NSIDRC Journal Article Alert — March 7, 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.
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Sudden Infant Death
1: Jenkins RO.
Mattress risk factors for the sudden infant death syndrome
and dust-mite allergen (der p 1) levels.
Allergy Asthma Proc. 2008 Jan-Feb;29(1):45-50.
School of Allied Health Sciences, De Montfort University,
The Gateway, Leicester, United Kingdom.
Allergen-induced anaphylaxis has been suggested as a possible
etiology for sudden infant death syndrome (SIDS). Some of the
measures recommended for reducing the risk of allergen exposure
also are recommended for reducing the risk of SIDS. The purpose
of this study is to evaluate possible associations between
dust-mite allergen (der p 1) levels within cot (crib) mattresses
and established cot mattress risk factors for SIDS. Dust from
polyurethane foam was extracted from two regions of used cot
mattresses donated by 28 households in Leicester (United Kingdom)
and der p 1 allergen levels estimated using a two-site monoclonal
antibody system. Infant and cot environment-related factors
were determined via parental questionnaire. For the infants'
head region of the mattresses, the following associations were
independently significant following multivariate analysis:
quantity of dust extracted, with older mattresses (p = 0.014);
high allergen concentrations (der p 1 per mg dust), with high
frequency of minor ailments (p < 0.001) and older infants
(p = 0.044); and high total der p 1 content, with high frequency
of minor ailments (p = 0.014). There were no independently
significant associations between levels of der p 1 in polyurethane
foam and the established cot mattress risk factors for SIDS.
Although der p 1 accumulates within polyurethane foam of cot
mattresses with use over time, this does not provide a valid
mechanistic explanation for the established cot mattress-related
risk factors for SIDS. There is an association between der
p 1 levels of cot mattress polyurethane foam and frequency
of minor ailments; additional research is required to establish
cause and effect.
Other Infant Death
1: Semba RD, de Pee S, Sun K, Best CM, Sari M, Bloem MW.
Paternal Smoking and Increased Risk of Infant and Under-5 Child
Mortality in Indonesia.
Am J Public Health. 2008 Feb 28 [Epub ahead of print]
Johns Hopkins School of Medicine.
We examined the relationship between paternal smoking and
child mortality. Among 361 021 rural and urban families in
Indonesia, paternal smoking was associated with increased infant
mortality (rural, odds ratio [OR]=1.30; 95% confidence interval
[CI]=1.24, 1.35; urban, OR= 1.10; 95% CI=1.01, 1.20), and under-5
child mortality (rural, OR=1.32; 95% CI=1.26, 1.37; urban,
OR= 1.14; 95% CI=1.05, 1.23). Paternal smoking diverts money
from basic necessities to cigarettes and adversely affects
child health; tobacco control should therefore be considered
among strategies to improve child survival.
2: Howell EA.
Racial disparities in infant mortality: A quality of care perspective.
Mt Sinai J Med. 2008 Feb 27;75(1):31-35 [Epub ahead of print]
Departments of Health Policy and Obstetrics, Gynecology, and
Reproductive Science, Mount Sinai School of Medicine, New York
City, NY 10029-6574.
Black infants in the United States are more than twice as
likely to die as White infants in the first year of life. Reducing
the existing racial disparity in infant mortality rates is
a major health policy focus. Despite decades of research aimed
at reducing preterm births, our efforts have been largely unsuccessful.
Much greater success has been achieved in reducing the morbidity
and mortality of premature infants, largely through improvements
in obstetrical and neonatal care. However, it is an open question
whether such improvements have reduced racial disparities in
infant mortality. In this article, we recommend a new framework
for addressing infant mortality disparities. We suggest that
a quality of care problem may partially underlie racial disparities
in infant mortality rates. Mt Sinai J Med 75:31-35, 2008. (c)
2008 Mount Sinai School of Medicine.
3: Krieger N, Rehkopf DH, Chen JT, Waterman PD, Marcelli E,
Kennedy M.
The fall and rise of US inequities in premature mortality:
1960-2002.
PLoS Med. 2008 Feb;5(2):e46.
