NSIDRC Journal Article Alert — July
2007
Whitcomb BW, Schisterman EF, Klebanoff
MA, Baumgarten M, Rhoton-Vlasak A, Luo X, Chegini N.
Circulating chemokine levels and miscarriage.
Am J Epidemiol. 2007 Aug 1;166(3):323-31.Epub 2007 May 15.
Evidence suggests that chemokines, proteins
involved in regulation of inflammation and immune response,
may have a regulatory function in pregnancy. The authors hypothesized
that circulating levels of chemokines are associated with increased
risk of miscarriage. Serum samples were obtained from women
in the Collaborative Perinatal Project cohort who had had a
miscarriage (n = 439) and controls (n = 373) matched by gestational
age at sample collection. Concentrations of interleukin 8,
epithelial cell-derived neutrophil-activating peptide (ENA)-78,
macrophage inhibitory protein (MIP)-1alpha, MIP-1beta, monocyte
chemotactic protein 1, and RANTES (regulated upon activation,
normal T-cell-expressed, and secreted) were determined by multiplex
assays, and values were standardized using the standard deviation
among controls. Conditional logistic regression was used to
model the relation between chemokine levels and risk of miscarriage.
In multivariable analysis using all available data, the authors
did not observe significant associations between any of the
evaluated chemokines and miscarriage risk. In analyses using
subsets of the study population based on the collection-outcome
interval, elevated ENA-78 levels were associated with increased
risk of miscarriage as the collection-outcome interval increased;
the adjusted odds ratio was 1.25 (95% confidence interval:
1.04, 1.49) for samples collected more than 35 days prior to
pregnancy outcome. The observation regarding ENA-78, which
has roles in regulation of angiogenesis and leukocyte recruitment,
suggests a possible role for this chemokine as an early indicator
of miscarriage risk.
Full-text available at: http://aje.oxfordjournals.org
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Hajat S, Armstrong B, Wilkinson P,
Busby A, Dolk H.
Outdoor air pollution and infant mortality: analysis
of daily time-series data in 10 English cities.
J Epidemiol Community Health. 2007 Aug;61(8):719-22.
BACKGROUND: There is growing concern that
moderate levels of outdoor air pollution may be associated
with infant mortality, representing substantial loss of life-years.
To date, there has been no investigation of the effects of
outdoor pollution on infant mortality in the UK. METHODS: Daily
time-series data of air pollution and all infant deaths between
1990 and 2000 in 10 major cities of England: Birmingham, Bristol,
Leeds, Liverpool, London, Manchester, Middlesbrough, Newcastle,
Nottingham and Sheffield, were analysed. City-specific estimates
were pooled across cities in a fixed-effects meta-regression
to provide a mean estimate. RESULTS: Few associations were
observed between infant deaths and most pollutants studied.
The exception was sulphur dioxide (SO2), of which a 10 mug/m(3)
increase was associated with a RR of 1.02 (95% CI 1.01 to 1.04)
in all infant deaths. The effect was present in both neonatal
and postneonatal deaths. CONCLUSIONS: Continuing reductions
in SO2 levels in the UK may yield additional health benefits
for infants.
Full-text available at: http://jech.bmj.com/
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Vashevnik S, Walker S, Permezel M.
Stillbirths and neonatal deaths in appropriate, small
and large birthweight for gestational age fetuses.
Aust NZ J Obstet Gynaecol. 2007 Aug;47(4):302-6.
Aims: To compare the risk of stillbirth and
neonatal death in small-for-gestational-age (SGA), appropriate-for-gestational-age
(AGA) and large-for-gestational-age (LGA) fetuses and neonates.
Design: Retrospective analysis of 662 043 births and outcomes
recorded in the Victorian Perinatal Data Collection Unit (1992-2002).
Inclusion criteria: Births in Victoria in 1992-2002. Exclusion
criteria: Multiple pregnancy and congenital birth defects.
Main outcome measures: Births, stillbirths and neonatal deaths
at each week of gestation after 23 weeks were stratified by
birthweight into appropriate, small and large for gestational
age. Stillbirth risk per 1000 ongoing pregnancies and neonatal
death rate per 1000 live births were calculated. Results: For
the AGA group, the overall stillbirth risk was 2.88 per 1000
and neonatal death rate was 1.35 per 1000. In the LGA group,
these were 2.62 and 1.83 per 1000, respectively. The slight
increase in neonatal death rate among LGA fetuses was confined
to those delivered after 28 weeks gestation. In the SGA group,
the stillbirth risk and neonatal death rate were 15.1 and 3.99
per 1000, respectively. Conclusion: The risk of stillbirth
per week of gestational age and neonatal death rates do not
differ significantly between AGA and LGA fetuses and neonates.
