NSIDRC Journal Article Alert — August
2007
Hong JS, Yi SW, Han YJ, Park YW, Nam
CM, Kang HC, Ohrr H.
Fetal growth and neonatal mortality in Korea.
Paediatr Perinat Epidemiol. 2007 Sep;21(5):397-410.
The fetal growth curve and neonatal mortality
rate, based on gestational age and birthweight, are important
for identifying groups of high-risk neonates and developing
appropriate medical services and health-care programmes. The
purpose of this study was to develop a national fetal growth
curve for neonates in Korea, and examine the Korean national
references for fetal growth and death according to their characteristics.
Data of Korean vital statistics linked National Infant Mortality
Survey conducted on births in 1999 were used in this study.
The total livebirths were 621 764 in 1999, which were grouped
into singletons (n = 609 643) and twins (n = 9805) for analysis.
Birthweight/gestational age-specific fetal growth curves and
neonatal mortality rates were based on 250 g of birthweight
and weekly gestational age intervals for each characteristic
of the birth. The features of high-risk neonates such as small-for-gestational-age
and the limit of viability in Korea were different from those
of Western countries. Difference in fetal growth and death
was also detected in other characteristics of the fetus (gender
and plurality of birth) besides race. The fetal growth curve
of males was higher than that of females, and was higher in
singleton than in twins. The neonatal mortality rate was higher
in males (singleton, 2.6; twin, 23.5) than females (singleton,
2.1; twin, 15.9), and higher in twins (19.8/1000) than in singletons
(2.4/1000). However, in neonates with gestational age >29 weeks
and birthweight >1000 g, the neonatal mortality rate was lower
in twins than in singletons. The limit of viability was gestational
age 27 weeks and birthweight 1000 g, which was similar in singletons
and twins regardless of gender. To improve the health of neonates
in a country, it is imperative to investigate the characteristics
of fetal growth and death under the particular circumstances
of the country. When risk is defined for neonates account must
be taken of differences in race, gender and plurality of birth,
as the neonatal mortality rate varies depending on those factors.
Full-text available at: http://www.blackwell-synergy.com
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Nikcevic AV, Kuczmierczyk AR, Nicolaides
KH.
Influence of medical and psychological interventions
on women's distress after miscarriage.
J Psychosom Res. 2007 Sep;63(3):283-90. Epub 2007 Aug 2.
OBJECTIVE: The aim of this study was to examine
the impact of medical and psychological interventions on women's
distress after early miscarriage. METHODS: This was a prospective
study of women attending for a routine scan at 10-14 weeks
of gestation and found to have a missed miscarriage. An intervention
group of 66 women had medical investigations to ascertain the
cause of miscarriage, and at 5 weeks after the scan, they all
had a medical consultation to discuss the results of the investigations.
These 66 women were randomly allocated into a group which received
further psychological counselling (MPC, n=33), and a group
which received no psychological counselling (MC, n=33). They
were compared to a control group of 61 women who received no
specific postmiscarriage counselling. All participants completed
preintervention and postintervention measures and 4-month follow-up
questionnaires. RESULTS: The scores on the outcome variables
decreased significantly with time for all three groups. In
group MPC, compared to controls, there was a significantly
greater decrease over time in the levels of grief, self-blame,
and worry and, compared to MC group, a significantly greater
decrease in grief and worry. In group MC, compared to controls,
there was a significantly greater decrease in self-blame. In
the MC and MPC groups, those with an identified cause of the
miscarriage had significantly lower levels of anxiety and self-blame
over time than those with a nonidentified cause. CONCLUSIONS:
Psychological counselling, in addition to medical investigations
and consultation, is beneficial in reducing women's distress
after miscarriage. However, absence of an identifiable cause
of miscarriage led to the maintenance of the initial anxiety
levels, which should have otherwise decreased with time.
Full-text available at: http://www.sciencedirect.com
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Xiong X, Buekens P, Vastardis S, Yu
SM.
Periodontal disease and pregnancy outcomes: State-of-the-science.
Obstet Gynecol Surv. 2007 Sep;62(9):605-615.
To examine the existing evidence on the relationship
between periodontal disease and adverse pregnancy outcomes,
we conducted a systematic review of studies published up to
December 2006. Studies published in full text were identified
by searching computerized databases (e.g., MEDLINE, EMBASE).
A meta-analysis was performed to pool the effect size of the
clinical trials. Forty-four studies were identified (26 case-control
studies, 13 cohort studies, and 5 controlled trials). The studies
focused on preterm low birth weight, low birth weight, preterm
birth, birth weight by gestational age, miscarriage or pregnancy
loss, preeclampsia, and gestational diabetes mellitus. Of the
chosen studies, 29 suggested an association between periodontal
disease and increased risk of adverse pregnancy outcome (odds
ratios [ORs] ranging from 1.10 to 20.0) and 15 found no evidence
of an association (ORs ranging from 0.78 to 2.54). A meta-analysis
of the clinical trials suggested that oral prophylaxis and
periodontal treatment may reduce the rate of preterm low birth
weight (pooled risk ratio (RR): 0.53, 95% confidence interval
[CI]: 0.30-0.95, P < 0.05), but did not significantly reduce
the rates of preterm birth (pooled RR: 0.79, 95% CI: 0.55-1.11,
P > 0.05) or low birth weight (pooled RR: 0.86, 95% CI: 0.58%1.29,
P > 0.05). The authors conclude that periodontal disease may
be associated with increased risk of adverse pregnancy outcomes.
