NSIDRC Journal Article Alert — November 16, 2007

Prepared by the National Sudden Infant Death Resource Center at Georgetown University.

This journal article alert provides selected items added to the National Library of Medicine’s PubMed database in the last week.

Past issues of NSIDRC journal alerts are available at http://www.sidscenter.org.
Availability of full-text journal articles is usually limited to subscribers or through inter-library loan.  Please see your local library for copies of these articles.

1: King-Hele SA, Abel KM, Webb RT, Mortensen PB, Appleby L, Pickles AR.
Risk of sudden infant death syndrome with parental mental illness.
Arch Gen Psychiatry. 2007 Nov;64(11):1323-30.

Centre for Women's Mental Health Research, The University of Manchester, Manchester, England.

CONTEXT: Sudden infant death syndrome is the leading cause of postneonatal death in developed countries. Little is known about risks linked with parental mental illness per se or how such risks are modified by specific psychiatric conditions and by maternal vs paternal psychopathological abnormalities. OBJECTIVE: To investigate cause-specific postneonatal death, including sudden infant death syndrome, in infants whose parents had been admitted as psychiatric inpatients. DESIGN: National cohort study. SETTING: The entire Danish population. Patients All of the singleton live births registered from January 1, 1973, to December 31, 1998. Linkage to the national psychiatric register enabled identification of all of the parental admissions from April 1, 1969, onward. MAIN OUTCOME MEASURE: All of the cases of sudden infant death syndrome in the postneonatal period classified via national mortality registration between January 1, 1973, and December 31, 1998. RESULTS: Psychiatric admission history in either parent doubled the risk of sudden infant death syndrome, but there was no difference in risk whether infants were exposed to maternal or paternal admission. Risk was particularly high if both parents had been admitted for any psychiatric disorder (relative risk, 6.9; 95% confidence interval, 4.1-11.6). Among specific parental disorders, the greatest risk was associated with admission for alcohol- or drug-related disorders (mothers: relative risk, 5.0; 95% confidence interval, 3.4-7.5; fathers: relative risk, 2.5; 95% confidence interval, 1.7-3.8). Contrary to prior expectation, parental schizophrenia and related disorders did not confer higher risks than other parental disorders that resulted in admission. CONCLUSIONS: Infants whose parents have been admitted for psychiatric treatment are at greater risk for sudden infant death syndrome. However, risks may be lower than previously thought with maternal schizophrenia and related disorders. Clinicians should be aware of particularly high risks if both parents have received any psychiatric inpatient treatment or if either parent (but the mother especially) was admitted with an alcohol- or drug-related disorder.

2: Malloy MH, Eschbach K.
Association of poverty with sudden infant death syndrome in metropolitan counties of the United States in the years 1990 and 2000.
South Med J. 2007 Nov;100(11):1107-13.

From the Department of Pediatrics and the Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

BACKGROUND:: Sudden infant death syndrome (SIDS) has been associated with poverty indirectly in the United States with the use of vital statistics data by using proxies of socioeconomic status such as maternal education. OBJECTIVES:: The objective of this analysis was to examine the relationship of poverty to SIDS at an ecologic level, by examining the association between poverty within metropolitan counties of the United States and the occurrence of SIDS within those metropolitan counties. METHODS:: The percentage of each US county's population below established federal poverty guidelines (poverty index) was obtained from US Census data for 1990 and 2000 by race (Hispanic-HISP, non-Hispanic white-NHW, and non-Hispanic black-NHB). These data were merged by year of birth, county, and race with US Vital Statistics Linked Birth and Infant Death Certificate data. RESULTS:: Fourth (highest poverty quartile) versus first quartile poverty odds ratios (OR) were significantly increased in 1990 and 2000 for NHB (OR1990 = 1.84, OR2000 = 2.29) and NHW (OR1990 = 1.87, OR2000 = 2.17), but not for HISP (OR1990 = 0.64, OR2000 = 0.59). CONCLUSIONS:: There is a significant association between poverty and SIDS at the metropolitan county level for NHB and NHW. Hispanics do not demonstrate this association.

3: Randall B, Wilson A.
The 2006 annual report of the Regional Infant and Child Mortality Review Committee.
S D Med. 2007 Sep;60(9):343, 345, 347 passim.

LCM Pathologists, PC, Sioux Falls, South Dakota, USA.

