Vestibulo-mediated cardiovascular control in hazardous situations is important. Our hypothesis is that the prerequisite for sudden infant death syndrome (SIDS) is impaired vestibulo-mediated cardiovascular control. Prematurity is a risk factor for SIDS, and postnatal intermittent hypoxia may contribute to this risk. We studied heart rate (HR) and blood pressure (BP) responses in 10 infants with bronchopulmonary dysplasia (BPD) who were born at 27 Ϯ 2.4 (23-30) wk of gestation. Twenty healthy term infants served as controls. Cardiovascular tests were performed under polysomnographic control during slow-wave sleep (SWS) at a corrected age of 12 Ϯ 3.5 (7-19) wk. Control infants showed biphasic HR and BP responses to side motion with an immediate increase followed by a modest decrease and return to baseline. Compared with the controls, half of the BPD infants had altered BP responses (p Ͻ 0.005) without an early increase, followed by a more prominent decrease in BP. BPD infants also presented with a greater variability in BP responses to head-up tilts than did the controls (p Ͻ 0.001). In conclusion, these findings suggest that some BPD infants have impaired vestibular sympathoreflex-mediated cardiovascular control. This dysfunction may become critical in life-threatening situations. V estibular and cerebellar dysfunction has been suggested to be part of the pathophysiology of SIDS (1). Cardiovascular control mediated by vestibular nuclei and the cerebellum are important in hazardous situations such as hypovolemic and endotoxin shock (2,3). More than 80% of SIDS victims have shown neuronal apoptosis in vestibular nuclei and nuclei of the tractus solitarii, which are involved in baroand vestibular sympathoreflexes (4). SIDS victims also present with abnormalities elsewhere in the vestibular sympathoreflex pathway (5-7).During normal daily living, vestibular sympathoreflex dysfunction is not expected to have a profound effect on cardiovascular control because several compensatory circuits are involved in control of HR and BP (8,9). The dysfunction results in greater variability in BP control during postural changes (10). Similarly, increased BP variability has been observed in tilt tests performed in infants who have suffered from apparent life-threatening events (ALTEs) (11,12), further supporting the idea of vestibular dysfunction in SIDS.Most SIDS victims have suffered from hypoxia for at least several hours before the lethal event (13). SIDS victims may also have suffered from hypoxia earlier in life for multiple reasons, including placental insufficiency (14), intrauterine nicotine exposure (15), low or very low birth weight (16,17), hypoxia related to obstructive apnea events (18,19), or unfavorable head position during sleep (20,21). Our hypothesis is that hypoxic episodes cause a dysfunction in vestibulo-mediated cardiovascular control, thus making the infant more liable to die in life-threatening situations. To test the possible effects of hypoxia and test our hypothesis, we previously studied infan...