIDS victims showed a significant increase of the metabolites of 5-HT (5,6). Medullary 5-HT abnormalities and enhanced 5-HT activity may result in exaggeration of responses to hypoxia including deleterious bradyarrhythmias.Respiratory responses to hypoxia include initial an increase, followed by a decrease, in the respiratory frequency in most mammals (7,8). Similarly, hypoxia evokes an initial increase in heart rate followed by a parasympathetically mediated bradycardia and ultimately, cessation of cardiac contractions (9 -11). This biphasic response to hypoxia is likely partly because of the biphasic increase followed by decrease in inhibitory GABAergic and glycinergic inputs to cardiac vagal neurons (CVNs) located within the nucleus ambiguus (NA) (12). However, the role of excitatory neurotransmission to CVNs in cardiorespiratory responses to hypoxia remains unclear.Hypoxia evokes neurotransmitter release in the brainstem including 5-HT (13), ATP...