The SGA fetus is at significantly greater risk of both stillbirth
and neonatal death, particularly with advancing gestational
age.
Full-text available at: http://www.blackwell-synergy.com/
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Mitchell EA.
Wrapping a cot mattress in plastic does not explain
the continuing fall in SIDS mortality.
Eur J Pediatr. 2007 Jul 20; [Epub ahead of print].
In 2005 in Auckland, New Zealand, the prevalence
of wrapping cot mattresses in polythene, which has been recommended
for sudden infant death syndrome (SIDS) prevention by proponents
of the toxic gas theory, was 21.7%. This cannot account for
the 63% decline in SIDS from 1994 to 2004.
Full-text available at: http://www.springerlink.com
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Fewell JE, Zhang C, Gillis AM.
Influence of adenosine A1-receptor blockade and vagotomy
on the gasping and heart rate response to hypoxia in rats
during early postnatal maturation.
J Appl Physiol. 2007 Jul 19; [Epub ahead of print].
Failure to autoresuscitate from apnea has
been suggested to play a role in sudden infant death. Little
is known, however, about factors that influence the gasping
and heart rate response to severe hypoxia which are fundamental
to successful autoresuscitation in the newborn. The present
experiments were carried out on 184 rat pups to investigate
the influence of the parasympathetic nervous system as well
as adenosine in mediating the profound bradycardia that occurs
with the onset of hypoxic-induced primary apnea and in modulating
hypoxic gasping. On days 1 to 2, 5 to 6 and 10 to 11 postpartum
and following bilateral cervical vagotomy (VAG) or administration
of a selective adenosine A1 receptor antagonist (DPCPX), each
pup was exposed to a single period of severe hypoxia produced
by breathing an anoxic gas mixture (97% N2 & 3% CO2). Exposure
to severe hypoxia resulted in an age-dependent decrease in
heart rate (p<0.001) -- accentuated with increasing postnatal
age -- that was attenuated in all age groups by DPCPX but not
by VAG. Furthermore, DPCPX but not VAG decreased the time to
last gasp but increased the total number of gasps in the 1
to 2 and 5 to 6 day-old pups but not in the 10 to 11 day-old
pups during exposure to severe hypoxia. Thus, our data provide
evidence that adenosine acting via adenosine A1-receptors plays
a role in modulating hypoxic gasping and in mediating the profound
bradycardia, which occurs coincident with hypoxic-induced primary
apnea in rats during early postnatal life.
Full-text available at: http://jap.physiology.org/
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Moon RY, Oden R, Iglesias J, Hauck
FR, Kington M.
Physician recommendations regarding SIDS risk reduction:
A national survey of pediatricians and family physicians.
Clin Pediatr (Phila). 2007 Jul 19; [Epub ahead of print].
Background: Sudden infant death syndrome
(SIDS) is a leading cause of death among infants. Recently,
new SIDS risk factors have emerged. Objective: To determine
knowledge and recommendations of pediatricians and family physicians
regarding SIDS-relevant practices. Methods: Cross-sectional
survey of 3005 pediatricians and family physicians. Results:
Of the 783 respondents, pediatricians comprised 64% and females
52%; 78% recognized supine as the recommended sleep position;
69% recommended supine. Almost all physicians recommended a
firm mattress, 82% recommended a crib or bassinet, and 42%
recommended a separate room for infants; 63% had no preference
about or did not recommend restricting pacifier use. Pediatricians
were more likely to discuss infant sleep position and room
sharing at every well-child visit. Conclusions: Knowledge about
recommended infant sleep position is relatively high, but there
are gaps in physician knowledge regarding safe sleep recommendations.
Greater dissemination of information is required, and barriers
to implementation need to be identified and addressed.
Full-text available at: http://cpj.sagepub.com/cgi/rapidpdf/
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Rubens DD, Vohr BR, Tucker R, O'neil
CA, Chung W.
Newborn oto-acoustic emission hearing screening tests
preliminary evidence for a marker of susceptibility to SIDS.