The 2006 annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is attached. This committee's mission is to review infant and child deaths so that information can be transformed into action to protect young lives. The 2006 review region includes South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties. Although there was only one death meeting the criteria for Sudden Infant Death Syndrome (SIDS) in our region, there were five infant deaths associated with unsafe sleeping environments that either caused or potentially caused these infants' deaths. We need to continue to promote the "Back to Sleep" campaign message of not only placing infants to sleep on their backs, but also making sure infants are put down to sleep on safe, firm sleeping surfaces and dressed appropriately for safe room temperatures.

4: Krous HF, Haas EA, Chadwick AE, Masoumi H, Mhoyan A, Stanley C.
 Delayed death in sudden infant death syndrome: A San Diego SIDS/SUDC Research Project 15-year population-based report.
Forensic Sci Int. 2007 Nov 5; [Epub ahead of print]

Rady Children's Hospital & Health Center, San Diego, CA, United States; University of California, San Diego School of Medicine, La Jolla, CA, United States.

A fraction of SIDS cases have death delayed by successful CPR, yet they have not been compared to SIDS cases which were found dead or not successfully resuscitated. Our aims were to: (1) determine the percent of SIDS cases in the San Diego SIDS Research Project database for whom death was delayed by CPR and subsequent life support; (2) compare demographics, circumstances of death and autopsy findings of delayed death SIDS cases (delayed SIDS) with those whose deaths were not delayed (non-delayed SIDS); (3) examine the evolution of pathologic changes in delayed SIDS as a function of survival interval. A retrospective 15-year population-based study of 454 infant deaths attributed to SIDS revealed 29 delayed SIDS cases (Group I) and 425 non-delayed SIDS cases (Group II). Group I cases were significantly older than Group II cases (mean age 132 days vs. 102 days and p<0.0001). Eighty-nine percent of the Group I cases were discovered between 08.00 and 19.59h; none were found between 00.00 and 07.59h, compared to 38% of the Group II cases. Group I infants were found significantly more often away from home (at daycare, or at the home of a relative, friend, or baby sitter) than Group II infants (45% vs. 25%, p<0.05). There were no differences between groups with regard to gender, gestational age, type of delivery, bed sharing, URI within 48h of death, ALTEs, a history of referral to child protective services, body position when placed or found, or face position when found. Pathologic changes were semiquantitatively evaluated; findings were characteristic of anoxic-ischemic injury that generally became more severe with increasing survival intervals. Anoxic-ischemic brain injury was the immediate cause of death in all delayed SIDS cases. Aspiration of gastric contents was identified in Group I cases surviving less than 48h and was the likely etiology of acute bronchopneumonia occurring in 83% of the Group I cases. We did not identify factors that would reliably predict which SIDS cases might be discovered soon enough to allow earlier and more effective CPR and survival without permanent brain injury.

5: Haycock G.
Recent research in sudden infant death syndrome.
J Fam Health Care. 2007;17(5):149-51.

Foundation for the Study of Infant Deaths.

Despite a considerable fall in numbers over the last 15 years, sudden infant death syndrome (SIDS) remains the commonest cause of death of infants between one month and one year of age in the U.K. The cause of SIDS is unknown and there may be several causes, some specific to the particular infant and some external and possibly modifiable. This article discusses some of the leading theories of possible causation and reviews some of the research that has been published in the last few years or is still ongoing. The main areas in which there have been progress in research are (i) aspects of brain function that are responsible for arousal and maintenance of breathing and circulation; (ii) factors regulating the inflammatory response to infection and exposure to bacterial toxins; (iii increased understanding of rare genetic diseases that may account for a few cases; and (iv) the importance of critical developmental stages, and the effect of premature delivery and low birth weight on these. It is hoped that further research will enable the incidence of SIDS to be further reduced below the current rate of about 300 cases per year in the U.K.

6: Russell N, Holloway P, Quinn S, Foley M, Kelehan P, McAuliffe F.
CARDIOMYOPATHY AND CARDIOMEGALY IN STILLBORN INFANTS OF DIABETIC MOTHERS.
Pediatr Dev Pathol. 2007 Sep 18;:1 [Epub ahead of print]

