NSIDRC Journal Article Alert — June
2007
Duarte CM.
Health policy effects on infant mortality trends
in Brazil: a literature review from the last decade.
Cad Saude Publica. 2007 Jul;23(7):1511-28.
The infant mortality rate (IMR) is considered
a good indicator of living conditions. It is simple to calculate
and reflects the health conditions of the most vulnerable segment
of the population: children less than one year of age. Official
Brazilian data indicating a decrease of 31% in the IMR seem
surprising, considering the deterioration in the country's
economy, income, and employment. Still, the last decade witnessed
important political decisions, especially the implementation
of the Family Health Strategy and incentives under the so-called
Basic Operational Norm (NOB)-96. The current study assesses
how the Brazilian literature analyzed the infant mortality
trends and possible associations with changes in the organization
and financing of the Unified National Health System (SUS).
A systematic review of the literature from 1998 to 2006 highlighted
both the need to monitor the IMR and the importance of local
studies, especially in cities with deficient data.
Full-text available at: http://www.scielo.br/
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Reix P, St-Hilaire M, Praud JP.
Laryngeal sensitivity in the neonatal period: From
bench to bedside.
Pediatr Pulmonol. 2007 Jun 22; [Epub ahead of print].
Laryngeal sensitivity in the newborn has
been a subject of great interest for both researchers and clinicians
for a number of years. From a clinical standpoint, laryngeal
sensitivity is essential for both preventing foreign substances
from entering into the lower airway and for finely tuning upper
airway resistance. However, heightened reflexes originating
from the laryngeal receptors in newborns and infants, due to
neural immaturity, can lead to potentially dangerous cardiorespiratory
events. The latter have been linked to apneas of prematurity,
apparent life-threatening events, and sudden infant death syndrome
(SIDS). From a physiological standpoint, many mechanisms pertaining
to reflexes originating from laryngeal receptors are yet to
be fully understood. This short review is an attempt to summarize
current knowledge on laryngeal sensitivity and its potential
consequences upon control of breathing abnormalities encountered
within the first weeks of life.
Full-text available at: http://www3.interscience.wiley.com/
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Liu X, Roth J.
Development and validation of an infant morbidity
index using latent variable models.
Stat Med. 2007 Jun 15; [Epub ahead of print].
Birth defect, abnormal condition of the newborn,
developmental delay or disability and low birth weight are
four major infant morbidity outcomes. Most studies have focused
on assessment of the effects of risk factors on each of these
outcomes or of the relationship among these outcomes or both.
Little attention has been paid to the development of a composite
index, which is a summary construct of infant morbidity outcomes.
In this paper, we develop extended latent variable (LV) models
and modified Gauss-Newton algorithms for multiple multinomial
morbidity outcomes with complete responses. By assuming the
marginal distribution of the LV to be log-normal, we model
the conditional probability of each outcome as a nonlinear
function of the LV, which has properties similar to the logistic
function. The estimated generalized nonlinear least-square
method is used to solve equations for parameters of interest.
The models are applied to an infant morbidity data set. A new
single variable, called infant morbidity index (IMI) that functions
as a summary of four infant morbidity outcomes and represents
propensity for infant morbidity, is developed. The validity
of this index is then assessed in detail. It is shown that
the IMI is correlated with each of the individual outcomes,
with infant mortality and with a face-valid index of morbidity
outcomes, and can be used in future research as a measure of
propensity for infant morbidity.
Full-text available at: http://www3.interscience.wiley.com
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Meeker JD, Missmer SA, Vitonis AF,
Cramer DW, Hauser R.
Risk of spontaneous abortion in women with childhood
exposure to parental cigarette smoke.
Am J Epidemiol. 2007 Jun 12; [Epub ahead of print].
There is increasing concern over whether
environmental exposures early in life may impact health in
adulthood. Recent evidence suggests that prenatal or childhood
exposure to cigarette smoke may result in poorer reproductive
health later in life. Among 2,162 nonsmoking women recruited
from three Boston, Massachusetts, clinics who underwent assisted
reproductive treatments between 1994 and 2003, adjusted odds
ratios for pregnancy outcomes in the initial treatment cycle
were calculated in relation to self-reported childhood exposure
to parental cigarette smoke. Women who reported having two
parents who smoked during their childhood had increased odds
of a spontaneous abortion compared with women reporting that
neither parent smoked (adjusted odds ratio = 1.8, 95% confidence
interval: 1.0, 3.0). A trend for increased risk was observed
for women reporting that zero, one, or two parents smoked.
In secondary analysis, the authors also found suggestive evidence
for increased risk of failed embryo implantation among women
reporting current secondhand tobacco smoke exposure. Future
large studies of pregnancy loss are needed that can distinguish
women's tobacco smoke exposure in childhood from that taking
place in utero.
Full-text available at: axe.oxfordjournals.org/
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Bacon C, Hall D, Stephenson T, Campbell
M.