Early Hum Dev. 2007 Jul 3; [Epub ahead of print].
OBJECTIVE: To evaluate the newborn transient
evoked otoacoustic emission (TEOAE) hearing screening tests
of infants later diagnosed with the sudden infant death syndrome
(SIDS). STUDY DESIGN: In a case-controlled study, the newborn
TEOAE hearing screens of 31 infants who subsequently died of
SIDS were retrospectively compared to those of 31 newborn infants
that survived the first year of life. SIDS cases were individually
matched to surviving controls based on gender, term versus
preterm age and NICU versus well baby nursery. RESULTS: The
TEOAE screens of SIDS infants demonstrated significantly decreased
signal to noise ratios at 2000, 3000, and 4000 Hz (p<0.05)
on the right side compared to healthy control infants. CONCLUSION:
Newborns at risk for SIDS are currently indistinguishable from
other newborns and are only identified following a later fatal
event. A unilateral difference in cochlear function is a unique
finding that may offer the opportunity to identify infants
at risk of SIDS during the early postnatal period with a simple
non invasive hearing screen test. The ability to implement
preventative measures well in advance of a potential critical
incident would be an important breakthrough.
Full-text available at: http://www.sciencedirect.com/
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Graham J, Zhang L, Schwalberg R.
Association of maternal chronic disease and negative
birth outcomes in a non-Hispanic black-white Mississippi
birth cohort.
Public Health Nurs. 2007 Jul-Aug;24(4)311-7.
Objective: To investigate the impact of selected
maternal chronic medical conditions, race, and age on preterm
birth (PTB), low birth weight (LBW), and infant mortality among
Mississippi mothers from 1999 to 2003. Design: A retrospective
cohort analysis of linked birth and death certificates. Sample:
The 1999-2003 Mississippi birth cohort comprising 202,931 singleton
infants born to African American and White women. Measurements:
The relationship between maternal chronic conditions and the
dependent variables of PTB, LBW, and infant mortality were
investigated using logistic regression analysis. Results: PTB,
LBW, and infant mortality were more prevalent among African
American women, very young women (</=15 years), and women
with certain chronic medical conditions. Among White mothers,
maternal chronic hypertension was significantly associated
with PTB and LBW, and maternal diabetes with PTB and infant
mortality. Among African American mothers, maternal cardiac
disease was significantly associated with PTB and LBW; maternal
chronic hypertension was significantly associated with LBW
and infant mortality; and maternal diabetes with PTB. Conclusions:
Maternal chronic hypertension and diabetes were significantly
associated with negative birth outcomes regardless of maternal
race. Maternal cardiac disease was only significantly associated
with PTB and LBW among African Americans.
Full-text available at: http://www.blackwell-synergy.com/
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Curtis C.
Meeting health care needs of women experiencing complications
of miscarriage and unsafe abortion: USAID’s
postabortion care program.
J Midwifery Women’s Health. 2007 Jul-Aug;52(4):368-75.
Each year, an estimated 210 million women
become pregnant. Worldwide, more than one fourth of these pregnancies
will end in abortion or an unplanned birth. While many abortions
may result from the desire to delay or avoid pregnancy, 15%
to 20% of pregnancies will end in miscarriage or stillbirth
with some causative agents being malaria, HIV/AIDS, and physical
violence. Postabortion care (PAC) is needed to provide treatment
for complications caused by incomplete or spontaneous abortion
and critical family planning counseling and services to prevent
future unplanned pregnancies that may result in repeat abortions.
In 2003, the United States Agency for International Development
(USAID) initiated a 5-year strategy wherein seven countries
were provided financial funding and technical assistance. Since
2003, more than 3000 women have been seen in health centers
and health posts for PAC services; more than 14,000 community
members have received messages on unsafe abortion; family planning,
and complications of unsafe abortion and miscarriage; and more
than 600 documents were reviewed for inclusion in a global
PAC resource package. This package has been used for developing
Cambodia's national PAC policy and for developing patient education
materials and provider job aids in Cambodia and Tanzania. These
promising methodologies will be replicated in other countries.
Full-text available at: http://www.sciencedirect.com/
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Heringstad B, Chang YM, Svendsen M,
Gianola D.
Genetic analysis of calving difficulty in Norwegian
Red cows.
J Dairy Sci. 2007 Jul;90(7):3500-7.