Objectives: To report the incidence of cardiomegaly in stillborn normally formed infants of mothers with diabetes mellitus. Study design: This is a retrospective study with institutional ethics approval. The presence of cardiomegaly was recorded in stillborn infants of diabetic mothers (N=27) and compared with that recorded in stillborn large for gestational age (LGA > 90th centile, n=18) and stillborn appropriately grown (10-90th centile, n=107) non-diabetic infants. Blinded to the clinical details, the histology slides were reviewed to measure cardiac wall thickness and to record the presence or absence of myocardial fibre disarray. Results: Stillborn infants of mothers with diabetes mellitus, when compared with appropriately grown stillborn non-diabetic infants and adjusted for birth weight, had heavier hearts, thicker ventricular free wall measurements and lighter brains. While cardiomegaly was reported in 22% of stillborn large for gestational age infants, comparison with stillborn appropriately grown infants revealed no difference in heart weights corrected for birth weight. Comparison of LGA non-diabetic infants with stillborn diabetes mellitus infants revealed greater actual heart weight/ expected for birth weight (p<0.05) and lighter brains (actual brain weight / expected for birth weight, p<0.05) in the diabetes mellitus group. Conclusions: Cardiomegaly is a common finding in stillborn infants of mothers with diabetes mellitus and may contribute to the risk of fetal death in these pregnancies. Keywords: diabetes, pregnancy, cardiomegaly, cardiomyopathy, stillbirth.

7: McCowan LM, George-Haddad M, Stacey T, Thompson JM.
Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting.
Aust N Z J Obstet Gynaecol. 2007 Dec;47(6):450-6.

Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.

Background: Stillbirth affects almost 1% of pregnant women in the Western world but is still not a research priority. Aims: To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC). Methods: The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n = 69 173. Results: After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95%CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95%CI (1.27, 2.14)); smoking (OR 1.33, 95%CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95%CI (2.30, 3.58)); nulliparity (OR 1.42, 95%CI (1.10, 1.83)), and para 2 (OR 1.36, 95%CI (1.01, 1.83)). One hundred and twenty-nine (46%) stillbirths born >/= 24 weeks (n = 278) were SGA by customised, and 94 (34%) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51%) vs 28 of 80 (35%), respectively, P = 0.02) but rates of population SGA did not differ (72 of 198 (36%) vs 22 of 80 (28%) P = 0.16). 'Spontaneous preterm' was the most common cause of stillbirth at < 28 weeks and 'unexplained' at >/= 28 weeks using PSANZ-PDC classification. Conclusions: This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.

8: Battin MR, McCowan LM, George-Haddad M, Thompson JM.
Fetal growth restriction and other factors associated with neonatal death in New Zealand.
Aust N Z J Obstet Gynaecol. 2007 Dec;47(6):457-63.

Department of Paediatrics, University of Auckland, Auckland, New Zealand.

Background: There are few studies of risk factors for neonatal death in Australia or New Zealand. Aims: To assess in a cohort of neonatal deaths (i) the demographic and clinical risk factors; (ii) the relationship between low weight for gestation using population and customised centiles; and (iii) the cause of death by the Perinatal Society of Australia and New Zealand Perinatal and Neonatal death classifications. Methods: A retrospective study of 410 babies who died, in the neonatal period, at National Women's Hospital, between 1993 and 2000. Demographic and clinical data were compared with that from a referent population of live births with neonatal deaths removed (n = 68 905). Results: The overall neonatal death rate was 5.9 per 1000 live births and after exclusion of congenital abnormalities was 3.9 per 1000 live births. Infants of Maori women had increased risk compared to European (adjusted odds ration (AOR) 1.52; 95% CI 1.06, 2.18), as did those born to primipara (AOR 1.52; 95% CI 1.10, 2.11), mothers with >/= 1 previous low-birthweight baby (AOR 2.97; 95% CI 1.99, 4.44), >/= 1 miscarriage (AOR 1.35; 95% CI 1.00, 1.81), and an index multiple pregnancy (AOR 10.51; 95% CI 8.04, 13.76). Infants of Chinese mothers had decreased risk (AOR 0.42; 95% CI 0.18, 0.96). Fifty (34%) babies were small for gestational age by customised and 26 (17%) by population centiles. The most common classification of neonatal death was congenital abnormality (34.6%), followed by extreme prematurity (34.1%). Conclusions: This study emphasises the importance of suboptimal fetal growth as an important risk factor for neonatal death especially when customised centiles are used.

9: Kaplan PW, Norwitz ER, Ben-Menachem E, Pennell PB, Druzin M, Robinson JN, Gordon JC.
Obstetric risks for women with epilepsy during pregnancy.
Epilepsy Behav. 2007 Nov;11(3):283-91.