How common is repeat sudden infant death syndrome?
Arch Dis Child. 2007 Jun 12; [Epub ahead of print].
Recurrence of sudden infant death syndrome
is rare but may give rise to confusion and controversy because
of the differential diagnoses of familial disease or covert
homicide. We examine eight studies of recurrent SIDS published
in English since 1970. These studies reported relative risks
of recurrence, as compared with the population or with controls,
ranging from 1.7 to 10.1. We assess the validity of the studies
by three main criteria: accuracy of ascertainment, adequacy
of investigation and matching of controls. We found that all
the studies failed to meet these criteria, and we think that
their flaws would have resulted mainly in overestimation of
recurrence risk. We conclude that, although an increase in
risk is probable on theoretical grounds, this risk cannot be
quantified from the available evidence. We suggest that professionals
should be cautious in their pronouncements on the chances of
recurrence, and that parents who have lost a baby to SIDS can,
with the exception of particularly vulnerable families, be
reassured that the risk of recurrence is small.
Full-text available at: adc.bmj.com/
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Dettmeyer R, Sperhake JP, Muller J,
Madea B.
Cytomegalovirus-induced pneumonia and myocarditis
in three cases of suspected sudden infant death syndrome
(SIDS): Diagnosis made by immunohistochemical techniques
and molecularpathologic methods.
Forensic Sci Int. 2007 Jun 11; [Epub ahead of print].
Immunohistochemical and molecularpathologic
techniques have improved the diagnosis of myocarditis as compared
with conventional histologic staining methods done according
to the Dallas criteria. Additionally, immunohistochemistry
and in situ-hybridization are able to demonstrate viral infection,
e.g. cytomegaloviruses in salivary glands and lungs, locations
both known to be involved in cytomegalovirusinfection. However,
in many cases of proved cytomegalovirusinfection the cause
of death remains unclear. We report on three children younger
than 1-year of age, who died suddenly without prodromal symptoms.
Their deaths were attributed to SIDS (sudden infant death syndrome).
In situ-hybridization, immunohistochemical (LCA, CD45R0, CD68,
MHC-class-II-molecules, E-selectine) and molecularpathologic
investigations (PCR), however, suggested that death was caused
by a cytomegalovirus-induced pneumonia or myocarditis. In the
future, these methods should be used for investigating cases
with suspicion of SIDS.
Full-text available at: http://www.elsevier.com
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Kinney HC, Armstrong DL, Chadwick
AE, Crandall LA, Hilbert C, Belliveau RA, Kupsky WJ, Krous
HF.
Sudden death in toddlers associated with developmental
abnormalities of the hippocampus: a report of five cases.
Arch Dis Child. 2007 Jun 7; [Epub ahead of print].
Sudden unexplained death in childhood (SUDC)
is the sudden death of a child older than 1 year of age that
remains unexplained after review of the clinical history, circumstances
of death, and autopsy with appropriate ancillary testing. We
report here 5 cases of SUDC in toddlers that we believe define
a new entity associated with hippocampal anomalies at autopsy.
All of the toddlers died unexpectedly during the night, apparently
during sleep. Within 48 hours before death, 2 toddlers had
fever, 3 had a minor upper respiratory tract infection, and
3 experienced minor head trauma. There was a history of febrile
seizures in 2 (40%) and a family history of febrile seizures
in 2 (40%). Hippocampal findings included external asymmetry
and 2 or more microdysgenetic features. The incidence of certain
microdysgenetic features was substantially increased in the
temporal lobes of these 5 cases compared with the temporal
lobes of 39 (control) toddlers with the causes of death established
at autopsy (P < 0.01). We propose that these 5 cases define
a potential subset of SUDC whose sudden death is caused by
an unwitnessed seizure arising during sleep in the anomalous
hippocampus and producing cardiopulmonary arrest. Precipitating
factors may be fever, infection, and/or minor head trauma.
Suggested risk factors are a history of febrile seizures and/or
a family history of febrile seizures. Future studies are needed
to confirm these initial findings and to define the putative
links between sudden death, hippocampal anomalies, and febrile
seizures in toddlers.
Full-text available at: http://www.pedpath.org
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Kahlert C, Rudin C, Kind C.
Sudden infant death syndrome in infants born to HIV-infected
and opiate using mother.
Arch Dis Child. 2007 Jun 7; [Epub ahead of print].
Objective: This study was undertaken to determine
the role of opiate use during pregnancy as a predisposing factor
for SIDS in infants born to HIV-infected mothers. OBJECTIVE:
This study was undertaken to determine the role of opiate use
during pregnancy as a predisposing factor for SIDS in infants
born to HIV-infected mothers. METHODS: In order to identify
all infant deaths and their cause and association with maternal
opiate use, data of a nationwide prospective cohort study of
HIV infected mothers and their children were extracted and
analysed for a 13 year period. RESULTS: 24 (5.1%) infant deaths
were observed out of 466 infants followed up until death or
at least 12 months of life. 3 (0.6%) of them were due to non
accidental trauma and not associated with maternal opiate use.