More methodologically rigorous studies are needed in this field.
Currently, there is insufficient evidence to support the provision
of periodontal treatment during pregnancy for the purpose of
reducing adverse pregnancy outcomes. Target Audience: Obstetricians & Gynecologists,
Family Physicians Learning Objectives: After completion of
this article, the reader should be able to state that the published
literature is not vigorous to clinically link periodontal disease
and/or its treatment to specific adverse pregnancy outcomes,
and explain that more rigorous studies with world-wide agreed-upon
definitions are particularly needed before periodontal disease
treatment can be recommended.
Full-text available at: http://meta.wkhealth.com/
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Kara F, Cinar O, Erdemli-Atabenli
E, Tavil-Sabuncuoglu B, Can A.
Ultrastructural alterations in human decidua in miscarriages
compared to normal pregnancy decidua.
Acta Obstet Gynecol Scand. 2007 Sep;86(9):1079-86.
Background. Pregnant endometrial stroma,
an immunologically privileged site in the female reproductive
system, is enriched by decidual and natural killer (NK) cells.
Since the cellular microenvironment in early pregnancy from
the decidual tissues of normal and miscarriage cases has gained
importance, with special emphasis on cell-to-cell contacts,
we aimed to document the plastic structure of the cellular
milieu in normal and miscarriage decidua. Methods. Endometrial
biopsies were obtained from women after legal curettage or
women who had been treated by curettage after miscarriage.
Samples were analysed in a light microscope (LM), a scanning
electron microscope (SEM) and a transmission electron microscope
(TEM). Results. Decidual cells possess several polyploidic
protrusions on cell membranes. NK cells were distributed among
decidual cells. Decidual cells were found to develop gap junctions
in the interfaces between each other. Their cytoplasms were
also found to possess well-developed protein synthesising organelles.
Decidual cells obtained from miscarriages showed a moderate
degree of degeneration and, in between, a decreased number
of junctional complexes. Mononuclear cell infiltration was
found to be significantly low. Conclusion. We conclude that
decidual cells during early pregnancy build a series of miniature
cell-cell contacts to assemble a proper endometrial milieu.
In contrast, in miscarriage samples, those intercellular communications
seem lacking, associated with an increased number of NK cells,
a phenomenon which obviously alters proper implantation and
leads to the induction of embryonic disgenesis and miscarriage.
Full-text available at: http://www.informaworld.com/
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Ustunyurt E, Kaymak O, Iskender C,
Ustunyurt OB, Celik C, Danisman N. Ruys JH, de Jonge GA, Brand
R, Engelberts AC, Semmekrot BA.
Bed-sharing in the first four months of life: a risk
factor for sudden infant death.
Acta Paediatr. 2007 Aug 20; [Epub ahead of print].
Aim: To investigate the risk of sudden infant
death in the Netherlands during bed-sharing in the first half
year of life and the protective effect of breastfeeding on
it. Methods: During a 10-year period between September 1996
and September 2006 nationwide, 213 cot deaths were investigated.
Results and discussion: Of 138 cot deaths of less than 6 months
of age, 36 (26%) bed-shared. In a reference group of 1628 babies
from infant welfare centres only 9.4% were bed-sharing in the
night prior to the interview. After correction for smoking
of one or both parents the odds ratio for cot death during
bed-sharing with parents decreased with age from 9.1 (CI 4.2-19.4)
at 1 month, to 4.0 (CI 2.3-6.7) at 2 months, to 1.7 (CI 0.9-3.4)
at 3 months and to 1.3 (CI 1.0-1.6) at 4 through 5 months of
age. The excess risk (OR > 1) associated with bed-sharing is
itself not significantly influenced by the presence or absence
of breastfeeding. Conclusion: Bed-sharing is a serious risk
factor for sudden infant death for all babies of less than
4 months of age. From 4 months onwards bed-sharing did not
contribute significantly to the risk of cot death anymore in
our study.
Full-text available at: http://www.blackwell-synergy.com/
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Tonkin SL, Lui D, McIntosh CG, Rowley
S, Knight DB, Gunn AJ.
Effect of pacifier use on mandibular position in
preterm infants.
Acta Paediatr. 2007 Aug 20; [Epub ahead of print].
Aim: It has been hypothesized that the association
of pacifier use with reduced risk of sudden infant death is
mediated by forward movement of the mandible and tongue that
helps open the upper airway. Our aim was to examine whether
the mandible is moved forward when an infant is sucking on
a pacifier, and if so, whether the mandible remains advanced
after the pacifier is removed. Methods: In sixty clinically
stable premature infants (corrected gestation age 36.5 +/-
0.3 weeks, mean +/- SEM) the distance from each ear where the
pinna met the cheek to the most prominent point of the chin
was measured bilaterally, and the average was used as an index
of mandibular position. Mandibular position was determined
before and after allowing the infants to suck on a pacifier
for 10-15 min, and after removing the pacifier. Results: There
was a significant forward movement of the mandible when the
infants were sucking on the pacifier (59.5 +/- 0.7 vs. 58.6
+/- 0.7 mm, p = 0.001), with no significant change after the
pacifier was removed. Conclusions: Pacifier use in preterm
infants was associated with a small significant forward displacement
of the jaw. These data suggest that pacifier use may help protect
the upper airway.