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Women with epilepsy (WWE) face particular challenges during their pregnancy. Among the several obstetric issues for which there is some concern and the need for further investigation are: the effects of seizures, epilepsy, and antiepileptic drugs on pregnancy outcome and, conversely, the effects of pregnancy and hormonal neurotransmitters on seizure control and antiepileptic drug metabolism. Obstetric concerns include preclampsia/eclampsia, preterm delivery, placental abruption, spontaneous abortion, stillbirth, and small-for-date babies in WWE whether or not they are taking antiepileptic drugs. The role of nutritional health elements, including body mass index, caloric and protein intake, vitamins and iron, and phytoestrogens, warrants further study. During the course of obstetric management, there is a need for a fuller understanding by neurologists of the risk-benefit calculations for various types and frequencies of fetal imaging, including CT, MRI, and ultrasound, as well as for the screening standards of care. As part of the Health Outcomes in Pregnancy and Epilepsy (HOPE) project, this expert panel provides a brief overview of these concerns, offers some approaches to management, and outlines potential areas for further investigation. More detailed information and guidelines are available elsewhere.

10: Goberman AM, Johnson S, Cannizzaro MS, Robb MP.
The effect of positioning on infant cries: Implications for sudden infant death syndrome.
Int J Pediatr Otorhinolaryngol. 2007 Nov 8; [Epub ahead of print]

Department of Communication Disorders, Bowling Green State University, 200 Health Center Building, Bowling Green, OH 43403-0149, United States.

OBJECTIVE: A definitive cause for sudden infant death syndrome (SIDS) has not yet been identified, but some theories point to laryngeal or respiratory causes, in addition to theories of reduced arousal or reduced autonomic response. The occurrence of SIDS has dropped since the movement to place newborns to sleep in the supine position; however, some research has found a respiratory disadvantage for infants in this position. The current paper studied acoustic characteristics of infant pain cries to determine the potential differences related to prone versus supine positioning. METHODS: Fifty-one newborn infant cries were recorded during and following a blood draw screening procedure, with infants placed either in the supine or prone position. All infants were healthy, full-term infants. Complete crying episodes were audio-recorded, and results were based on compositional analysis and long-time average spectrum analysis across each crying episode. RESULTS: Spectral analysis revealed acoustic differences related to infant positioning, and acoustic analysis also revealed that there were no respiratory differences between supine-positioned and prone-positioned infants. Overall, the acoustic differences suggest decreased arousal and/or a decreased response to pain for healthy infants recorded in the prone position. CONCLUSIONS: As decreased arousal and prone positioning have been seen as possible causative factors for SIDS, the current results are seen as a successful step in evaluating the possibility of using acoustic analysis of infant cries as a means of evaluating SIDS risk for healthy infants.

11: Milstein JM, Raingruber B.
Choreographing the end of life in a neonate.
Am J Hosp Palliat Care. 2007 Oct-Nov;24(5):343-9.

Department of Pediatrics, Division of Neonatology, University of California. jmmilstein@ucdavis.edu.

As caregivers, we often have the privilege of accompanying patients and their families at the end of life. When the patients are newborn infants, the parents are totally unprepared cognitively, emotionally, and spiritually. Their experience represents uncharted territory. The concept of uncharted territory probably applies to everyone facing the death of a loved one for the first time for both the patients and their families. Providing some guidance to patient/family dyads, while simultaneously respecting their autonomy, may be helpful to facilitate healing and meaning construction during the process of bereavement. In applying an integrative universal paradigm of care when curative measures elude us, healing measures become of paramount importance. An exemplar involving a neonate is presented in this commentary; however, healing measures are relevant to patients of all ages as well as to their loved ones.

12: Thum MY, El-Sheikhah A, Faris R, Parikh J, Wren M, Ogunyemi T, Gafar A, Abdalla, H.
The influence of body mass index to in-vitro fertilisation treatment outcome, risk of miscarriage and pregnancy outcome.
J Obstet Gynaecol. 2007 Oct;27(7):699-702.

The Lister Fertility Clinic, Lister Hospital, London, UK.