7 (1.5%) died due to SIDS, confirmed by autopsy. All SIDS cases
occurred in infants born to mothers reporting use of opiates
during pregnancy (n=124). The relative risk of SIDS compared
to the general population was 18 (95% CI 9 - 38) for all infants
of HIV-infected mothers, and 69 (95%-CI 33 - 141) for those
with intrauterine opiate exposure (p < 0.0001). CONCLUSIONS:
Compared to the Swiss general population the risk for SIDS
in this cohort of infants born to HIV-infected mothers was
highly increased, but only for mothers reporting opiate use
during pregnancy. This effect appeared not to be mediated by
prematurity, low birth weight, perinatal HIV infection or antiretroviral
drug exposure.
Full-text available at: adc.bmj.com/
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Cripe SM, Phung TT, Nguyen TP, Williams
MA.
Risk factors associated with stillbirth in Thai Nguyen
Province, Vietnam.
J Trop Padiatr. 2007 Jun 7; [Epub ahead of print].
We investigated risk factors associated with
stillbirths using personal interviews and medical records abstraction
in a hospital-based case-control study in Thai Nguyen Province,
Vietnam. There were 47 stillbirth cases and 365 controls in
this study. Maternal education (</=12 years) (Odds Ratio,
OR = 3.07; 95% CI = 1.19-7.96), from rural communities (OR
= 2.42; 95% CI = 1.16-5.03), primiparous (OR = 3.83; 95% CI
= 1.10-13.40) and lack of prenatal care vitamins (OR = 2.56;
95% CI = 1.25-5.23) were statistically significant risk factors
associated with stillbirth in an age-adjusted multivariable
model. Our findings suggest that improved maternal health education
and care in all communities may reduce the burden of fetal
loss in this province.
Full-text available at: tropej.oxfodjournals.org/
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Pasquale-Styles MA, Tackitt PL, Schmidt
CJ.
Infant death scene investigation and the assessment
of potential risk factors for asphyxia: A review of 209 sudden
unexpected infant deaths.
J Forensic Sci. 2007 Jun 6; [Epub ahead of print].
At the Wayne County Medical Examiner Office
(WCMEO) in Detroit, Michigan, from 2001 to 2004, thorough scene
investigations were performed on 209 sudden and unexpected
infant deaths, ages 3 days to 12 months. The 209 cases were
reviewed to assess the position of the infant at the time of
discovery and identify potential risk factors for asphyxia
including bed sharing, witnessed overlay, wedging, strangulation,
prone position, obstruction of the nose and mouth, coverage
of the head by bedding and sleeping on a couch. Overall, one
or more potential risk factors were identified in 178 of 209
cases (85.2%). The increasing awareness of infant positions
at death has led to a dramatic reduction in the diagnosis of
sudden infant death syndrome at the WCMEO. This study suggests
that asphyxia plays a greater role in many sudden infant deaths
than has been historically attributed to it.
Full-text available at: http://www.blackwell.com
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Smith GC, Shah I, White IR, Pell JP,
Crossley JA, Dobbie R.
Maternal and biochemical predictors of antepartum
stillbirth among nulliparous women in relation to gestational
age of fetal death.
BJOG. 2007 Jun;114(6):705-14.
OBJECTIVE: To determine whether maternal
serum levels of alphafetoprotein (alpha-FP) and human chorionic
gonadotrophin (hCG) at 15-21 weeks provided clinically useful
prediction of stillbirth in first pregnancies. DESIGN: Retrospective
study of record linkage of a regional serum screening laboratory
to national registries of pregnancy outcome and perinatal death.
SETTING: West of Scotland, 1992-2001. POPULATION: A total of
84,769 eligible primigravid women delivering an infant at or
beyond 24 weeks of gestation. METHODS: The risk of stillbirth
between 24 and 43 weeks was assessed using the Cox proportional
hazards model. Logistic regression models within gestational
windows were then used to estimate predicted probability. Screening
performance was assessed as area under the receiver operating
characteristic (ROC) curve. MAIN OUTCOME MEASURE: Antepartum
stillbirth unrelated to congenital abnormality. RESULTS: The
odds ratio (95% CI) for stillbirth at 24-28 weeks for women
in the top 1% were 11.97 (5.34-26.83) for alpha-FP and 5.80
(2.19-15.40) for hCG. The corresponding odds ratios for stillbirth
at or after 37 weeks were 2.44 (0.74-8.10) and 0.79 (0.11-5.86),
respectively. Adding biochemical to maternal data increased
the area under the ROC curve from 0.66 to 0.75 for stillbirth
between 24 and 28 weeks but only increased it from 0.64 to
0.65 for stillbirth at term and post-term. Women in the top
5% of predicted risk had a positive likelihood ratio of 7.8
at 24-28 weeks, 3.7 at 29-32 weeks, 5.1 at 33-36 weeks and
3.4 at 37-43 weeks, and the corresponding positive predictive
values were 0.97, 0.33, 0.47 and 0.63%, respectively. CONCLUSIONS:
Maternal serum levels of alpha-FP and hCG were statistically
associated with stillbirth risk. However, the predictive ability
was generally poor except for losses at extreme preterm gestations,
where prevention may be difficult and interventions have the
potential to cause significant harm.