Full-text available at: http://www.blackwell-synergy.com/
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Perricone C, De Carolis C, Giacomelli
R, Zaccari G, Cipriani P, Bizzi E, Perricone R.
High levels of NK cells in the peripheral blood of
patients affected with anti-phospholipid syndrome and recurrent
spontaneous abortion: a potential new hypothesis.
Rheumatology (Oxford). 2007 Aug 17; [Epub ahead of print].
Objectives. No data regarding phenotypic
assets of circulating lymphocytes in anti-phospholipid syndrome
(APS) are reported in the literature. Role of anti-phospholipid
antibodies (aPL) in recurrent spontaneous abortion (RSA) remains
uncertain, while natural killer (NK)-cells are involved in
RSA pathogenesis. In this study, patients affected with APS
without RSA, APS with RSA and RSA without aPL were studied
for NK-cell subpopulation to evaluate its role in abortive
events typical of APS. Methods. NK-cell levels in peripheral
blood of APS patients without RSA (n = 28) and in APS-RSA patients
(n = 25) were evaluated by means of flow cytofluorimetry. NK-cells
levels were evaluated also in RSA without aPL associated with
either endocrine (n = 86), anatomic (n = 30) or idiopathic
(n = 77) conditions and in 42 healthy women. Results. High
NK levels were found in 14/25 (56%) APS-RSA patients. Among
these patients, all except one aborted before the 10th gestational
week (GW), while among the remaining patients all except one
aborted after the 10th GW. NK mean levels were significantly
higher in APS-RSA than in all the other conditions studied,
including healthy subjects, except idiopathic RSA. Conclusions.
Our results demonstrate that the numbers and proportions of
NK-cells are significantly higher in patients with RSA with
APS than in APS without RSA. Increased numbers of NK-cells
correlate with reduced gestational age at abortion in patients
with APS-RSA. These data lead to a hypothesis that NK-cells
contribute to the development of RSA in patients with APS.
NK-cells might precipitate damage initiated by aPL or they
might cause pathology in RSA independent of aPL.
Full-text available at: http://rheumatology.oxfordjournals.org/
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Nanyonjo RD, Montgomery SB, Modeste
N, Fujimoto E.
Secondary analysis of race/ethnicity and other maternal
factors affecting adverse birth outcomes in San Bernardino
County.
Matern Child Health J. 2007 Aug 10; [Epub ahead of print].
Objectives Though it is the largest county
in the lower United States, minimal attention has been given
to the elevated rates of poor perinatal outcomes and infant
mortality in San Bernardino County. This study sought to analyze
adverse birth outcomes such as low birth weight, and infant
mortality as an outcome of specific proxy maternal sociodemographic
factors. Methods Data from the California Department of Health
Services Office of Vital Statistics birth cohort of mothers
delivering between 1999 and 2001 (N = 1,590,876 participants)
were analyzed. Of those, 5.5% (n = 86,736) were births in San
Bernardino County. Low birth weight, very low birth weight,
death in infants less than one year of age, and other maternal
sociodemographic factors were explored. All events of low birth
weight and deaths among infants less than one year of age were
used as significant variables in statistical models. Results
Black mothers experienced more than twice the rate of very
low birth weight (3.89) than their White counterparts (1.39).
The most significant contributors to adverse birth outcomes
among Black women were length of gestation and maternal education,
whereas the most significant predictor of infant mortality
was birth weight. Conclusions This study demonstrates that
traditional risk factors such as length of gestation and maternal
age only partially explain adverse birth outcomes. These findings
highlight the need to advocate for the systematic collection
of data on maternal education and length gestation and for
the promotion of public health initiatives that address these
inequities in our most vulnerable of populations.
Full-text available at: http://www.springerlink.com/
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Macinko J, de Fátima
Marinho de Souza M, Guanais FC, da Silva Simões
CC.
Going to scale with community-based primary care:
An analysis of the family health program and infant mortality
in Brazil, 1999-2004.
Soc Sci Med. 2007 Aug 7; [Epub ahead of print].
This article assesses the effects of an integrated
community-based primary care program (Brazil's Family Health
Program, known as the PSF) on microregional variations in infant
mortality (IMR), neonatal mortality, and post-neonatal mortality
rates from 1999 to 2004. The study utilized a pooled cross-sectional
ecological analysis using panel data from Brazilian microregions,
and controlled for measures of physicians and hospital beds
per 1000 population, Hepatitis B coverage, the proportion of
women without prenatal care and with no formal education, low
birth weight births, population size, and poverty rates. The
data covered all the 557 Brazilian microregions over a 6-year
period (1999-2004). Results show that IMR declined about 13
percent from 1999 to 2004, while Family Health Program coverage
increased from an average of about 14 to nearly 60 percent.