Department of Society, Human Development and Health, Harvard
School of Public Health, Boston, Massachusetts, USA. nkrieger@hsph.harvard.edu
BACKGROUND: Debates exist as to whether, as overall population
health improves, the absolute and relative magnitude of income-
and race/ethnicity-related health disparities necessarily increase-or
decrease. We accordingly decided to test the hypothesis that
health inequities widen-or shrink-in a context of declining
mortality rates, by examining annual US mortality data over
a 42 year period. METHODS AND FINDINGS: Using US county mortality
data from 1960-2002 and county median family income data from
the 1960-2000 decennial censuses, we analyzed the rates of
premature mortality (deaths among persons under age 65) and
infant death (deaths among persons under age 1) by quintiles
of county median family income weighted by county population
size. Between 1960 and 2002, as US premature mortality and
infant death rates declined in all county income quintiles,
socioeconomic and racial/ethnic inequities in premature mortality
and infant death (both relative and absolute) shrank between
1966 and 1980, especially for US populations of color; thereafter,
the relative health inequities widened and the absolute differences
barely changed in magnitude. Had all persons experienced the
same yearly age-specific premature mortality rates as the white
population living in the highest income quintile, between 1960
and 2002, 14% of the white premature deaths and 30% of the
premature deaths among populations of color would not have
occurred. CONCLUSIONS: The observed trends refute arguments
that health inequities inevitably widen-or shrink-as population
health improves. Instead, the magnitude of health inequalities
can fall or rise; it is our job to understand why.
Bereavement
1: Rogers S, Babgi A, Gomez C.
Educational Interventions in End-of-Life Care: Part I: An Educational
Intervention Responding to the Moral Distress of NICU Nurses
Provided by an Ethics Consultation Team.
Adv Neonatal Care. 2008 Feb;8(1):56-65.
1The Georgetown School of Nursing and Health Studies, Washington,
D.C.; 2The George Mason School of Nursing and Health Science,
Fairfax, VA; 3The District of Columbia Pediatric Palliative
Care Collaborative, Washington, D.C.
PURPOSE: This study was conducted to assess whether neonatal
nurses who care for dying infants could be assisted in their
knowledge and comfort via an educational intervention provided
by hospital ethics committee members and hospice specialists.
PARTICIPANTS: Eighty-two registered nurses working in a level
III neonatal intensive care unit (NICU) were included. METHODS
AND DESIGN: This was a quantitative pretest, intervention,
post-test design with a single group undergoing educational
sessions in the 6 areas of pain management, symptom management,
ethical/legal issues, communication/culture, spiritual/anxiety,
and prevention of compassion fatigue. MAIN OUTCOME MEASUREMENTS:
An instrument, "Comfort in Caring for Dying Infants" (CLCDI),
was developed to assess pre- and posteducational knowledge
and comfort in these areas. RESULTS: There were statistically
significant higher levels of comfort and knowledge in care
for dying infants in the areas of ethical/legal issues and
symptom management after the educational programs. Although
not statistically significant, mean scores were higher after
the educational sessions on pain management, spirituality/anxiety,
and prevention of compassion fatigue. The communication/culture
module scores were lower in the post-test administration. CONCLUSIONS:
Education by hospice experts in the NICU can assist nurses'
comfort with care of the dying infant. In addition, ongoing
support is highly desirable for all staff participating in
such care. The authors suggest incident debriefings from outside
experts, debriefing after each infant's death, multidisciplinary
meetings for the whole team, and having sessions of lessons
learned on infant death cases.
Miscarriage/Stillbirth/Prenatal Issues
1: Nabukera SK, Wingate MS, Owen J, Salihu HM, Swaminathan
S, Alexander GR, Kirby RS.
Racial Disparities in Perinatal Outcomes and Pregnancy Spacing
Among Women Delaying Initiation of Childbearing.
Matern Child Health J. 2008 Mar 4 [Epub ahead of print]
Department of Maternal and Child Health, School of Public
Health, University of Alabama at Birmingham, 1665 University
Blvd. Room 320, Birmingham, AL, 35294, USA, nabukera@uab.edu.
