NSIDRC Journal Article Alert — October 12, 2007

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

Loghmanee DA, Weese-Mayer DE.
Sudden infant death syndrome: another year of new hope but no cure.
Curr Opin Pulm Med. 2007 Nov; 13(6):497-504.

PURPOSE OF REVIEW: Sudden infant death syndrome has inspired increasingly sophisticated studies at a time when rates are declining because of the Back-to-Sleep campaign, but ethnic disparities are widening. This review evaluates and discusses original, recent research in this area. RECENT FINDINGS: The epidemiology of sudden infant death syndrome was evaluated, corroborating known risk factors and identifying new risk factors such as socioeconomic depression and air pollution. Deficits in our understanding of risk factors for this syndrome persist, suggesting a need for ethnicity-specific education, especially among the underserved. Both autopsy and genetic testing were found to improve diagnostic accuracy or identify other causes of death (e.g. long Q-T syndrome). Debate persists over counseling regarding pacifiers and co-sleeping within the context of breastfeeding. Support was found for a relationship between sudden infant death syndrome and autonomic dysregulation via the serotonergic pathway, but more research is needed. SUMMARY: The cause of sudden infant death syndrome remains elusive. Recent studies, however, suggest that improved culturally sensitive educational programs, increased diagnostic specificity, and further clarification of the link between genetics and developmental stage might further decrease the number of infants lost to this devastating disease and elucidate the mechanism(s) responsible for this syndrome.

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

Johns J, Muttukrishna S, Lygnos M, Groome N, Jauniaux E.
Maternal serum hormone concentrations for prediction of adverse outcome in threatened miscarriage.
Reprod Biomed Online. 2007 Oct; 15(4):413-21.

Many serum markers have been investigated in attempts to predict the outcome of pregnancy in the first trimester, with varying degrees of success. The objective of this study was to investigate whether they can be related to pregnancy outcome in women presenting with first trimester threatened miscarriage. A cohort study of women attending the Early Pregnancy Unit of a London teaching hospital was studied. A total of 122 women presenting with bleeding in the first trimester and an ongoing pregnancy, and 33 women undergoing termination of pregnancy, were recruited. The main outcome measures were gestation at delivery, birth weight and the incidence of adverse pregnancy outcome. Inhibin A, activin A, human chorionic gonadotrophin (HCG), pregnancy-associated plasma protein-A and follistatin concentrations were all significantly lower in women who subsequently miscarried when compared with live births. Serum HCG concentrations were significantly higher in cases of threatened miscarriage compared with controls (P = 0.0009). Logistic regression analysis indicated that inhibin A alone provided the best predictor for first trimester miscarriage. This pilot study suggests that placental hormone concentrations could be useful in predicting adverse pregnancy outcome in women presenting with threatened miscarriage. Inhibin A was best at predicting the likelihood of subsequent miscarriage in this group.

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

van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TW, L'Hoir MP.
Swaddling: a systematic review.
Pediatrics. 2007 Oct; 120(4):e1097-106.

Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and The Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluate its possible benefits and disadvantages. In general, swaddled infants arouse less and sleep longer. Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled. When compared with massage, excessively crying infants cried less when swaddled, and swaddling can soothe pain in infants. It is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions. It can be helpful in regulating temperature but can also cause hyperthermia when misapplied. Another possible adverse effect is an increased risk of the development of hip dysplasia, which is related to swaddling with the legs in extension and adduction. Although swaddling promotes the favorable supine position, the combination of swaddling with prone position increases the risk of sudden infant death syndrome, which makes it necessary to warn parents to stop swaddling if infants attempt to turn. There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling. Furthermore, swaddling does not influence rickets onset or bone properties. Swaddling immediately after birth can cause delayed postnatal weight gain under certain conditions, but does not seem to influence breastfeeding parameters.

Full-text available at: http://pediatrics.aappublications.org/

Robb MP, Crowell DH, Dunn-Rankin P, Tinsley C.
Cry features in siblings of SIDS.
Acta Paediatr. 2007 Oct; 96(10):1404-8.