Controlling for other health determinants, a 10 percent increase
in Family Health Program coverage was associated with a 0.45
percent decrease in IMR, a 0.6 percent decline in post-neonatal
mortality, and a 1 percent decline in diarrhea mortality (p<0.05).
PSF program coverage was not associated with neonatal mortality
rates. Lessons learned from the Brazilian experience may be
helpful as other countries consider adopting community-based
primary care approaches.
Full-text available at: http://www.sciencedirect.com/
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Bhalotra S.
Spending to save? State health expenditure and infant
mortality in India.
Health Econ. 2007 Aug 2; [Epub ahead of print].
There are severe inequalities in health in
the world, poor health being concentrated amongst poor people
in poor countries. Poor countries spend a much smaller share
of national income on health expenditure than do richer countries.
What potential lies in political or growth processes that raise
this share? This depends upon how effective government health
spending in developing countries is. Existing research presents
little evidence of an impact on childhood mortality. Using
specifications similar to those in the existing literature,
this paper finds a similar result for India, which is that
state health spending saves no lives. However, upon allowing
lagged effects, controlling in a flexible way for trended unobservables
and restricting the sample to rural households, a significant
effect of health expenditure on infant mortality emerges, the
long run elasticity being about -0.24. There are striking differences
in the impact by social group. Slicing the data by gender,
birth order, religion, maternal and paternal education and
maternal age at birth, I find the weakest effects in the most
vulnerable groups (with the exception of a large effect for
scheduled tribes).
Full-text available at: http://www3.interscience.wiley.com/
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Saito S, Shima T, Nakashima A, Shiozaki
A, Ito M, Sasaki Y.
What is the role of regulatory T cells in the success
of implantation and early pregnancy?
J Assist Reprod Genet. 2007 Aug 1; [Epub ahead of print].
PROBLEM: The immune system is well controlled
by the balance between immunostimulation and immunoregulation.
CD4(+)CD25(+) regulatory T (Treg) cells and an enzyme called
indoleamine-2, 3-dioxygenase (IDO) mediate maternal tolerance
of the allogeneic fetus. Treg cells, therefore, may prevent
early pregnancy loss due to maternal 'rejection.' METHODS:
The latest understanding of tolerance during pregnancy is reviewed.
RESULTS AND CONCLUSIONS: Recent data show that CD4(+)CD25(+)
Treg cells play essential roles in the induction and maintenance
of tolerance, and that they augment the IDO activity in dendritic
cells and macrophages. Therefore, CD4(+)CD25(+) Treg cells
and IDO enzyme may cooperate in the induction of tolerance
during pregnancy. Treg deficiency is associated with very early
post-implantation loss and spontaneous abortion in animal models,
and low Treg levels are associated with recurrent miscarriages
in humans.
Full-text available at: http://www.springerlink.com/
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Grieve PG, Stark RI, Isler JR, Housman
SL, Fifer WP, Myers MM.
Electrocortical functional connectivity in infancy:
response to body tilt.
Pediatr Neurol. 2007 Aug;37(2):91-8.
To test the hypothesis that infant cortical
regions activated by a head-up tilt also exhibit increased
functional electrocortical connectivity, prone sleeping newborn
and 2- to 4-month-old infants were tilted head-up to 30 degrees
. Electroencephalogram (EEG) data were collected with 128 electrodes
and coherence calculated to quantify electrocortical synchrony.
Local coherence, defined as the average of coherence measurements
between the EEG at each electrode site and neighboring sites
( approximately 1 cm electrode spacing), was found in activated
cortical regions that had previously shown increased high-frequency
power with tilt. Long-distance coherence was computed between
the regions. Newborn infants had significant increases in local
coherence in the activated left frontal, right frontal-temporal,
and occipital cortical regions; long-distance coherence increased
between the right frontal-temporal and occipital regions. In
contrast, infants at 2 to 4 months old, the age of maximum
risk for sudden infant death syndrome, had no significant changes
in coherence. Newborn and 2- to 4-month-old infants thus have
different electrocortical responses to a classic cardiovascular
challenge.
Full-text available at: http://www.sciencedirect.com/
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Pharoah PO, Platt MJ.
Sudden infant death syndrome in twins and singletons.
Twin Res Hum Genet. 2007 Aug;10(4):644-8.
Twins compared with singletons and monozygous
(MZ) compared with dizygous (DZ) twins are at increased risk
of fetal and infant death, cerebral palsy and many congenital
anomalies. The aim of this study is to investigate whether
zygosity is a risk factor for the sudden infant death syndrome
(SIDS). Birth registration data and draft infant death certificates
for all multiple births in England and Wales 1993 to 2003 were
provided by the Office for National Statistics. As a partial
proxy for zygosity, same-sex was compared with opposite-sex
twins for birthweight-specific mortality and mortality attributed
to SIDS. Data on singleton infants were obtained by subtraction
of multiple births from routinely published population births
and infant deaths. SIDS mortality among low birthweight infants
was significantly less in twins than singletons. The twin-singleton
relative risk was reversed in infants of normal birthweight.