Full-text available at: http://www.blackwell-synergy.com
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Smith GC, Crossley JA, Aitken DA,
Jenkins N, Lyall F, Cameron AD, Connor JN, Dobbie R.
Circulating angiogenic factors in early pregnancy
and the risk of preeclampsia, intrauterine growth restriction,
spontaneous preterm birth, and stillbirth.
Obstet Gynecol. 2007 Jun; 109(6):1316-1324.
OBJECTIVE: To estimate the relationship between
maternal serum levels of placental growth factor (PlGF) and
soluble fms-like tyrosine kinase-1 (sFlt-1) in early pregnancy
with the risk of subsequent adverse outcome. METHODS: A nested,
case-control study was performed within a prospective cohort
study of Down syndrome screening. Maternal serum levels of
sFlt-1 and PlGF at 10-14 weeks of gestation were compared between
939 women with complicated pregnancies and 937 controls. Associations
were quantified as the odds ratio for a one decile increase
in the corrected level of the analyte. RESULTS: Higher levels
of sFlt-1 were not associated with the risk of preeclampsia
but were associated with a reduced risk of delivery of a small
for gestational age infant (odds ratio [OR] 0.92, 95% confidence
interval [CI] 0.88-0.96), extreme (24-32 weeks) spontaneous
preterm birth (OR 0.90, 95% CI 0.83-0.99), moderate (33-36
weeks) spontaneous preterm birth (OR 0.93, 95% CI 0.88-0.98),
and stillbirth associated with abruption or growth restriction
(OR 0.77, 95% CI 0.61-0.95). Higher levels of PlGF were associated
with a reduced risk of preeclampsia (OR 0.95, 95% CI 0.90-0.99)
and delivery of a small for gestational age infant (OR 0.95,
95% CI 0.91-0.99). Associations were minimally affected by
adjustment for maternal characteristics. CONCLUSION: Higher
early pregnancy levels of sFlt-1 and PlGF were associated with
a decreased risk of adverse perinatal outcome. LEVEL OF EVIDENCE:
II.
Full-text available at: http://www.greenjournal.org
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Hogberg U, Holmgren PA.
Infant mortality of very preterm infants by mode
of delivery, institutional policies and maternal diagnosis.
Acta Obstet Gynecol Scand. 2007 Jun; 86(6):693-700.
Objective. The aim of this study was to analyse
infant mortality among infants born extremely preterm in relation
to mode of delivery, maternal diagnosis, and different institutional
policies. Methods. We conducted a national tertiary health
care center study using Swedish Medical Birth Register (MBR)
data from 1990 to 2002, to examine the 2,094 live births of
infants at 23+0 to 27+6 weeks gestation. We assessed the association
between mode of delivery, gestational age (GA), calendar year,
maternal condition, and institutional policies on infant mortality
outcome. Results. At 23-25 weeks, 38% of infants (range: 34-69%)
were delivered by cesarean section (CS), while at 26-27 weeks,
66% (59-80%) were delivered by CS. The CS rate for fetal or
maternal indications was 98% in cases of pre-eclampsia/eclampsia,
42% for premature rupture of membranes (PROM), 68% for hemorrhage,
76% for PROM+hemorrhage, 56% for breech presentation, and 30%
for preterm vertex with no other complications. After cases
of pre-eclampsia/eclampsia were excluded, vaginal delivery
was associated with a small increase of risk for infant death.
Vaginal delivery was associated with a significantly increased
risk for infant death in breech presentations and multiple
births, while vaginal delivery posed a non-significant risk
increase for PROM and hemorrhage. For preterm vertex without
any other complications, 4 out of 5 infants were delivered
vaginally without any risk increase. Conclusion. This study
reports high CS rates for very preterm births at Swedish hospitals.
In performing CS for very preterm infants, this study suggests
a survival advantage for certain maternal conditions, but not
for preterm labor with a vertex presentation without other
obstetrical complications.
Full-text available at: http://www.informaworld.com
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Valusek PA, St Peter SD, Tsao K, Spilde
TL, Ostlie DJ, Holcomb GW.
Use of fundoplication for prevention of apparent
life-threatening events.
J Pediatr Surg. 2007 Jun;42(6):1022-4.
