NSIDRC Journal Article Alert — September 7, 2007

Past issues of NSDIRC journal alerts are available at: http://www.sidscenter.org

Corey TS, Hanzlick R, Howard J, Nelson C, Krous H.
A Functional Approach to Sudden Unexplained Infant Deaths.
Am J Forensic Med Pathol. 2007 Sep;28(3):271-277.

There is a great deal of variation in the methods and wording used by medical examiners in the medicolegal investigation and certification of infant deaths. This paper was created by the NAME Ad Hoc Committee on Sudden Unexplained Infant Death to address several specific issues, namely. This paper was electronically posted for NAME member review and comment for a period of 30 days. The paper was further revised based on member comments and then submitted to the NAME board of directors in the fall of 2005 prior to the annual meeting. This text of this paper was officially approved and endorsed by the NAME board of directors on October 14, 2005, at the annual meeting in Los Angeles, CA.

Full-text available at: http://meta.wkhealth.com/

Thach BT, Rutherford GW Jr, Harris K.
Deaths and injuries attributed to infant crib bumper pads.
J Pediatr. 2007 Sep;151(3):271-4, 274.e1-3. Epub 2007 Jul 25.

OBJECTIVE: To document deaths attributed to bumper pads and injuries from their use that are potentially preventable. STUDY DESIGN: The US Consumer Product Safety Commission maintains files on cases voluntarily reported to them of deaths and injury related to commercial products. These cases represent an unknown fraction of total occurrences. We searched this database for deaths related to crib bumpers for the years 1985 to 2005. We also searched other Consumer Product Safety Commission databases for crib-related injuries that potentially might have been prevented by bumpers. Additionally, we examined 22 retail crib bumpers and described features that could be hazardous. RESULTS: Twenty-seven accidental deaths reported by medical examiners or coroners were attributed to bumper pads. The mechanism of death included suffocation and strangulation by bumper ties. Twenty-five nonfatal injuries were identified, and most consisted of minor contusions. All retail bumpers had hazardous properties. CONCLUSIONS: These findings suggest that crib and bassinet bumpers are dangerous. Their use prevents only minor injuries. Because bumpers can cause death, we conclude that they should not be used.

Full-text available at: http://www.sciencedirect.com/

Salihu HM, Dunlop AL, Hedayatzadeh M, Alio AP, Kirby RS, Alexander GR.
Extreme Obesity and Risk of Stillbirth Among Black and White Gravidas.
Obstet Gynecol. 2007 Sep;110(3):552-557.

OBJECTIVE: To estimate the risk for stillbirth among three generally accepted obesity subtypes based on severity. METHODS: We used the Missouri maternally linked cohort data containing births from 1978 to 1997. Using prepregnancy weight and height, mothers were classified on the basis of calculated body mass index (BMI) above 30 into three subsets: class I (30-34.9), class II (35-39.9), and extreme obesity (greater than or equal to 40). Using normal-weight, white women (18.5-24.9) as a reference, we applied Cox proportional hazard regression models to estimate risks for stillbirth. RESULTS: The prevalence of obesity in pregnant women was 9.5% (12.8% among blacks and 8.9% among whites). Overall, obese mothers were about 40% more likely to experience stillbirth compared with nonobese gravidas (adjusted hazard ratio 1.4; 95% confidence interval [CI] 1.3-1.5). The risk for stillbirth increased in a dose-dependent fashion with increase in BMI: class I (adjusted hazard ratio 1.3; 95% CI 1.2-1.4); class II (adjusted hazard ratio 1.4; 95% CI 1.3-1.6) and extreme obesity (adjusted hazard ratio 1.9; 95% CI 1.6-2.1; P for trend <.01). Obese black mothers experienced more stillbirths than their white counterparts (adjusted hazard ratio 1.9; 95% CI 1.7-2.1 compared with adjusted hazard ratio 1.4; 95% CI 1.3-1.5). The black disadvantage in stillbirth widened with increase in BMI, with the greatest difference observed among extremely obese black mothers (adjusted hazard ratio 2.3; 95% CI 1.8-2.9). CONCLUSION: Obesity is a risk factor for stillbirth, particularly among extremely obese, black mothers. Strategies to reduce black-white disparities in birth outcomes should consider targeting obese, black women.

Full-text available at: http://www.greenjournal.org/

Heinrich J, Slama R.
Fine particles, a major threat to children.
Int J Hyg Environ Health. 2007 Aug 31; [Epub ahead of print].

BACKGROUND: There is a growing body of evidence for serious health consequences of exposure to ambient air pollution. The general question of who is susceptible is one of the most important gaps in current knowledge regarding particulate matter (PM)-related health effects. Who is susceptible depends on the specific health endpoint being evaluated and the level and length of exposure. Here, we restrict the review on the impact of fine particle exposure on children's health to the following outcomes: infant death, lung function, respiratory symptoms and reproductive outcomes. METHODS: This is a strategic review of children's susceptibility to ambient fine particles and characteristics of infant and children which underlie their increased susceptibility to PM. RESULTS: Ambient fine PM is associated with intra-uterine growth retardation, infant mortality; it is associated with impaired lung function and increased respiratory symptoms, particularly in asthmatics. Concerning infant mortality, exposure to PM is strongly and consistently associated with postneonatal respiratory mortality and less consistently with sudden infant death syndrome. Although most of the studies reported adverse effects for this health outcome, the evidence is weaker than for infant death. Exposure to fine PM has been associated with impaired lung function and lung function growth. Most of the studies reported increased prevalence of symptom with increased exposure to fine PM. CONCLUSION: Fine PM is a major threat to children, because of their higher exposure to PM compared to adults, the immature state of the lung in childhood and also of the immune function at birth. The first months of life might be a period of particular sensitivity. Although the mechanisms of air pollution effects have not yet been completely understood, pregnant women, infants and children need specific protection against exposure to fine particles.

Full-text available at: http://www.sciencedirect.com/

Amir A, Merlob P, Linder N, Sirota L, Klinger G.
Mortality of full-term infants during the first month of life in a tertiary care hospital.
J Perinatol. 2007 Aug 23; [Epub ahead of print].

Objective:The neonatal mortality rate is disproportionately influenced by preterm infants and does not reflect the rate in full-term infants. Our objectives were to estimate the full-term neonatal mortality rate and to identify causes of death in full-term infants during the first month of life.Study Design:A retrospective study of full-term infant deaths during a 6-year period from 2000 to 2005, in a tertiary medical center.Result:During the study period there were 44 703 full-term births and 31 deaths, representing a mortality rate of 0.69 per 1000 live births. The main cause of death was congenital anomalies (64.5%), specifically cardiac anomalies. Other causes were chromosomal anomalies or syndromes (12.9%), labor complications (12.9%), infections (3.2%), congenital diseases (3.2%) and metabolic disorders (3.2%).Conclusion:The mortality rate of full-term infants may be lower than previous estimates. Efforts aimed at decreasing mortality among full-term infants should focus on prenatal diagnosis.

Full-text available at: http://www.nature.com/

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