Among infants of normal birthweight, neonatal SIDS was significantly
more common in same- compared with opposite-sex pairs. Among
infants of low birthweight, postneonatal SIDS was significantly
more common in same- compared with opposite-sex pairs. The
difference in birthweight distribution of same- compared with
opposite-sex twins for neonatal SIDS suggests that zygosity
is a risk factor for SIDS. As congenital cerebral anomalies
are a feature of many monozygous twin conceptions, a detailed
macro- and microscopical examination of the brain in twin SIDS
may indicate an otherwise unrecognised pathology.
Full-text available at: http://springer.metapress.com/
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Howards PP, Schisterman EF, Heagerty
PJ.
Potential confounding by exposure history and prior
outcomes: An example from perinatal eidemiology.
Epidemiology. 2007 Jul 31;Publish Ahead of Print [Epub ahead
of print].
Prior pregnancy outcomes, such as spontaneous
abortion and preterm birth, are often predictive of future
pregnancy outcomes. Therefore, many researchers adjust for
reproductive history. Although this adjustment may be appropriate
for a predictive model, it is not necessarily appropriate when
the goal is to obtain an unbiased estimate of the effect of
exposure on disease. Reproductive history may seem to meet
the conventional criteria for confounding because it is unlikely
to be on the causal pathway between exposure and current outcome,
is often associated with current outcome, and may be associated
with exposure as well. However, whether reproductive history
is a confounder or not depends on the underlying reason for
its associations with exposure and current outcome. Thus, conventional
methods for assessing confounding are often inadequate. Directed
acyclic graphs (DAGs) can be used to evaluate complex scenarios
for confounding when the research question is clearly defined
with respect to the exposure, the outcome, and the effect estimate
of interest. Special care is required when reproductive history
affects future exposure. We use 5 DAGs to illustrate possible
relations between reproductive history and current outcome.
We assess each DAG for confounding, and identify the appropriate
analytic technique. We provide a numeric example using data
from the Collaborative Perinatal Project. There is no single
answer as to whether reproductive history should be included
in the model; the decision depends on the research question
and the underlying DAG.
Full-text available at: http://meta.wkhealth.com/
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Abu Mourad T, Radi S, Shashaa S, Lionis
C, Philalithis A.
Palestinian primary health care in light of the National
Strategic Health Plan 1999-2003.
Public Health. 2007 Jul 27; [Epub ahead of print].
BACKGROUND: In 1994, the Palestinian Health
Authority took over responsibility for primary health care
(PHC) in Gaza Strip and West Bank. OBJECTIVES: This paper reports
on the Palestinian National Strategic Health Plan (PNSHP 1999-2003).
The extent to which the PHC objectives were achieved is discussed,
together with areas that still require improvement. METHODS:
This descriptive study used content analysis with a retrospective
review of data gathered from the PNSHP and other related reports
and publications. RESULTS: The crude death rate and total fertility
rate had improved, but the infant mortality rate had increased
by the end of the study period. Heart diseases were the primary
cause of death in Palestine. Acceptable vaccination coverage
had mainly been achieved, particularly for tetanus, diphtheria,
measles and polio. There were still concerns regarding water
supply and other sanitary conditions, a notable increase in
the incidence of vector-borne diseases, especially cutaneous
Leishmaniasis in West Bank, and mental health had worsened
by the end of the study period. CONCLUSIONS: Certain health
promotion and environmental health actions should be undertaken
urgently by the Palestinian health care services to cope with
environmental and sanitary conditions, and to further improve
health status regarding communicable and non-communicable diseases
in Palestinians. Health research and surveys are insufficient
and should be undertaken regularly. The main barrier to the
success of the PNSHP was the lack of follow-up due to political
and socio-economic instability. There is an urgent need for
international intervention and support.
Full-text available at: http://www.sciencedirect.com/
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Abu-Shaweesh JM.
Activation of central adenosine A2A receptors enhances
superior laryngeal nerve stimulation induced apnea in piglets
via a GABAergic pathway.
J Appl Physiol. 2007 Jul 26; [Epub ahead of print].
Activation of the laryngeal mucosa results
in apnea that is mediated through, and can be elicited via
electrical stimulation of, the superior laryngeal nerve (SLN).
This potent inhibitory reflex has been suggested to play a
role in the pathogenesis of apnea of prematurity and SIDS and
is attenuated by theophylline and blockade of GABAA receptors.
However, the interaction between GABA and adenosine in the
production of SLN stimulation induced apnea has not been previously
examined. We hypothesized that activation of adenosine A2A
receptors will enhance apnea induced by SLN stimulation while
subsequent blockade of GABAA receptors will reverse the effect
of A2A receptor activation. The phrenic nerve responses to
increasing levels of SLN stimulation were measured before and
after sequential intracisternal administration of adenosine
A2A receptor agonist CGS (n=10) and GABAA receptor blocker
bicuculline (n=7) in ventilated, vagotomized, decerebrate and
paralyzed newborn piglets. Increasing levels of SLN stimulation
caused progressive inhibition of phrenic activity and lead
to apnea during higher levels of stimulation. CGS caused inhibition
of baseline phrenic activity, hypotension and enhancement of
apnea induced by SLN stimulation. Subsequent bicuculline administration
reversed the effects of CGS and prevented the production of
apnea when compared to control at higher SLN stimulation levels.
We conclude that activation of adenosine A2A receptors enhances
SLN stimulation induced apnea probably via a GABAergic pathway.