OBJECTIVE: Gastroesophageal reflux disease
(GERD) is cited by many to be a common cause of apparent life-threatening
events (ALTEs). However, there are few reports in the literature
regarding the surgical treatment of GERD to prevent a recurrent
ALTE. METHODS: A retrospective review of infants undergoing
fundoplication between 2000 and 2005 for the prevention of
another ALTE was undertaken. Preoperative, operative, and postoperative
data as well as follow-up information were collected. RESULTS:
During the study period, 81 patients underwent fundoplication
after presenting with an ALTE. All but 3 patients (96.3%) had
been treated with antireflux medication. Moreover, 71 infants
(87.7%) were taking antireflux medication at the time of their
ALTE. A significant number of infants (77.8%) were hospitalized
with a second ALTE before referral for fundoplication. After
fundoplication, only 3 patients (3.7%) experienced a recurrent
ALTE during the follow-up period; 2 required a second fundoplication
and 1 underwent pyloromyotomy. None of these 3 patients have
experienced a recurrent ALTE after the second operation. The
median follow-up has been 1738 days. CONCLUSION: Our data suggest
that among patients who had an ALTE and are found to have GERD,
fundoplication appears to be an effective method for preventing
recurrent ALTE.
Full-text available at: http://www.sciencedirect.com
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Zanconato G, Piazzola E, Caloi E,
Iacovella C, Ruffo R, Franchi M.
Clinicopathological evaluation of 59 cases of fetal
death.
Arch Gynecol Obstet. 2007 May 31; [Epub ahead of print].
OBJECTIVE: The purpose of this study has
been assessing the determinants of stillbirth among the newborns
of the Verona University Obstetrics Department. MATERIALS AND
METHODS: A total of 59 stillbirth cases, observed between January
2000 and June 2006, were retrospectively studied. WHO definition
for stillbirth was adopted as the inclusion criterion. Clinical
files, feto-maternal laboratory data, feto-placental pathology
findings as well as delivery mode and circumstances were all
systematically reviewed. RESULTS: The 59 observed cases correspond
to an incidence of 9.8 stillbirths/year, which, considering
the institutional delivery rate, correspond to 5.4 cases per
1000 births. Frequent relevant conditions associated with stillbirth
were intrauterine growth restriction (15.2%), congenital fetal
anomalies (13.5%), various maternal diseases (21.0%); no cause
of fetal demise could be found in 10/59 (17.0%) cases, which
were classified as unexplained. Most deliveries were successfully
induced with prostaglandins except 11 cases (19.0%) which required
a C-section due to severe maternal conditions associated with
the fetal loss. CONCLUSION: Thorough investigation of each
individual stillbirth case, by means of an integrated study
protocol, along with the Pathologist's close collaboration,
allows identification of a likely cause in the majority of
cases. Better knowledge of unexpected fetal loss is the premise
for better parental counselling and for prevention of recurrences.
Full-text available at: http://www.springerlink.com
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David R, Collins Jr. J.
Disparities in infant mortality: What’s
genetics got to do with it?
Am J Public Health. 2007 May 30; [Epub ahead of print].
Since 1950, dramatic advances in human genetics
have occurred, racial disparities in infant mortality have
widened, and the United States' international ranking in infant
mortality has deteriorated. The quest for a "preterm birth
gene" to explain racial differences is now under way. Scores
of papers linking polymorphisms to preterm birth have appeared
in the past few years. Is this strategy likely to reduce racial
disparities? We reviewed broad epidemiological patterns that
call this approach into question. Overall patterns of racial
disparities in mortality and secular changes in rates of prematurity
as well as birthweight patterns in infants of African immigrant
populations contradict the genetic theory of race and point
toward social mechanisms. We postulate that a causal link to
class disparities in health exists.
Full-text available at: http://www.ajph.org/
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Mathews TJ, MacDorman MF.
Infant mortality statistics from the 2004 period
linked birth/infant death data set.
Natl Vital Stat Rep. 2007 May 2;55(14):1-32.
OBJECTIVES: This report presents 2004 period
infant mortality statistics from the linked birth/infant death
data file by a variety of maternal and infant characteristics.
The linked file differs from the mortality file, which is based
entirely on death certificate data. METHODS: Descriptive tabulations
of data are presented and interpreted. Excluding rates by cause
of death, the infant mortality rate is now published with two
decimal places. RESULTS: The U.S. infant mortality rate was
6.78 infant deaths per 1000 live births in 2004 compared with
6.84 in 2003. Infant mortality rates ranged from 4.67 per 1,000
live births for Asian and Pacific Islander mothers to 13.60
for non-Hispanic black mothers. Among Hispanics, rates ranged
from 4.55 for Cuban mothers to 7.82 for Puerto Rican mothers.
Infant mortality rates were higher for those infants whose
mothers were born in the 50 states and the District of Columbia,
were unmarried, or were born in multiple births. Infant mortality
was also higher for male infants and infants born preterm or
at low birthweight. The neonatal mortality rate declined from
4.63 in 2003 to 4.52 in 2004 while the postneonatal mortality
rate was essentially unchanged. Infants born at the lowest
gestational ages and birthweights have a large impact on overall
U.S. infant mortality. More than one-half (55 percent) of all
infant deaths in the United States in 2004 occurred to the
2 percent of infants born at less than 32 weeks of gestation.
