NSIDRC Journal Article Alert — January 25, 2008
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 often limited to
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Infant Death
1: Supplementation with Multiple Micronutrients Intervention
Trial (SUMMIT) Study Group, Shankar AH, Jahari AB, Sebayang
SK, Aditiawarman , Apriatni M, Harefa B, Muadz H, Soesbandoro
SD, Tjiong R, Fachry A, Shankar AV, Atmarita , Prihatini S,
Sofia G.
Effect of maternal multiple micronutrient supplementation on
fetal loss and infant death in Indonesia: a double-blind cluster-randomised
trial.
Lancet. 2008 Jan 19;371(9608):215-27.
Helen Keller International, Jakarta, Indonesia; Johns Hopkins
University, Baltimore, MD, USA.
BACKGROUND: Maternal nutrient supplementation in developing
countries is generally restricted to provision of iron and
folic acid (IFA). Change in practice toward supplementation
with multiple micronutrients (MMN) has been hindered by little
evidence of the effects of MMN on fetal loss and infant death.
We assessed the effect of maternal supplementation with MMN,
compared with IFA, on fetal loss and infant death in the setting
of routine prenatal care services. METHODS: In a double-blind
cluster-randomised trial in Lombok, Indonesia, we randomly
assigned 262 midwives to distribute IFA (n=15 ,86) or MMN (n=15,804)
supplements to 31 290 pregnant women through government prenatal
care services that were strengthened by training and community-based
advocacy. Women obtained supplements, to be taken daily, every
month from enrolment to 90 days post partum. The primary outcome
was early infant mortality (deaths until 90 days post partum).
Secondary outcomes were neonatal mortality, fetal loss (abortions
and stillbirths), and low birthweight. Analysis was by intention
to treat. The study is registered as an International Standard
Randomised Controlled Trial, number ISRCTN34151616. FINDINGS:
Infants of women consuming MMN supplements had an 18% reduction
in early infant mortality compared with those of women given
IFA (35.5 deaths per 1000 livebirths vs 43 per 1000; relative
risk [RR] 0.82, 95% CI 0.70-0.95, p=0.010). Infants whose mothers
were undernourished (mid upper arm circumference <23.5 cm)
or anaemic (haemoglobin <110 g/L) at enrolment had a reduction
in early infant mortality of 25% (RR 0.75, 0.62-0.90, p=0.0021)
and 38% (RR 0.62, 0.49-0.78, p<0.0001), respectively. Combined
fetal loss and neonatal deaths were reduced by 11% (RR 0.89,
0.81-1.00, p=0.045), with significant effects in undernourished
(RR 0.85, 0.73-0.98, p=0.022) or anaemic (RR 0.71, 0.58-0.87,
p=0.0010) women. A cohort of 11 101 infants weighed within
1 h of birth showed a 14% (RR 0.86, 0.73-1.01, p=0.060) decreased
risk of low birthweight for those in the MMN group, with a
33% (RR 0.67, 0.51-0.89, p=0.0062) decrease for infants of
women anaemic at enrolment. INTERPRETATION: Maternal MMN supplementation,
as compared with IFA, can reduce early infant mortality, especially
in undernourished and anaemic women. Maternal MMN supplementation
might therefore be an important part of overall strengthening
of prenatal-care programmes.
2 : Woodruff TJ, Darrow LA, Parker JD.
Air pollution and postneonatal infant mortality in the United
States, 1999-2002.
Environ Health Perspect. 2008 Jan;116(1):110-5.
Department of Obstetrics, Gynecology, and Reproductive Sciences,
University of California, San Francisco, California, USA.