We speculate that SLN stimulation causes endogenous release
of adenosine that activates A2A receptors on GABAergic neurons
resulting in the release of GABA at inspiratory neurons and
subsequent respiratory inhibition.
Full-text available at: http://jap.physiology.org/
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Chen A, Basso O.
Does low maternal blood pressure during pregnancy
increase the risk of perinatal death?
Epidemiology. 2007 Jul 20;Publish Ahead of Print [Epub ahead
of print].
BACKGROUND: A recent report described an
association between low maximum diastolic blood pressure (DBP)
during pregnancy and perinatal death (stillbirth and death
in the first week combined). The authors did not account for
gestational length, a strong predictor of perinatal death.
METHODS:: We studied 41,089 singleton pregnancies from the
U.S. Collaborative Perinatal Project (1959-1966). RESULTS::
We observed an association between low maximum DBP and elevated
risk of perinatal death. However, this association disappeared
after accounting for reverse causation related to gestational
length. At any given gestational week, women whose offspring
ultimately experienced perinatal death did not have significantly
lower maximum DBP than women whose offspring survived the perinatal
period. When accounting for the trend of increasing DBP during
late pregnancy through gestational-age-specific DBP standardized
score, we saw no association between low diastolic blood pressure
and perinatal death. CONCLUSIONS:: Low maximum maternal DBP
during pregnancy is a post hoc correlate of perinatal death,
not a true risk factor.
Full-text available at: http://meta.wkhealth.com/
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Aurore Cote, Aida Bairam, Marianne
Deschesne and George Hatzakis.
Sudden infant deaths in sitting devices.
Arch Dis Child. Published Online First: 19 July 2007.
Episodes of decreased oxygenation levels
have been recorded in prematurely born infants positioned in
car seats. It is therefore believed these infants traveling
in car seats are at risk of life-threatening events and even
death. No data on the prevalence of such infant deaths are
available. The aim of our study was to determine the incidence
of sudden deaths occurring in sitting devices in a whole population
and to determine whether prematurely born infants represent
a disproportionate number of these deaths. Design: Retrospective
population based cohort study reviewing all cases of sudden
unexpected death in infants between 0 and 365 days of age that
occurred in the province of Quebec between January 1991 and
December 2000. Results: Of the 508 deaths reviewed, 409 were
unexplained and 99 were explained after investigation. Seventeen
deaths occurred in a sitting device, of which 10 were unexplained
deaths. There was no excess of prematurely born infants dying;
there was, however, an excess of infants of less than one month
of age found to have died in a sitting position in the unexplained
death group. In addition, three infants had an increased risk
of upper airway obstruction. Conclusion: Although very few
deaths occurred in car seats, our results would suggest that
caution be used when placing younger infants in car seats and
similar sitting devices, whether the infants had been born
prematurely or not. We also recommend that more attention be
given to infants at increased risk of upper airway obstruction.
Full-text available at: http://adc.bmj.com/
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Glaser A, Bucher H, Moergeli H, Fauchère
J, Buechi S.
Loss of a preterm infant: psychological aspects in
parents.
Swiss Med Wkly. 2007 Jul 14;137(27-28):392-401.
QUESTIONS UNDER STUDY: The unexpected death
of a preterm infant is an extremely painful situation for parents.
Despite a number of quantitative studies, little is known about
parents' inner experience. The aim of this study was to gather
more in-depth information about what preoccupies parents in
this situation of suffering, thus leading to a deeper understanding
of their dealing with the stressful event and enabling more
adequate support to be provided by professionals. 10 mothers
and 9 fathers, who had lost their extremely premature infant
born between 24 and 26 weeks of gestation were invited for
a semi-structured interview and retrospectively asked about
their emotional, cognitive, physical and social experience
at three different points in time (time of hospitalisation,
6 months and 3.5-6.5 years after the loss). The interviews
were analysed by method of qualitative context analysis. RESULTS:
The loss of a preterm infant is an extremely intense experience
for parents resulting in a rollercoaster of emotions and perceptions
as well as relevant effects on the social network. The strain
of this situation notwithstanding, parents also experience
positive aspects, eg, feelings of closeness to their infant,
comforting thoughts or help from their social network. Although
still mourning the loss of their baby, most parents have overcome
the tragic event. CONCLUSIONS: Most parents seem to have the
psychological strength to overcome the traumatic experience
of losing their premature infant and are able to face life
normally again. Professionals can play an important role in
supporting them. Some parents require additional help to overcome
the loss.
Full-text available at: http://www.smw.ch/dfe/index.html
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Sharma PP, Salihu HM, Kirby RS.
Stillbirth recurrence in a population of relatively
low-risk mothers.
Paediatr Perinat Epidemiol. 2007 Jul;21 Suppl 1:24-30.
We sought to estimate the risk of stillbirth
recurrence among relatively low-risk women, a group defined
as maternal age <35 years; absence of congenital anomalies;
gestational age range of 20-44 weeks inclusive; singleton births;
and non-smokers. The Missouri maternally linked data containing
births from 1978 to 1997 were used for the study. We identified
the study group (low-risk gravidae who experienced a stillbirth
in the first pregnancy) and a comparison group (low-risk gravidae
who delivered a live birth in their first pregnancy) and compared
the stillbirth risks in the second pregnancy between both groups.