Still, infant mortality rates for late preterm (34-36 weeks
of gestation) infants were three times those for term (37-41
week) infants. The three leading causes of infant death-Congenital
malformations, low birthweight, and SIDS-taken together accounted
for 45 percent all infant deaths. Results from a new analysis
of preterm-related causes of death show that 36.5 percent of
infant deaths in 2004 were due to preterm-related causes. The
preterm-related infant mortality rate for non-Hispanic black
mothers was 3.5 times higher, and the rate for Puerto Rican
mothers was 75 percent higher than for non-Hispanic white mothers.
Full-text available at: http://www.cdc.gov/nchs/
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Gold KJ, Dalton VK, Schwenk TL.
Hospital care for parents after perinatal death.
Obstet Gynecol. 2007 May;109(5):1156-66.
OBJECTIVE: To systematically review parent
experiences with hospital care after perinatal death. DATA
SOURCES: An evaluation of more than 1,100 articles from 1966
to 2006 was performed to identify studies of fetal death in
the second or third trimester and neonatal death in the first
month of life. METHODS OF STUDY SELECTION: Studies were limited
to those that were in English, evaluated care in U.S. hospitals,
and contained direct parent data or opinions. TABULATION, INTEGRATION,
AND RESULTS: Results were compiled on five aspects of recommended
care: 1) obtaining photographs and memorabilia of the deceased
infant, 2) seeing and holding the infant, 3) labor and delivery
of the child, 4) autopsies, and 5) options for funerals or
memorial services. Sixty eligible studies with over 6,200 patients
were reviewed. In general, parents reported appreciating time
and contact with their deceased infant, being given options
about labor, delivery, and burial, receiving photographs and
memorabilia, and having appropriate hospital follow-up after
autopsy. CONCLUSION: Although care after perinatal death often
adheres to published guidelines, substantial room for improvement
is apparent. Parents with perinatal losses report few choices
during labor and delivery and inadequate communication about
burial options and autopsy results. Hospitals, nurses, and
doctors should increase parental choice about timing and location
of delivery and postpartum care, encourage parental contact
with the deceased infant, and facilitate provision of photos
and memorabilia.
Full-text available at: greenjournal.org
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Hogge W, Allen W, Prosen TL, Lanasa
MC, Huber HA, Reeves MF.
Recurrent spontaneous abortion and skewed X-inactivation:
Is there an association?
American Journal of Obstetrics & Gynecology. 196(4):384e1-384e8,
April 2007.
OBJECTIVE: The purpose of this study was
to determine whether there is an association between skewed
X-inactivation and recurrent spontaneous abortion in a large,
well-defined sample of women with recurrent loss. STUDY DESIGN:
X-chromosome inactivation patterns were compared in 5 groups
of women. Group 1 (recurrent spontaneous abortion) consisted
of 357 women with 2 or more spontaneous losses. In group 2
(infertility), there were 349 subjects from infertility practices
recruited at the time of a positive serum beta-human chorionic
gonadotropin. Group 3 (spontaneous abortion) women (n = 81)
were recruited at the time of an ultrasound diagnosis of an
embryonic demise or an anembryonic gestation. Groups 4 (primiparous)
and 5 (multiparous) were healthy pregnant subjects previously
enrolled in another study to determine the incidence and cause
of pregnancy complications, such as preeclampsia and intrauterine
growth restriction. The Primiparous group included 114 women
in their first pregnancy, whereas the Multiparous group consisted
of 79 women with 2 or more pregnancies but without pregnancy
loss. RESULTS: The rate of extreme skewing (90% or greater)
in the recurrent spontaneous abortion population was 8.6%,
and not statistically different from any of the other groups,
except the Primiparous group (1.0%, P < .01). The incidence
of X-inactivation skewing of 90% or greater was no different
whether there had been at least 1 live birth (9.9%), or no
previous live births and at least 3 losses (5.6%, P > .05).
When age and skewing of 90% or greater are compared, subjects
with extreme skewing have a mean age of 2 years older than
those without extreme skewing (P < .05). CONCLUSION: Skewed
X-inactivation is not associated with recurrent spontaneous
abortion but is associated with increasing maternal age.
Full-text available at: http://www.sciencedirect.com
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Simon A, Volz S, Hofling K, Kehl A,
Tillman R, Muller A, Kupfer B, Eis-Hubinger AM, Lentze MJ,
Bode U, Schildgen O.
Acute life threatening event (ALTE) in an infant
with human coronavirus HCoV-229E infection.
Pediatr Pulmonol. 2007 Apr; 42(4):393-6.