The objectives of this study were to infer
genetic parameters for stillbirth (SB) and calving difficulty
(CD) and to evaluate phenotypic and genetic change for these
traits in the Norwegian Red breed. Stillbirth is recorded as
a binary trait and calving difficulty has 3 categories: 1)
easy calving, 2) slight problems, and 3) difficult calving.
The overall mean frequency of SB in Norwegian Red was 3% at
first calving and 1.5% for second and later calvings; mean
frequency of the category "difficult calving" was 2 to 3% for
heifers and 1% for cows at second and later calvings. Mean
stillbirth rate has remained unchanged from 1978 to 2004. The
proportion of the category "difficult calving" has not changed
over the years, but the "slight problems" category increased
from 4 to 7% for heifers and from 2 to 3% for cows. A total
of 528,475 first-calving records were analyzed with a Bayesian
bivariate sire-maternal grandsire threshold liability model.
Posterior means of direct and maternal heritabilities were
0.13 and 0.09 for CD, and 0.07 and 0.08 for SB, respectively.
Strong genetic correlations were found between direct SB and
direct CD (0.79), and between maternal SB and maternal CD (0.62),
whereas all genetic correlations between direct and maternal
effects within or between traits were close to zero. These
positive correlations are favorable in the sense that selection
for one of the traits would result in a favorable selection
response for the second trait. No genetic correlations between
direct and maternal effects imply that bulls should be evaluated
both as sire of the calf (direct) and sire of the cow (maternal).
No genetic change for SB was found, and a slight genetic improvement
for CD was detected.
Full-text available at: http://jds.fass.org/
(Back to the Top)
Warren J, Biagioli F, Hamilton A.
Evaluation of apparent life-threatening events in
infants.
American Family Physician. 76(1):124-126. July 1, 2007.
What is the appropriate evaluation for an
infant presenting with an apparent life-threatening event (ALTE)?
A comprehensive, detailed history and physical examination
with pulse oximetry and nondilated funduscopy (to look for
traumatic retinal hemorrhage) helps to determine the underlying
etiology of an ALTE in 70 percent of infants. (Strength of
Recommendation [SOR]: C, based on case series). Initial diagnostic
evaluation should include 12-lead electrocardiography (ECG);
blood gas analysis; chest radiography; complete blood count
(CBC); pertussis and respiratory syncytial virus cultures,
if respiratory symptoms are present; serum electrolytes; and
urinalysis. (SOR: C, expert opinion and case series). If the
initial evaluation does not reveal the underlying etiology
of an ALTE, then the following tests should be performed: a
barium-contrast upper gastrointestinal series or gastric pH
probe to evaluate for reflux; computed tomography of the head
or a skeletal survey to evaluate for occult cases of deliberate
harm; and electroencephalography (EEG) to help diagnose seizure
disorders. (SOR: C, expert opinion and case series).
Full-text available at: http://www.aafp.org/afp/
(Back to the Top)
Rand CM, Berry-Kravis EM, Zhou L,
Fan W, Weese-Mayer DE.
Sudden infant death syndrome: Rare mutation in the
serotonin system FEV gene.
Pediatr. Res. 2007 Jun 25; [Epub ahead of print].
Recent studies have identified abnormalities
in the development and function of medullary serotonin (5-HT)
pathways in postmortem brain from sudden infant death syndrome
(SIDS) cases, suggesting 5-HT-mediated dysregulation of the
autonomic nervous system (ANS) in SIDS. The human fifth Ewing
variant gene FEV is specifically expressed in central 5-HT
neurons in the brain, with a predicted role in specification
and maintenance of serotonergic neuronal phenotype. We hypothesized
that variations of FEV may underlie abnormalities of the 5-HT
system in SIDS cases and thus may be associated with SIDS risk.
To elucidate the relationship between variation in FEV and
SIDS, DNA was prepared from 96 African American and white SIDS
cases and 96 gender- and ethnicity-matched controls. Standard
sequencing and analysis of FEV revealed a heterozygous insertion
mutation (IVS-191_190insA) upstream of the 5' exon 3 splice
site occurring more frequently in SIDS cases (6/96) compared
with controls (0/96; p = 0.01) and in the overall African American
group (6/98) compared with the white group (0/94; p = 0.03).