OBJECTIVE: Our goal was to evaluate the relationship between
cause-specific postneonatal infant mortality and chronic early-life
exposure to particulate matter and gaseous air pollutants across
the United States. METHODS: We linked county-specific monitoring
data for particles with aerodiameter of </= 2.5 mum (PM(2.5))
and </= 10 mum (PM(10)), ozone, sulfur dioxide, and carbon
monoxide to birth and death records for infants born from 1999
to 2002 in U.S. counties with > 250,000 residents. For each
infant, we calculated the average concentration of each pollutant
over the first 2 months of life. We used logistic generalized
estimating equations to estimate odds ratios of postneonatal
mortality for all causes, respiratory causes, sudden infant
death syndrome (SIDS), and all other causes for each pollutant,
controlling for individual maternal factors (race, marital
status, education, age, and primiparity), percentage of county
population below poverty, region, birth month, birth year,
and other pollutants. This analysis includes about 3.5 million
births, with 6,639 postneonatal infant deaths. RESULTS: After
adjustment for demographic and other factors and for other
pollutants, we found adjusted odds ratios of 1.16 [95% confidence
interval (CI), 1.06-1.27] for a 10-mug/m(3) increase in PM(10)
for respiratory causes and 1.20 (95% CI, 1.09-1.32) for a 10-ppb
increase in ozone and deaths from SIDS. We did not find relationships
with other pollutants and for other causes of death (control
category). CONCLUSIONS: This study supports particulate matter
air pollution being a risk factor for respiratory-related postneonatal
mortality and suggests that ozone may be associated with SIDS
in the United States.
3: Luke B, Brown MB.
Maternal morbidity and infant death in twin vs triplet and
quadruplet pregnancies.
Am J Obstet Gynecol. 2008 Jan 4 [Epub ahead of print]
University of Miami School of Nursing and Health Studies,
Coral Gables, and the Departments of Obstetrics & Gynecology
and Pediatrics, Miller School of Medicine, University of Miami,
Miami, FL.
OBJECTIVE: The purpose of this study was to calculate nationally
representative, population-based estimates of maternal and
neonatal risks in triplet and quadruplet pregnancies compared
with twin pregnancies. STUDY DESIGN: The study population included
316,696 twin, 12,193 triplet, and 778 quadruplet pregnancies
from the 1995-2000 Matched Multiple Birth Data Set. Adjusted
odds ratios (AORs) and 95% CIs estimated the risk of complications
and were controlled for maternal age, race, parity, and smoking
status. RESULTS: Compared with mothers of twins, mothers of
triplets and quadruplets were more likely to be diagnosed with
preterm premature rupture of membranes (AORs, 1.53, 1.74, respectively),
pregnancy-associated hypertension (AORs, 1.22, 1.27), and excessive
bleeding (AORs, 1.50, 2.22), to require tocolysis (AORs, 2.85,
5.03), and to be delivered by cesarean (AORs, 6.55, 7.38) at <29
weeks of gestation (AORs, 3.76, 7.96), and to have >/=1
infants die (AORs, 3.02, 4.07). CONCLUSION: Triplet and quadruplet
pregnancies have significantly higher risks than twin pregnancies
for most maternal and neonatal complications. Maternal anthropometric,
nutritional, and previous reproductive factors may be particularly
important in the reduction of these excess risks and improvement
of outcomes in multiple births.
Bereavement
1: Chan MF, Lou FL, Arthur DG, Cao FL, Wu LH, Li P, Sagara-Rosemeyer
M, Chung LY, Lui L.
Investigating factors associate to nurses' attitudes towards
perinatal bereavement care.
J Clin Nurs. 2008 Feb;17(4):509-18.
School of Nursing, Hong Kong Polytechnic University, Hong
Kong SAR, China.
Aim. The purpose of this study was to explore nurses' attitudes
towards perinatal bereavement care and to identify factors
associate with such attitudes. Background. Caring for and supporting
parents whose infant has died is extremely demanding, difficult
and stressful. It is likely that the attitude of nursing staff
can influence recovery from a pregnancy loss and nurses with
positive attitude to bereavement care can help bereaved parents
to cope during their grieving period. Method. Data were collected
through a structured questionnaire; 334 nurses were recruited
(63% response rate) from the Obstetrics and Gynaecology unit
in five hospitals in Hong Kong during May-August 2006. Outcome
measures including attitudes towards perinatal bereavement
care, importance on hospital policy and training support for
bereavement care. Results. Majority of nurses in this study
held a positive attitude towards bereavement care. Results
showed that only 39.3% (n = 130) of nurses had bereavement
related training. By contrast, about 89.8% of nurses (n = 300)
showed they need to be equipped with relevant knowledge, skills
and understanding in the care and support of bereaved parents
and more than 88.0% (n = 296) would share experiences with
colleagues and seek support when feeling under stress. Regression
model showed that age, past experience in handling grieving
parents and nurses' perceived attitudes to hospital policy
and training provided for bereavement cares were factors associate
with nurses' attitudes towards perinatal bereavement care.