The aim of this work was to evaluate the effects of extreme body mass index (BMI) on assisted reproductive treatment outcome and pregnancy outcome. This is a descriptive cohort study that evaluated 8,145 consecutive in-vitro fertilisation/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles in which BMI were known, from July 1997 to June 2005 in an inner London major fertility clinic. The data were collected prospectively and analysed retrospectively on women undergoing IVF/ICSI and ET. Patients' weight and height were established prior to treatment. IVF/ICSI treatment was then started using either a long or an antagonist protocol. Patients were divided into five groups: Group A (BMI < 19); Group B (BMI between 19 and 25.9); Group C (BMI between 26 and 30.9); Group D (BMI between 31 and 35.9); Group E (BMI > 36). The main outcomes measured were number of eggs collected, fertilisation rate, number of embryos available for transfer, pregnancy rate (PR), live-birth rate (LBR) and miscarriage rate (MR). The results showed no significant difference in the average number of days taking follicle stimulating hormone (FSH) for ovarian stimulation, the average amount of gonadotrophin used for stimulation, number of eggs collected and fertilisation rate. The pregnancy rate, miscarriage rate and the live-birth rate were not statistically different between all groups. However, in group E the miscarriage rate was significantly higher and the LBR was statistically lower compared with group B. We concluded that extreme BMI did not affect the super-ovulation outcome fertilisation rate and pregnancy rate. Women with a BMI > 35 had a higher miscarriage rate and hence a lower live-birth rate, but a reasonable pregnancy and live-birth rate can be achieved. For women with a BMI < 20 there was no difference in assisted reproduction treatment (ART) outcome and pregnancy outcome when compared with women with a normal BMI. This information should be used to advise patients who wish to embark on ART with extreme BMI.

13: Hack KE, Derks JB, Elias SG, Franx A, Roos E, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GH.
Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study.
BJOG. 2007 Nov 12; [Epub ahead of print]

Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.

Objective: To evaluate mortality and morbidity in a large cohort of twin pregnancies according to chorionicity. We aimed to estimate the optimal time of delivery. Design Historical cohort design. Setting Two teaching hospitals. Population Twin pregnancies delivered in the University Medical Centre, Utrecht, and the St Elisabeth Hospital, Tilburg (1995-2004), The Netherlands (n = 1407). Methods Pregnancy outcomes were documented according to chorionicity. Mortality >/=32 weeks was reviewed carefully with special attention to antenatal fetal monitoring, autopsy and placental histopathology to find an explanation for adverse outcome. Main outcome measures Perinatal mortality and morbidity in monochorionic (MC) and dichorionic (DC) twins. Results Perinatal mortality was 11.6% in MC twin pregnancies and 5.0% in DC twin pregnancies. After 32 weeks, the risk of intrauterine death (IUD) was significantly higher in MC twins than in DC twins (hazard ratio 8.8, 95% CI 2.7-28.9). In most of these cases of IUD, no antenatal signs of impaired fetal condition had been present. Median gestational age was 1 week longer in DC twins than in MC twins, and the mean birthweight was 221 g higher. Severe birthweight discordancy (>20%) occurred more often in MC twins than in DC twins (OR 1.23, 95% CI 0.97-1.55). The incidence of necrotising enterocolitis (NEC) was higher in MC twins, after adjustment for age and weight at birth (OR 4.05, 95% CI 1.97-8.35). There was a trend towards higher neuromorbidity in MC twins. Conclusions This is the largest cohort study of twin pregnancies evaluating outcome according to chorionicity thus far. MC twins are at increased risk for fetal death (even at term), NEC and neuromorbidity. Current antenatal care is insufficient to predict and prevent this excess perinatal mortality and morbidity. Planned delivery at or even before 37 weeks of gestation seems to be justified for MC twins.

14: Henderson J, Kesmodel U, Gray R.
Systematic review of the fetal effects of prenatal binge-drinking.
J Epidemiol Community Health. 2007 Dec;61(12):1069-1073.
Clinical Epidemiologist, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; ron.gray@npeu.ox.ac.uk.

OBJECTIVE: The effects of binge-drinking during pregnancy on the fetus and child have been an increasing concern for clinicians and policy-makers. This study reviews the available evidence from human observational studies. DESIGN: Systematic review of observational studies. Population: Pregnant women or women who are trying to become pregnant. METHODS: A computerised search strategy was run in Medline, Embase, Cinahl and PsychInfo for the years 1970-2005. Titles and abstracts were read by two researchers for eligibility. Eligible papers were then obtained and read in full by two researchers to decide on inclusion. The papers were assessed for quality using the Newcastle-Ottawa Quality Assessment Scales and data were extracted. MAIN OUTCOME MEASURES: Adverse outcomes considered in this study included miscarriage; stillbirth; intrauterine growth restriction; prematurity; birth-weight; small for gestational age at birth; and birth defects, including fetal alcohol syndrome and neurodevelopmental effects. RESULTS: The search resulted in 3630 titles and abstracts, which were narrowed down to 14 relevant papers. There were no consistently significant effects of alcohol on any of the outcomes considered. There was a possible effect on neurodevelopment. Many of the reported studies had methodological weaknesses despite being assessed as having reasonable quality. CONCLUSIONS: This systematic review found no convincing evidence of adverse effects of prenatal binge-drinking, except possibly on neurodevelopmental outcomes.

Prepared by the
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