Aim: To examine the acoustic features of crying demonstrated by infants whose older sibling died of sudden infant death syndrome (SIDS) and compare these features to a nonrisk group of infants. Methods: Pain-induced crying episodes were collected from a group of healthy term (HT) infants and siblings of SIDS infants. One complete crying episode was obtained from each infant and analyzed acoustically with regard to durational and spectral features. Results: The cries of SIDS siblings were found to be significantly higher in pitch and reflected hyperadductory vocal fold vibratory behaviour compared to the HT group. There were no group differences with regard to durational features of crying. Conclusions: The laryngeal behaviour of infant crying, as inferred via acoustic analyses, differs between HT infants and siblings of SIDS infants. Accordingly, acoustic features of infant crying may serve as an additional diagnostic marker in the identification of children who may be at risk for SIDS.

Full-text available at: http://www.blackwell-synergy.com/

Nassi N, Piumelli R, Lombardi E, Landini L, Donzelli G, de Martino M.
Comparison between pulse oximetry and transthoracic impedance alarm traces during home monitoring.
Arch Dis Child. 2007 Sep 24; [Epub ahead of print].

OBJECTIVE: To compare transthoracic impedance (TTI/ECG) and pulse oxymetry (Po) alarm traces detected during home monitoring in infants at risk of apnoea, bradycardia and hypoxemia. Study DESIGN: A retrospective evaluation of the monitor downloads of 67 infants who had undergone either TTI/ECG or Po home monitoring using a device that allows for detecting both parameters. Patients and METHODS: The patients belonged to the following diagnostic categories: Apparent Life-Threatening Events (ALTE, n=39), Preterms (Pt, n=21) and Miscellaneous (Mi, n=7). TTI/ECG and Po alarm traces were downloaded and inspected in order to score as either true or false alarms. Classification criteria were based on the visual analysis of the impedance and plethysmographic waveforms which were captured by the memory monitor every time the alarm thresholds were violated. RESULTS: Over a total period of 3,452 days of monitoring, 5,242 alarms occurred; 4,562 (87%) were false and 680 (13%) true. The mean duration of monitoring was 51 days (range 5-220 days). Overall TTI/ECG false alarms were 2,982 accounting for 65% of the total, while there were 1,580 Po false alarms (35%), (p=.0042). Among the 680 true alarms, 507 (74%) were desaturations not attributable to central apnoeas, while the true TTI/ECG alarms accounted for 173 (26%) (p=.0013). CONCLUSIONS: The comparison between PO and TTI/ECG alarm traces has shown that true events were mostly attributable to desaturations, while false alarms were mainly provoked by TTI/ECG. The total number of the false alarms is lower than that reported in other studies adopting TTI/ECG only, thus indicating that monitoring using both Po and TTI/ECG is suitable for home use. When the combination of both techniques is not feasible or not required, we recommend the use of motion resistant pulseoxymetry alone.

Full-text available at: http://adc.bmj.com/cgi/rapidpdf/adc.2007.118513v1

Fleming P, Blair PS.
Sudden Infant Death Syndrome and parental smoking.
Early Hum Dev. 2007 Sep 17; [Epub ahead of print].

Prenatal exposure to tobacco smoke is a major risk factor associated with Sudden Infant Death Syndrome (SIDS) and the risk has increased despite continued advice against this practice. Evidence from the UK suggests the prevalence of maternal smoking during pregnancy has risen amongst SIDS mothers (from 50% to 80%) when the rate amongst expectant mothers in the general population has fallen (from 30% to 20%) confirming pooled estimates from recent studies of a four-fold risk. An additional risk from postnatal exposure has also been identified; increasing with the number of smokers in the household or the daily hours the infant is subjected to a smoke-filled environment. Exposure may lead to a complex range of effects upon normal physiological and anatomical development in fetal and postnatal life that places infants at greatly increased risk of SIDS. Recent legislation prohibiting smoking in public places needs to emphasise the adverse effects of tobacco smoke exposure to infants and amongst pregnant women.

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

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