Introduction Reducing racial/ethnic disparities is a key objective
of the Healthy People 2010 initiative. Unfortunately, racial
disparities among women delaying initiation of childbearing
have received limited attention. As more women in the US are
delaying initiation of childbearing, it is important to examine
racial disparities in reproductive health outcomes for this
subgroup of women. Objective To examine racial disparities
in perinatal outcomes, interpregnancy interval, and to assess
the risk for adverse outcomes in subsequent pregnancy for women
delaying initiation of childbearing until age 30 or older compared
to those initiating childbearing at age 20-29. Methods We conducted
a retrospective cohort study using the Missouri maternally
linked cohort files 1978-1997. Final study sample included
239,930 singleton sibling pairs (Whites and African Americans).
Outcome variables included first and second pregnancy outcomes
(fetal death, low birth weight, preterm delivery and small-for-gestational
age) and interpregnancy interval between first and second pregnancy.
Independent variables included maternal age at first pregnancy
and race. Analysis strategies used involved stratified analyses
and multivariable unconditional logistic regression; interactions
between maternal race, age and interpregnancy interval were
examined in the regression models. Results Compared to Whites,
African American mothers initiating childbearing at age 30
or older had significantly higher rates of adverse outcomes
in the first and second pregnancy (P < 0.0001). Generally,
African Americans had significantly higher rates of second
pregnancy following intervals <6 months compared to Whites;
however, no significant racial differences were noted in interpregnancy
interval distribution pattern after controlling for maternal
age at first pregnancy. African Americans delaying initiation
of childbearing had significantly higher risk for adverse perinatal
outcomes in the second pregnancy compared to Whites after controlling
for potential confounders, however there were no significant
interactions between maternal age at first pregnancy, race
and short interpregnancy interval. Conclusion Although African
Americans were less likely to delay initiation of childbearing
than were White women, their risk for adverse perinatal outcomes
was much greater. As health care providers strive to address
racial disparities in birth outcomes, there is need to pay
attention to this unique group of women as their population
continues to increase.
2: Aliyu MH, Salihu HM, Wilson RE, Kirby RS.
Prenatal smoking and risk of intrapartum stillbirth.
Arch Environ Occup Health. 2007 Mar-Apr;62(2):87-92.
Department of Family and Community Medicine, Meharry Medical
College, Nashville, TN.
The purpose of this study was to examine the association between
prenatal smoking and intrapartum stillbirth by the use of a
cohort of singleton births in Missouri from 1978 through 1997.
Overall, the authors identified a total of 7,325 counts of
stillbirth, yielding a stillbirth rate of 4.4 per 1,000. The
timing of the occurrence of the stillbirth to onset of labor
was specified in 85.6% (n = 6,273). Of these, 1,070 (17.0%)
occurred intrapartum. Smoking mothers were 50% more likely
to experience intrapartum fetal death as compared with nonsmoking
gravidas (adjusted hazard ratio = 1.5; 95% confidence interval
= 1.3-1.7). Women who smoked 10 to 19 cigarettes per day were
at the highest risk of experiencing intrapartum stillbirth
(adjusted hazard ratio = 1.7 [95% confidence interval = 1.4-2.0]).
Our findings underscore the need for increased smoking-cessation
education efforts targeted toward pregnant women.
3: Toal M, Keating S, Machin G, Dodd J, Adamson SL, Windrim
RC, Kingdom JC.
Determinants of adverse perinatal outcome in high-risk women
with abnormal uterine artery Doppler images.
Am J Obstet Gynecol. 2008 Mar;198(3):330.e1-7.
Maternal-Fetal Medicine Division (Placenta Clinic), Department
of Obstetrics & Gynaecology, Mount Sinai Hospital, University
of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: The purpose of this study was to evaluate the prognostic
role of placental ultrasound imaging at 19-23 weeks of gestation
in clinically high-risk women with abnormal uterine artery
Doppler (UTAD). STUDY DESIGN: Placentas of 60 women with abnormal
UTAD were examined at 19-23 weeks of gestation for shape and
texture abnormalities. Findings were correlated with clinical
outcomes (preterm delivery at <32 weeks of gestation; birth
weight <10th percentile [small for gestational age]; preeclampsia/hemolysis,
elevated liver enzymes, low platelets; early-onset intrauterine
growth restriction with abnormal umbilical artery Doppler;
and intrauterine fetal death) and maternal serum screening
data. Placental disease was reviewed by 2 perinatal pathologists.