Analysis was based on 261 384 women with information on first
and second pregnancies [1050 (0.5%) women with stillbirth].
Of the 947 cases of stillbirth in the second pregnancy, 20
cases occurred in women with a history of stillbirth (stillbirth
rate 19.0 per 1000 births) and 927 in the comparison group
(stillbirth rate 3.6 per 1000 births; P<0.001). The adjusted
risk of stillbirth was almost six times higher in women with
a prior stillbirth (hazard ratio [HR] 5.8, [95% CI 3.7, 9.0]).
Analysis by stillbirth subtype in the second pregnancy showed
that history of stillbirth conferred greater risk for subsequent
early (fetal deaths between 20 and 28 weeks) (HR 10.3, [95%
CI 6.1, 17.2]) than late stillbirths (fetal deaths at >or=29
weeks) (HR 2.5, [95% CI 1.0, 6.0]); and for intrapartum (HR
12.2, [95% CI 4.5, 33.3]) than antepartum (HR 4.2, [95% CI
2.3, 7.7]) stillbirths. Among relatively low-risk women, history
of stillbirth was associated with increased recurrence, with
substantial heterogeneity by timing of stillbirth.
Full-text available at http://www.blackwell-synergy.com
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Di Mario S, Say L, Lincetto O.
Risk factors for stillbirth in developing countries:
a systematic review of the literature.
Sex Transm Dis. 2007 Jul;34(7 Suppl):S11-21.
OBJECTIVE: To identify risk factors for stillbirth
in developing countries and to measure their impact by calculating
the population attributable fraction (PAF) for each risk factor.
STUDY DESIGN: Systematic review of published studies on risk
factors for stillbirth within 3 broadly defined categories:
infections, other clinical conditions, and context-dependent
conditions such as socioeconomic status, maternal literacy,
and receipt of antenatal care. Where statistically significant
associations were found between a risk factor and occurrence
of stillbirth, the PAF (the proportion of cases occurring in
the total population that would be avoided if the exposure
was removed) was calculated. RESULTS: A total of 33 studies,
conducted in 31 developing countries, were included in the
review. The definition of stillbirth varied widely in these
studies. Risk factors for stillbirth having a PAF higher than
50% were maternal syphilis, chorioamnionitis, maternal malnutrition,
lack of antenatal care, and maternal socioeconomic disadvantage.
CONCLUSIONS: Maternal syphilis prevention, screening and treatment
together with other interventions targeting universal use of
antenatal care (that includes screening for syphilis) and improving
the socioeconomic conditions including nutritional status of
the mother, could effectively contribute towards reducing the
unacceptably high burden due to stillbirth in developing countries.
Full-text available at: http://meta.wkhealth.com/
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Corabian P, Scott NA, Lane C, Guyon
G.
Guidelines for investigating stillbirths: an update
of a systematic review.
J Obstet Gynaecol Can. 2007 Jul;29(7):560-7.
OBJECTIVE: To identify formal, publicly available
guidelines for stillbirth investigation and to identify the
most appropriate clinical practice guideline (or component
of a guideline) for use in Alberta. METHODS: A systematic literature
search was conducted to identify primary and secondary research
studies published between January 1985 and August 2006 and
formal, publicly available guidelines on the subject of stillbirth
investigation. The Cochrane Library, PubMed, EMBASE, CINAHL,
HealthSTAR, Science Citation Index, BIOSIS, and the NHS and
CRD databases were searched. The methodological quality of
the selected primary research studies was assessed according
to specific criteria. RESULTS: All six of the publicly available
clinical practice guidelines selected for this review outlined
similar steps in the stillbirth investigation but differed
about which tests to include and which components should be
core or additional investigations. They agreed on including
several elements for routine investigation, such as complete
autopsy and detailed examination of the cord and placenta.
Of 61 retrieved primary research studies, only seven met the
inclusion criteria. No studies compared the value of specific
guidelines. Although reviewed evidence highlights the value
of fetal autopsy and placental examinations as integral components
of stillbirth investigation, the value of other components
is still not clear. CONCLUSIONS: No firm scientific judgement
could be made about which clinical practice guideline for stillbirth
investigation is the most appropriate or which components are
essential. Currently here is no generally accepted reference
guideline for stillbirth investigation. Fetal autopsy and placental
examination remain important components, assuming the postmortem
examination is of high quality. These data may be helpful in
counselling parents who are considering whether or not to consent
to a postmortem examination.
Full-text available at: http://www.sogc.org/jogc/
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Lee J, Oh J, Choi E, Park I, Han C,
Kim DH, Choi BC, Kim JW, Cho C.
Differentially expressed genes implicated in unexplained
recurrent spontaneous abortion. Int
J Biochem Cell Biol. 2007 Jun 30; [Epub ahead of print].
Recurrent spontaneous abortion occurs in
approximately 3% of women with diagnosed pregnancies. The etiology
in approximately 40% of recurrent spontaneous abortion is unexplained.