Conclusions. Hong Kong nurses emphasized their need for increased
knowledge and experience, improved communication skills and
greater support from team members and the hospital for perinatal
bereavement care. Relevance to clinical practice. These findings
may be used for health policy makers and nursing educators
to ensure delivery of sensitive bereavement care in perinatal
settings and to enhance nursing school curricula respectively.
Miscarriage/Stillbirth/Prenatal Issues
1: Bick RL.
Antiphospholipid syndrome in pregnancy.
Hematol Oncol Clin North Am. 2008 Feb;22(1):107-20.
10455 North Central Expressway, Suite 109-320, Dallas, TX
75231, USA.
During the past 5 years the author and his colleagues have
assessed carefully 351 women referred for evaluation of thrombosis
and hemostasis after they had suffered recurrent miscarriages.
This article describes the flow protocol the author and associates
follow to maximize success and keep the costs of evaluation
of recurrent miscarriage syndrome/infertility at a minimum
while providing the best chances for defining a cause and thus
providing optimal therapy for successful term pregnancy outcome.
It presents the outcomes of the author's protocol and those
of others in treating women who have antiphospholipid syndrome
and who have suffered recurrent miscarriages.
2: Harper J, Sermon K, Geraedts J, Vesela K, Harton G, Thornhill
A, Pehlivan T, Fiorentino F, Sengupta S, de Die-Smulders C,
Magli C, Moutou C, Wilton L.
What next for preimplantation genetic screening?
Hum Reprod. 2008 Jan 17 [Epub ahead of print]
UCL Centre for PGD, Institute for Women's Health, University
College London, 86-96 Chenies Mews, WC1E6HX London, UK.
Preimplantation genetic diagnosis for aneuploidy screening
(preimplantation genetic screening-PGS) has been used to detect
chromosomally normal embryos from subfertile patients. The
main indications are advanced maternal age (AMA), repeated
implantation failure, repeated miscarriages and severe male
factor infertility. Many non-randomized PGS studies have been
published and report an increase in implantation rate, and/or
a decrease in miscarriage rate. Recently, two randomized controlled
trials have been conducted on patients with AMA as the only
indication. Neither study showed a benefit in performing PGS
using live birth rate as the measure of success. The debate
on the usefulness of PGS is ongoing; the only effective way
to resolve the debate is to perform more well-designed and
well-executed randomized clinical trials.
3: Rawlinson WD, Hall B, Jones CA, Jeffery HE, Arbuckle SM,
Graf N, Howard J, Morris JM.
Viruses and other infections in stillbirth: what is the evidence
and what should we be doing?
Pathology. 2008 Apr;40(2):149-60.
Virology Division, Microbiology SEALS, Prince of Wales Hospital,
Randwick.
In Australia, as in other developed countries, approximately
40-50% of stillbirths are of unknown aetiology. Emerging evidence
suggests stillbirths are often multifactorial. The absence
of a known cause leads to uncertainty regarding the risk of
recurrence, which can cause extreme anguish for parents that
may manifest as guilt, anger or bewilderment. Further, clinical
endeavours to prevent recurrences in future pregnancies are
impaired by lack of a defined aetiology. Therefore, efforts
to provide an aetiological diagnosis of stillbirth impact upon
all aspects of care of the mother, and inform many parts of
clinical decision making. Despite the magnitude of the problem,
that is 7 stillbirths per 1000 births in Australia, diagnostic
efforts to discover viral aetiologies are often minimal. Viruses
and other difficult to culture organisms have been postulated
as the aetiology of a number of obstetric and paediatric conditions
of unknown cause, including stillbirth. Reasons forwarded for
testing stillbirth cases for infectious agents are non-medical
factors, including addressing all parents' need for diagnostic
closure, identifying infectious agents as a sporadic cause
of stillbirth to reassure parents and clinicians regarding
risk for future pregnancies, and to reduce unnecessary testing.