In this short report we discuss the temporal
association between an acute life threatening event (ALTE)
and a RT-PCR confirmed coronavirus HCoV-229E infection in a
4 months old otherwise healthy infant. More detailed microbiological
investigations of affected children even without apparent signs
of a respiratory tract infection may help to clarify the etiology
in some patients and extend our understanding of the pathogenesis.
PCR-based techniques should be utilized to increase the sensitivity
of detection for old and new respiratory viral pathogens in
comparable cases.
Full-text available at: http://www3.interscience.wiley.com
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Tester DJ, Dura M, Carturan E, Reiken
S, Wronska A, Marks AR, Ackerman MJ.
Mechanism for sudden infant death syndrome (SIDS):
Stress-induced leak via ryanodine receptors.
Heart Rhythm. 2007 Jun;4(6):733-9. Epub 2007 Mar 3.
BACKGROUND: Sudden infant death syndrome
(SIDS) is the leading cause of postneonatal mortality in the
United States. Mutations in the RyR2-encoded cardiac ryanodine
receptor cause the highly lethal catecholaminergic polymorphic
ventricular tachycardia (CPVT1) in the young. OBJECTIVE: The
purpose of this study was to determine the spectrum and prevalence
of RyR2 mutations in a large cohort of SIDS cases. METHODS:
Using polymerase chain reaction, denaturing high performance
liquid chromatography, and direct DNA sequencing, a targeted
mutational analysis of RyR2 was performed on genomic DNA isolated
from frozen necropsy tissue on 134 unrelated cases of SIDS
(57 females, 77 males; 83 white, 50 black, 1 Hispanic; average
age = 2.7 months). RyR2 mutations were engineered by site-directed
mutagenesis, heterologously expressed in HEK293 cells, and
functionally characterized using single-channel recordings
in planar lipid bilayers. RESULTS: Overall, two distinct and
novel RyR2 mutations were identified in two cases of SIDS.
A 6-month-old black female hosted an R2267H missense mutation,
and a 4-week-old white female infant harbored a S4565R mutation.
Both nonconservative amino acid substitutions were absent in
400 reference alleles, involved conserved residues, and were
localized to key functionally significant domains. Under conditions
that simulate stress [Protein Kinase A (PKA) phosphorylation]
during diastole (low activating [Ca(2+)]), SIDS-associated
RyR2 mutant channels displayed a significant gain-of-function
phenotype consistent with the functional effect of previously
characterized CPVT-associated RyR2 mutations. CONCLUSIONS:
Here we report a novel pathogenic mechanism for SIDS, whereby
SIDS-linked RyR2 mutations alter the response of the channels
to sympathetic nervous system stimulation such that during
stress the channels become "leaky" and thus potentially trigger
fatal cardiac arrhythmias.
Full-text available at: http://www.sciencedirect.com
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Byrd DR, Katcher ML, Peppard P, Durkin
M, Remington PL.
Infant mortality: Explaining Black/White disparities
in Wisconsin.
Matern Child Health J. 2007 Jul;11(4):319-26. [Epub 2007 Feb
14].
Objectives: Understanding the factors contributing
to black/white disparities in infant mortality rates in Wisconsin
is a prerequisite to decreasing these disparities and improving
birth outcomes. We examined multiple determinants of infant
mortality to understand the impact of specific risk factors
on the infant mortality rates of blacks and whites in Wisconsin.
Methods: We used the Wisconsin Interactive Statistics on Health
database to examine infant mortality data for the 5-year time
period, 1998-2002 (N=32,166 black infant births; 272,559 white
infant births). We conducted a bivariate analysis of relative
risks (RR) of infant mortality (black vs. white) using specific
variables available in the database. We then examined the relationship
between infant mortality rate and selected risk factors using
regression analyses. Results: Unadjusted, black infants were
3.0 times more likely to die during their first year of life,
compared with white infants. Adjusting for gestational age
black infants were only 1.9 times more likely to die. The risk
was further reduced, after adjusting for birth weight, to 1.3.
However, stratifying and adjusting for 8 other multiple variables
accounted for some, but not all of the disparity. Black infants
who had the same risk profile as white infants still had a
2-fold excess risk of death. In addition, simultaneously controlling
for 4 of the 8 risk factors (maternal age, maternal education,
adequacy of prenatal care received, and region of the state)
also reduced, but did not eliminate, this excess risk (RR was
still 2.2 for black infants). Independent of maternal age and
region of the state, adequate prenatal care and higher levels
of education are significant indicators of the racial disparity
between whites and blacks. Conclusions: These results suggest
that, within a given racial group, increasing access to prenatal
care and increasing maternal educational attainment will improve
infant mortality rates but will not eliminate the black/white
disparity in infant mortality. In fact, these interventions
may actually widen the disparity in infant mortality rate between
blacks and whites, especially if funds and programs are applied
equally throughout the population, rather than targeted to
high-risk individuals, who lag significantly behind the majority
population. The Wisconsin white population, which has already
attained an infant mortality rate of 4.5 per 1,000 live births,
will continue to have greatest benefit from these programs
compared to blacks who have a rate of 19.2 in 2004; thus, the
disparity is not eliminated and the gap widens probably due
to differential uptake of health messages secondary to health
literacy issues. Further research is needed to fully understand
the additional, more difficult to measure factors that contribute
significantly to infant mortality, especially among black women.