Identification of a variation in a gene responsible for 5-HT
neuronal development, exclusively in a subset of African American
SIDS cases in this cohort, may help explain both the observed
abnormalities of this system in some SIDS cases and the ethnic
disparity observed in SIDS.
Full-text available at: http://meta.wkhealth.com/
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Price SK, Gardner P, Hillman L, Schenk
K, Warren C.
Changing hospital newborn nursery practice: results
from a statewide “back to sleep” nurses training
program.
Matern Child Health J. 2007 Jun 15; [Epub ahead of print].
OBJECTIVE: In response to findings from a
statewide survey of hospital nurses, the authors designed,
conducted, and evaluated a "Back to Sleep" nursing curriculum
and training program in Missouri hospitals using two distinct
training formats. This article evaluates the initial and follow-up
outcomes for training participants and assesses the impact
of training format on participant outcomes. METHODS: Participants
selected training format by hospital site. In each training
format, participants responded to a pre and post test questionnaire
measuring knowledge, beliefs, and current infant care behaviors
as well as satisfaction with the training. Three months after
completion of all statewide trainings, the authors also conducted
a follow-up survey. RESULTS: Nurses who participated in the
training reported statistically significant improvements in
knowledge and "Back to Sleep" adherent beliefs. Over 98% of
participants (N = 515) intended to place infants in back-only
sleep positions following the training. Knowledge, attitudes,
and practice intentions were significantly improved across
both training formats. Additionally, follow-up survey respondents
statewide (N = 295) reported lasting improvements, including
63% of nurses reportedly using supine-only sleep position for
infants after the first 24 h of life, compared to 28% in the
original statewide survey. CONCLUSIONS: Further research is
needed to determine the long-term impact of this intervention
and assess its applicability beyond this initial implementation.
Ultimately, the findings from the evaluation of this pilot
intervention and nursing-specific "Back to Sleep" curriculum
demonstrate that it has a promising effect on risk-reduction
adherence in hospital settings where parent observations of
safe sleep behavior first occur.
Full-text available at: http://www.springerlink.com/
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Branger B, Savagner C, Rose JC, Winer
N, Pediatres des maternites des Pays-de-la-Loire.
Eleven cases of early neonatal death or near death
of full term and healthy neonates in maternity wards.
J Gynecol Obstet Biol Reprod (Paris). 2007 Jun 12; [Epub ahead
of print].
OBJECTIVE: Sécurité naissance-Naître
ensemble des Pays-de-la-Loire network organized a survey to
evaluate the incidence rate of early neonatal sudden death
or near death syndrome for the full term and healthy presume
neonates. METHOD: Maternity wards are declared apparent life-threatening
events and deaths from 2001 to 2006. Certain cases and probable
cases were defined. Incidence rate have been calculated with
births in maternity wards during period... RESULTS: Eleven
apparent life-threatening events are observed with 7 deaths
during five and half years. The incidence rate was one apparent
life-threatening events for 26000 births and one death for
40000 births, with certain cases for 41000 births and probable
cases for 71000 births. All kind of maternities were involved.
Nothing very special could be noticed about pregnancies and
deliveries. Five times on eight well known cases, the newborn
was in skin to skin contact with heir mother at the moment
of the event, once in her arms and once in the delivery room,
far from the mother, at three minutes of life. Twice on four
well known cases, newborns were lying on their belly. A baby
has been considered as dead at the maternity, ten have been
transferred to care unit, and six died in the ward. CONCLUSION:
Without systematic survey in France, it's not easy to say if
the incidence of this type of event have increased, and if
their happening is linked with skin-to-skin practices at the
birth. In Sécurité naissance-Naître
ensemble des Pays-de-la-Loire from September 2006, prevent
measures have been suggested in all maternities in the recommendation
on care to normal newborns. A systematic study with a standard
questionary has been organized in region area to notice apparent
life-threatening events and neonatal sudden deaths, and we
could hope a systematic prospective survey in France.
Full-text available at: http://www.masson.fr/
(Back to the Top)
Leiter JC, Böhm I.
Mechanisms of pathogenesis in the Sudden Infant Death
Syndrome.
Respir Physiol Neurobiol. 2007 Jun 8; [Epub ahead of print].