It is clear that viral agents including rubella, human cytomegalovirus
(CMV), parvovirus B19, herpes simplex virus (HSV), lymphocytic
choriomeningitis virus (LCMV), and varicella zoster virus (VZV)
may cause intrauterine deaths. Evidence for many other agents
is that minimal or asymptomatic infections also occur, so improved
markers of adverse outcomes are needed. The role of other viruses
and difficult-to-culture organisms in stillbirth is uncertain,
and needs more research. However, testing stillborn babies
for some viral agents remains a useful adjunct to histopathological
and other examinations at autopsy. Modern molecular techniques
such as multiplex PCR, allow searches for multiple agents.
Now that such testing is available, it is important to assess
the clinical usefulness of such testing.
4: Esteves SC, Schneider DT, Verza S Jr.
Influence of antisperm antibodies in the semen on intracytoplasmic
sperm injection outcome.
Int Braz J Urol. 2007 Nov-Dec;33(6):795-802.
Androfert, Male Reproduction Reference Center, Campinas, Sao
Paulo, Brazil.
Objective: The aim of this study was to analyze the influence
of autoantibodies against spermatozoa present in the semen
on the outcome of in vitro fertilization with intracytoplasmic
sperm injection (ICSI). Materials and Methods: We performed
a retrospective analysis of clinical and laboratorial data
from a six year-period ICSI cycles. Screening for the presence
of ASA in the semen, by using the direct immunobeads test (IBT),
was available for 351 cycles. According to the percentage of
antibody-bound spermatozoa in the semen, we divided the cycles
in four groups: I (n = 194): 0%-10% ASA; II (n = 107): 11%-20%;
III (n = 33): 21%-50% and IV (n = 17): 51%-100% ASA. Additionally,
a group of 349 ICSI cycles performed with ejaculated spermatozoa
from oligo/asthenozoospermic men who had insufficient number
of motile sperm available for ASA screening was included for
comparison. ICSI outcomes were compared among groups and included
fertilization rate (2 PN), cleavage rate, cleavage velocity,
embryo quality, clinical pregnancy and miscarriage rates. Data
were examined statistically, with an alpha level of 5% considered
significant. Results: Fertilization, cleavage rate and velocity,
percentage of good quality embryos, as well as clinical pregnancy
and miscarriage rates did not differ among different ASA levels
groups. ICSI outcomes in men exhibiting different levels of
autoimmunity against spermatozoa did not differ from those
with severely abnormal seminal parameters. Conclusions: Our
data indicate that intracytoplasmic sperm injection (ICSI)
outcomes are not influenced by ASA levels on sperm.
5: Hadden DR.
Prediabetes and the big baby.
Diabet Med. 2008 Jan;25(1):1-10.
The Sir George E Clark Metabolic Unit, Royal Victoria Hospital,
Belfast, UK. david.hadden@royalhospitals.n-i.nhs.uk
The concept of prediabetes has come to the fore again with
the worldwide epidemic of Type 2 diabetes. The careful observations
of W. P. U. Jackson and his colleagues in Cape Town, South
Africa 50 years ago still deserve attention. Maternal hyperglycaemia
cannot be the only cause of fetal macrosomia, and the pathophysiological
reason for the unexplained stillbirth in late diabetic pregnancy
still eludes us. The biochemical concepts of 'facilitated anabolism'
and 'accelerated starvation' were developed by Freinkel as
explanations of the protective mechanisms for the baby during
the stresses of pregnancy. Some of these nutritional stresses
may also occur in the particular form of early childhood malnutrition
known in Africa as kwashiorkor, where subcutaneous fat deposition,
carbohydrate intolerance, islet hyperplasia and sudden death
may follow a period of excess carbohydrate and deficient protein
intake. Different feeding practices in different parts of the
world make comparisons uncertain, but there is evidence for
insulin resistance in both the macrosomic fetus of the hyperglycaemic
mother and in the child with established kwashiorkor. These
adaptive changes in early development may play both a physiological
and a pathological role. Worldwide studies of hyperglycaemia
in pregnancy are gradually establishing acceptable diagnostic
criteria, appropriate screening procedures and an evidence
base for treatment. Nevertheless the challenge of prediabetes
and the big baby is still with us--in Jackson's words--'diabetes
mellitus is a fascinating condition-the more we know about
it the less we understand it'.
Prepared by the
National Sudden Infant Death Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
(866) 866-7437 toll free
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