Full-text available at: http://www.springerlink.com
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Edner A, Wennborg M, Alm B, Lagercrantz
H.
Why do ALTE infants not die in SIDS?
Acta Paediatr. 2007 Feb; 96(2):191-4.
AIM: To compare known risk factors for sudden
infant death syndrome (SIDS) amongst infants with apparent
life threatening events (ALTE) with their matched controls,
and ALTE infants who subsequently died of SIDS with infants
surviving an ALTE. METHODS: Questionnaires with replies were
obtained from 58 ALTE infants and 56 sex and age matched ALTE
control infants. 244 SIDS cases and 868 SIDS controls were
used as comparison. RESULTS: The incidence of ALTE was found
to be 1.9% among SIDS controls, but 7.4% among infants who
later on died of SIDS. The parents sought medical advice in
0.9% vs 3.7%. ALTE infants did not differ from their matched
controls. In the ALTE group 13.3% of the survivors had the
combination of prone sleeping and maternal smoking compared
with 33.3% of those who became SIDS victims. CONCLUSIONS: Our
results show some major differences between the ALTE infants
and SIDS victims not supporting that these conditions belong
to the same entity. However, we cannot exclude the possibility
that there is a subpopulation of ALTE infants who did not die
in SIDS due to that they were sleeping on the back and not
exposed to nicotine.
Full-text available at: http://www.blackwell-synergy.com
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Lavezzi AM, Ottaviani G, Mauri M,
Matturri L.Neurol
Biopathology of the dentate-olivary complex in sudden
unexplained perinatal death and sudden infant death syndrome
related to maternal cigarette smoking.
Neurol Res. 2007 Jan 16; [Epub ahead of print].
OBJECTIVES: The present study was aimed to
evaluate the possible presence of cytohistologic and/or biologic
modifications of the human dentate-olivary complex in sudden
unexplained perinatal and infant deaths. METHODS: We investigated
the histologic morphology of the dentate and inferior olivary
nuclei, the glial index, the c-fos and apoptotic immunopositivity,
as well as the possible effects elicited by maternal cigarette
smoking, in 44 cases of perinatal and infant death victims,
aged from the 26th gestational week to 10 months of life. RESULTS:
We observed subtle alterations of both the medullary inferior
olivary nucleus and of the cerebellar dentate nucleus, represented
by a significant increase in the reactive astrocyte density
and in the neuronal c-fos and apoptotic expression in unexplained
death victims, compared with age-matched controls. These alterations
were closely related to a maternal cigarette smoking habit.
DISCUSSION: We postulate that maternal smoking, besides inducing
the previously demonstrated morpho-functional alterations of
the autonomic central nervous system, could also exert an adverse
influence on the dentate-olivary complex, leading to sudden
death in vulnerable periods of perinatal development or early
infancy.
Full-text available at: http://www.ingentaconnect.com
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Schell CO, Reilly M, Rosling H, Peterson
S, Ekstrom AM.
Socioeconomic determinants of infant mortality: A
worldwide study of 152 low-, middle-, and high-income countries.
Scand J. Public Health. 2007; 35(3):288-97.
Background: To reach the Millennium Development
Goals for health, influential international bodies advocate
for more resources to be directed to the health sector, in
particular medical treatment. Yet, health has many determinants
beyond the health sector that are less evident than proximate
predictors. Aim: To assess the relative importance of major
socioeconomic determinants of population health, measured as
infant mortality rate (IMR), at country level. Methods: National-level
data from 152 countries based on World Development Indicators
2003 were used for multivariate linear regression analyses
of five socioeconomic predictors of IMR: public spending on
health, GNI/capita, poverty rate, income equality (Gini index),
and young female illiteracy rate. Analyses were performed on
a global level and stratified for low-, middle-, and high-income
countries. Results: In order of importance, GNI/capita, young
female illiteracy, and income equality predicted 92% of the
variation in national IMR whereas public spending on health
and poverty rate were non-significant determinants when adjusted
for confounding. In low-income countries, female illiteracy
was more important than GNI/capita. Income equality (Gini index)
was an independent predictor of IMR in middle-income countries
only. In high-income countries none of these predictors was
significant. Conclusions: The relative importance of major
health determinants varies between income levels, thus extrapolating
health policies from high- to low-income countries is problematic.
Since the size, per se, of public health spending does not
independently predict health outcomes, functioning health systems
are necessary to make health investments efficient. Potential
health gains from improved female education and economic growth
should be considered in low- and middle-income countries.
Full-text available at: http://www.informaworld.com/
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