The likely processes of the Sudden Infant
Death Syndrome (SIDS) were identified many years ago (apnea,
failed arousal, failed autoresuscitation, etc.). The neurophysiological
basis of these processes and the neurophysiological reasons
some infants die of SIDS and others do not are, however, only
emerging now. We reviewed recent studies that have shed light
on the way in which epidemiological risk factors, genetics,
neurotransmitter receptor defects and neonatal cardiorespiratory
reflex responses interact to lead to sudden death during sleep
in a small number of normal appearing infants. As a result
of this review and analysis, we hypothesize that the neurophysiological
basis of SIDS resides in a persistence of fetal reflex responses
into the neonatal period, amplification of inhibitory cardiorespiratory
reflex responses and reduced excitatory cardiorespiratory reflex
responses. The hypothesis we developed explores the ways in
which multiple subtle abnormalities interact to lead to sudden
death and emphasizes the difficulty of ante-mortem identification
of infants at risk for SIDS, although identification of infants
at risk remains an essential goal of SIDS research.
Full-text available at: http://www.sciencedirect.com/
(Back to the Top)
Donovan EF, Ammerman RT, Besl J, Atherton
H, Khoury JC, Altaye M, Putnam FW, Van Ginkel JB.
Intensive home visiting is associated with decreased
risk of infant death.
Pediatrics. 2007 Jun; 119(6):1145-51.
OBJECTIVE: The goal was to test the hypothesis
that participation in a community-based home-visiting program
is associated with a decreased risk of infant death. METHODS:
A retrospective, case-control design was used to compare the
risk of infant death among participants in Cincinnati's Every
Child Succeeds program and control subjects matched for gestational
age at birth, previous pregnancy loss, marital status, and
maternal age. The likelihood of infant death, adjusted for
level of prenatal care, maternal smoking, maternal education,
race, and age, was determined with multivariate logistic regression.
The interaction between race and program participation and
the effect of home visiting on the risk of preterm birth were
explored. RESULTS: Infants whose families did not receive home
visiting (n = 4995) were 2.5 times more likely to die in infancy
compared with infants whose families received home visiting
(n = 1665). Black infants were at least as likely to benefit
from home visiting as were nonblack infants. No effect of program
participation on the risk of preterm birth was observed. CONCLUSION:
The current study is consistent with the hypothesis that intensive
home visiting reduces the risk of infant death.
Full-text available at: http://pediatrics.aappublications.org/
(Back to the Top)
Arafa MA, Amine T, Abdel Fattah M.
Association of maternal work with adverse perinatal
outcome.
Can J Public Health. 2007 May-Jun;98(3):217-21.
OBJECTIVE: To investigate the relationship
between maternal work and pregnancy outcome. METHODS: Over
a 4-month period from October 2004 through February 2005, 2,419
women were interviewed shortly after delivery in the three
main public and Health Insurance hospitals in Alexandria, Egypt.
Of these, 730 (30.2%) were working and 1,689 (69.8%) were not
working prior to delivery. A detailed description of working
status was analyzed, along with a risk profile which was compared
between the two groups. RESULTS: There was no significant association
between different work characteristics and perinatal outcomes
except for that between working posture, stress and delivery
of small-for-gestational-age (SGA) babies. There was an excess
rate of SGA and perinatal death among the non-working group,
while preterm delivery was significantly increased among those
who worked throughout the whole pregnancy. After adjusting
for confounders, the risk of preterm delivery was no longer
significant (OR = 1.2, 95% CI = 0.96-1.7). On the other hand,
working status had a beneficial effect on SGA and perinatal
death (OR = 0.41, 95% CI = 0.26-0.64 and OR = 0.26, 95% CI
= 0.14-0.48, respectively). CONCLUSION: These results cast
doubt on the risk of adverse pregnancy outcome for women who
work during pregnancy. Work per se does not constitute a health
risk factor and may even have a positive social impact on pregnancy.
Further research on this topic in our region is recommended.
Full-text available at: http://www.cpha.ca/english/cjph/cjph.htm
(Back to the Top)
Tuan WJ, Hatfield P, Bhattacharya
A, Sarto GE, Kling PJ.
Possible factors illuminating increased disparities
in neonatal mortality in Wisconsin from 1991-2005.
WMJ. 2007 May;106(3):130-6.
BACKGROUND: Neonatal mortality has been perceived
as one of the critical and sensitive measures that reflect
not only the heath status of infants and their mothers, but
also the general well-being of a society. However, our knowledge
of racial disparities in neonatal mortality associated with
low birth weight and short gestation is relatively limited.