To elucidate unexplained recurrent spontaneous abortion at
the molecular level, we systemically identified differentially
expressed genes during implantation window period in unexplained
recurrent spontaneous abortion and characterized their functions
in a human endometrial cell line. Expression levels of implantation-related
genes selected from previously reported, various microarray
data were determined to identify differentially expressed genes
between normal fertile and unexplained recurrent spontaneous
abortion subjects by real-time quantitative RT-PCR. Of 29 implantation-related
genes, the transcript levels of cellular retinoic acid binding
protein 2 and olfactomedin 1 were higher, whereas that of complement
component 4 binding protein alpha was lower in subjects with
unexplained recurrent spontaneous abortion, compared to normal
fertile subjects. A correlation was evident between the transcript
and protein levels of complement component 4 binding protein
alpha and cellular retinoic acid binding protein 2. Expression
of cellular retinoic acid binding protein 2 was positively
correlated with retinoic acid-related genes in normal fertile
subjects, but no significant association was observed in unexplained
recurrent spontaneous abortion subjects. In relation to complement
component 4 binding protein alpha, C5a receptor protein level
was significantly higher in subjects with unexplained recurrent
spontaneous abortion. Stable expression of cellular retinoic
acid binding protein 2 and olfactomedin 1 in a human endometrial
cell line inhibited cell growth and induced cell accumulation
in the S and G(2)-M phase fractions, but did not trigger apoptosis.
This study represents the first systematic identification of
differentially expressed genes in unexplained recurrent spontaneous
abortion. Defective cell growth by the differentially expressed
genes suggests their implication in implantation failure in
women with unexplained recurrent spontaneous abortion.
Full-text available at: http://www.sciencedirect.com/
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Côté-Arsenault
D.
Threat appraisal, coping, and emotions across pregnancy
subsequent to perinatal loss.
Nurs Res. 2007 Mar-Apr;56(2):108-16.
BACKGROUND: Pregnancies after perinatal loss
are known to be anxiety-filled. Stress in pregnancy and the
response to it, often seen as anxiety and depression, have
known negative consequences for obstetric outcomes, parenting,
and infant behaviors. Women have reported fluctuating emotions
in response to events in their subsequent pregnancies, but
these pregnancies have not been studied longitudinally. OBJECTIVES:
To test Lazarus' theory of stress, coping, and emotions in
this population, and to understand the patterns of threat appraisal,
coping, and emotional states of women across pregnancy after
perinatal loss. METHODS: In this predictive correlational study,
82 women pregnant after loss (PAL) were followed, and the study
was guided longitudinally by Lazarus' theory of stress, coping,
and emotions. Obstetric and loss history, and assigned fetal
personhood were gathered at intake (Time 1). Measures completed
at 10-week intervals (one time each trimester) included Moneyham
Threat Index (threat appraisal), Ways of Coping Checklist-Revised
(relative coping), Pregnancy Anxiety Scale (pregnancy anxiety),
Multiple Affect Adjective Checklist-Revised (emotional states),
and Stress in Life (stress). Time 3 sample size was 70. RESULTS:
Threat appraisal was correlated with assigned fetal personhood
and gestational age of past loss. Pregnancy subsequent to loss
was perceived as a threat, and threat appraisal strongly predicted
pregnancy anxiety. Pregnancy anxiety, reported at moderate
levels on average, decreased over time; threat appraisal, coping,
and other emotions were stable across pregnancy. Coping did
not mediate these effects, but relative coping was correlated
with emotional status as theorized, with problem-focused coping
used more than emotion-focused coping. DISCUSSION: Women find
pregnancy after loss stressful and a threat, and this appraisal
remains across pregnancy. Because pregnancy anxiety is common,
and highest in early pregnancy, providers should address worries
and fears with all women early in PAL. Interventions must be
tested in future studies.
Full-text available at: http://meta.wkhealth.com/
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Balci Y, Tok M, Kocaturk BK, Yenilmez
C, Yirulmaz C.
Simultaneous sudden infant death syndrome.
J Forensic Leg Med. 2007 Feb;14(2):87-91.
The simultaneous sudden deaths of twins rarely
occur and therefore it has received limited attention in the
medical literature. When the deaths of the twins meet the defined
criteria for sudden infant death syndrome (SIDS) independently
and take place within the same 24 h range it can be called
as simultaneous SIDS (SSIDS). The case(s): Twin girls (3.5-month-old)
were found dead by their mother in their crib, both in supine
position. The infants were identical twins and delivered at
a hospital by cesarean section. Both infants were healthy and
did not have any serious medical history. Two days prior to
the incident, the twins had received the second dose of oral
polio, DPT and the first dose of hepatitis B vaccines and they
had fever on the first day of the vaccination and been given
teaspoonful of acetaminophen. Death scene investigation, judicial
investigation, parental assessment, macroscopic and microscopic
autopsy findings and the toxicological analysis did not yield
any specific cause of death. The case(s) were referred to a
supreme board composed of multidisciplinary medical professionals
at the Institute of Forensic Medicine, Ministry of Justice,
in Istanbul. The Board decided that the available data was
consistent with SIDS. These SIDS case(s) are presented because
twin SIDS are rare and this is the first time that a simultaneous
twin SIDS have been reported in Turkey. Simultaneous SIDS cases
have many implications regarding definition, diagnosis and
medico-legal approach.
Full-text available at: http://www.elsevier.com/
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