NSIDRC Journal Article Alert — February 15, 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 subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details.

Sudden Infant Death

1. Highet AR.
An infectious aetiology of sudden infant death syndrome.
J Appl Microbiol. 2008 Feb 6 [Epub ahead of print]

Department of Microbiology and Infectious Diseases, Children, Youth and Women’s
Health Service, Women’s and Children’s Hospital, North Adelaide, SA, Australia
and Discipline of Paediatrics, School of Paediatrics and Reproductive Health,
Faculty of Health Sciences, University of Adelaide, SA, Australia.

Due attention has been given to infectious agents and immune responses to infection in sudden infant death syndrome (SIDS). It has been acknowledged that the pathological, epidemiological and genotypic findings in SIDS infants suggest an infectious aetiology possibly being potentiated by immunoregulatory polymorphisms, however, the cause of SIDS is a mystery and remains open to debate. Consistent pathological findings are seen which display similarities to the pathogenesis of toxaemic shock and/or sepsis. The major risk factors for SIDS parallel those for increased colonization and serious bacterial infections and the natural variation in the incidence of SIDS cases is typical of an infectious disease. The roles played by viral infection, immunoregulatory genes and suspected bacterial species are discussed herein.

Bereavement

1. Leighton S.
Bereavement therapy with adolescents: facilitating a process of spiritual growth.
J Child Adolesc Psychiatr Nurs. 2008 Feb;21(1):24-34.

South Staffordshire Healthcare NHS Trust, UK.

TOPIC: Bereavement therapy as a catalyst for spiritual growth. PURPOSE: This study aims to review the literature and reflect on the bereavement therapy undertaken with two adolescents who had been bereaved during childhood. SOURCES: Research articles and books identified through a combination of electronic and manual searches. CONCLUSIONS: It would appear that grief therapy could facilitate spiritual growth in such circumstances. Further in-depth studies are required to identify how typical or atypical this experience is, and to contribute to the evidence base for working with bereaved children and adolescents.

2. Jenewein J, Moergeli H, Fauchère JC, Bucher HU, Kraemer B, Wittmann L, Schnyder
U, Büchi S.
Parents' mental health after the birth of an extremely preterm child: A comparison between bereaved and non-bereaved parents.
J Psychosom Obstet Gynaecol. 2008 Mar;29(1):53-60.

Department of Psychiatry, University Hospital, Zurich, Switzerland.

Objective. To assess the impact of extremely preterm birth (24-26 weeks of gestation) on the mental health of parents two to six years after delivery, and to examine potential differences in post-traumatic growth between parents whose newborn infant died and those whose child survived. Method. A total of 54 parents who had lost their newborn and 38 parents whose preterm child survived were assessed by questionnaires with regard to depression and anxiety (HADS) and post-traumatic growth (PTGI). Results. Neither group of parents had clinically relevant levels of depression and anxiety. Mothers showed higher levels of anxiety than fathers. Bereaved parents with no other, living child reported higher levels of depression than bereaved parents with one or more children. Mothers reported higher post-traumatic growth compared to fathers. In particular, bereaved mothers experienced the value and quality of their close social relationships more positively compared to the non-bereaved parents. Conclusion. In the long term, bereaved and non-bereaved parents cope reasonably well with an extremely preterm birth of a child. Post-traumatic growth appears to be positively related to bereavement, particularly in mothers.

Miscarriage/Stillbirth/Prenatal Issues

1. Dixit A, Girling JC.
Obesity and pregnancy.
J Obstet Gynaecol. 2008 Jan;28(1):14-23.

Maternal Medicine, Chelsea and Westminster and West Middlesex University
Hospital.

Obesity is reaching pandemic proportions worldwide. It is increasingly being recognised as a risk factor during pregnancy. Women should ideally be counselled preconceptionally about the increased risks and encouraged to lose weight actively, some may be candidates for bariatric surgery. Maternal risks include gestational diabetes, hypertension and pre-eclampsia, increased incidence of operative delivery, postpartum haemorrhage, anaesthetic risks as well as infective and thrombo-embolic complications while fetal risks include miscarriage, neural-tube defects, macrosomia and stillbirth. Obstetric units should institute appropriate guidelines for the management of pregnancy in this 'high-risk' group of women.

2. Harrison PA, Sidebottom AC.
Systematic prenatal screening for psychosocial risks.
J Health Care Poor Underserved. 2008;19(1):258-76.

The Prenatal Risk Overview (PRO) was designed to screen for 13 psychosocial risk factors associated with poor birth outcomes. This study describes the development and implementation of the PRO in 4 community health centers. The study also examines the prevalence, co-occurrence, and inter-correlations of psychosocial risks in their prenatal populations. The study sample included 1,386 prenatal patients screened between November 2005 and April 2007; 95% were women of color; 77% were not married. The PRO classified 48% at moderate or high risk for housing instability; 32% for food insecurity; 75% for lack of social support; 7% for intimate partner violence; 9% for other physical/sexual abuse; 18% for depression; 23% for cigarette use, 23% for alcohol use, and 25% for drug use. Systematically assessing and quantifying psychosocial risks are essential activities for evaluating the extent to which appropriate and timely responses to identified risks reduce infant mortality, preterm births, and low birth weights.

3. Poon LC, Kametas NA, Pandeva I, Valencia C, Nicolaides KH.
Mean Arterial Pressure at 11+0 to 13+6 Weeks in the Prediction of Preeclampsia.
Hypertension. 2008 Feb 7 [Epub ahead of print]

Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital,
London, United Kingdom.

This study aimed to determine the performance of screening for preeclampsia (PE) by maternal medical history and mean arterial pressure (MAP) at 11(+0) to 13(+6) weeks. In 5590 women with singleton pregnancies attending for routine care at 11(+0) to 13(+6) week's gestation we recorded maternal variables and measured the MAP. We excluded 397 because they had missing outcome data or the pregnancies resulted in miscarriage or termination. In 104 patients there was subsequent development of PE, 97 developed gestational hypertension, 574 delivered small-for-gestational-age newborns, and 4418 were unaffected by PE, gestational hypertension, or small for gestational age. A multivariate Gaussian model was fitted to the distribution of log multiple of the median MAP in the PE and unaffected groups. Likelihood ratios for log multiple of the median MAP were computed and used together with maternal variables to produce patient-specific risks for each case. Detection rates and false-positive rates were calculated by taking the proportions with risks above a given risk threshold. In the unaffected group, log MAP was influenced by maternal age, ethnic origin, smoking, family and personal history of PE, and fetal crown-rump length. In the prediction of PE, significant contributions were provided by log multiple of the median MAP, ethnic origin, body mass index, and personal history of PE. The detection rate of PE by log multiple of the median MAP and maternal variables was 62.5% for a false-positive rate of 10%. Maternal variables, together with MAP, at 11(+0) to 13(+6) weeks identify a group at high risk for development of PE.

Prepared by the
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