As part of continuing statewide efforts to achieve better birth
outcomes, this study intends to develop a better understanding
of potential mechanisms contributing to the discrepancy in
neonatal mortality rates (NMR) to help public health practitioners
formulate more effective interventions to prevent unnecessary
infant deaths. OBJECTIVES: To assess racial/ethnic disparities
in neonatal morality risks by infant birth weight and gestational
age in Wisconsin from 1991 through 2005, and to provide more
information for programs emphasizing the development of policies
and environmental changes to reduce and prevent infant mortality
in minority populations. METHODS: Linked birth/infant death
data were obtained from the Wisconsin Interactive Statistics
on Health (WISH) query system by birthweight, prematurity,
race/ethnicity for the periods, 1991-1995, 1996-2000, and 2001-2006.
The probability of neonatal mortality was analyzed through
log-linear Poisson regression models to test for the pattern
of variation of neonatal mortality risks in relation to infant's
race/ethnicity, birth weight, prematurity, and their interactions.
RESULTS: The proportion of the neonatal deaths to the infant
deaths has gradually increased over time, and accounted for
more than two-thirds of Wisconsin infant deaths. Despite a
large decrease in white NMRs, neonatal mortality risks for
blacks and Hispanics did not significantly change. This discord
led to a widened racial/ethnic gap in NMRs. Substantial variations
on neonatal mortality risks by birth weight and preterm birth
were found among whites, blacks, and Hispanics infants. Notably,
among low birth weight and preterm infants, blacks and Hispanics
appeared to have more favorable NMRs than whites. White infants
had the lowest NMRs only delivered at full-term and about 2500
g. CONCLUSION: Wisconsin infant mortality rates are largely
driven by neonatal deaths. This shows an urgent need to develop
effective public health interventions to prevent early neonatal
deaths. To reduce racial/ethnic disparities in NMRs, the design
of the interventions should also take into account the variation
of the effects of birth weight and gestation age on neonatal
mortality among racial/ethnic groups. It is hoped the result
of this study will provide a critical understanding: when it
comes to racial/ethnic disparities, there is far more to low
birth weight or short gestational age than simply not having
enough weight or days.
Full-text available at: http://test.wismed.org/health_news/
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Brosig CL, Pierucci RL, Kupst MJ,
Leuthner SR.
Infant end-of-life care: the parents’ perspective.
J Perinatol. 2007 Apr 19; [Epub ahead of print].
Objective: The purpose of this study was
to identify factors important to parents in their infant's
end-of-life care. Study Design: Participants were parents (n=19
families) whose infant (less than 1 year old) had died. Parents
completed the Revised Grief Experience Inventory (RGEI) and
a semi-structured interview regarding their infant's end-of-life
care. Interviews were rated using the Post-Death Adaptation
Scale (PDAS).Results: Parents scored significantly lower than
the normative sample on the RGEI, and PDAS scores suggested
that these parents were adapting positively. Parent interviews
identified the aspects of care that were important to parents:
honesty, empowered decision-making, parental care, environment,
faith/trust in nursing care, physicians bearing witness and
support from other hospital care providers. Conclusions: Results
of this study suggest that parents can effectively cope following
the death of an infant and the medical staff can do much to
improve the end-of-life care for infants and their families.
Full-text available at: http://www.nature.com/jp/
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Masoumi H, Kinney HC, Chadwick AE,
Rubio A, Krous HF.
Sudden unexpected death in childhood associated with
cardiac rhabdomyoma involuting adrenal ganglioneuroma, and
megalencephaly: another expression of tuberous sclerosis?
Pediatr Dev Pathol. 2007 Mar-Apr;10(2):129-33.
We report a 9-year-old, previously healthy
girl who died suddenly and unexpectedly and was found at postmortem
examination to have a cardiac rhabdomyoma, megalencephaly,
and an involuting adrenal ganglioneuroma. Her death was possibly
caused by a fatal cardiac arrhythmia resulting from interference
of the ventricular septal rhabdomyoma with the cardiac conduction
fibers. Her extended family history included a variety of disorders,
including cleft lip and palate and ill-defined cardiac and
neurologic diseases. The constellation of her autopsy findings
suggested a diagnosis of tuberous sclerosis, for which there
are gene defects that can be identified in surviving family
members.
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