RESULTS: Women with abnormal placental shape at 19-23 weeks
of gestation (n = 28) had higher odds of intrauterine fetal
death (odds ratio, 4.5; 95% CI, 1.3-15.6), delivery at <32
weeks of gestation (odds ratio, 4.7; 95% CI, 1.6-14.1]), and
intrauterine growth restriction (odds ratio, 4.7; 95% CI, 1.4-15.1])
than did the women with a normal placental shape. Thirty-two
of 41 placentas (74%) weighed <10th percentile, and 36 of
43 placentas (83%) had ischemic-thrombotic pathologic condition.
There was no association between abnormal placental shape at
19-23 weeks of gestation and placental weight, but 5 of 6 placentas
that were <10 cm long were <10th percentile for weight
at delivery. There was a poor correlation between measures
of ultrasound texture at 19-23 weeks of gestation and the presence
of specific lesions at delivery. CONCLUSION: Combined abnormal
UTAD and placental dysmorphologic condition before fetal viability
identifies a subset of women who are at risk of adverse outcomes.
Placental size is critical in the determination of the outcome
in this situation because of the very high prevalence of destructive
lesions, although present methods of placental imaging have
significant limitations.
4: Chiodo I, Somigliana E, Dousset B, Chapron C.
Urohemoperitoneum During Pregnancy with Consequent Fetal Death
in a Patient with Deep Endometriosis.
J Minim Invasive Gynecol. 2008 March - April;15(2):202-204.
Université Paris V, Faculté de Médecine,
Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier
Universitaire Ouest, CHU Cochin–Saint Vincent de Paul,
Service de Gynécologie Obstétrique II et Médecine
de la Reproduction, Paris, France; Department of Obstetrics
and Gynecology, Fondazione IRCCS Ospedale Maggiore Policlinico,
Mangiagalli e Regina Elena, Milan, Italy.
A 25-year-old woman with unoperated deep endometriosis of
the uterosacral ligament suddenly experienced severe abdominal
pain, hematuria, hemoperitoneum, and intrauterine death at
31 weeks' gestation. Surgical intervention revealed active
hemorrhage arising from right uterine artery and interruption
of the ureter in an area of previously documented but not treated
endometriotic nodule. Histologic examination confirmed presence
of decidualized endometriosis at this site. Urohemoperitoneum
during pregnancy is a rare but possible complication in women
carrying deep peritoneal endometriotic nodules.
5: Tong S, Kaur A, Walker SP, Bryant V, Onwude JL, Permezel
M.
Miscarriage risk for asymptomatic women after a normal first-trimester
prenatal visit.
Obstet Gynecol. 2008 Mar;111(3):710-4.
University Department of Obstetrics and Gynaecology, Mercy
Hospital for Women, Victoria, Australia; Department of Obstetrics
and Gynaecology, Monash Medical Centre, Victoria, Australia;
and Capio Springfield Hospital, Lawn Lane, Chelmsford, United
Kingdom.
OBJECTIVE: To estimate the risk of miscarriage among asymptomatic
women after a prenatal visit between 6 and 11 weeks of gestation
where proof of fetal viability of a singleton was obtained
by office ultrasonography at the same visit. METHODS: This
was a prospective cohort study performed over 2 years (March
2004-2006) at an antenatal clinic at a large tertiary hospital
in Victoria, Australia. Those recruited were 697 asymptomatic
women who attended their first antenatal visit between 6 (+2
days) and 11(+6 days) weeks of gestation, where evidence of
fetal cardiac activity of a singleton was obtained by office
ultrasonography. The main outcome measure was rates of miscarriage,
stratified by gestation at presentation. RESULTS: One case
was lost to follow-up. The risk of miscarriage among the entire
cohort was 11 of 696 (1.6%). The risk fell rapidly with advancing
gestation; 9.4% at 6 (completed) weeks of gestation, 4.2% at
7 weeks, 1.5% at 8 weeks, 0.5% at 9 weeks and 0.7% at 10 weeks
(chi(2); test for trend P=.001). Most who miscarried received
their ultrasound diagnoses many weeks after their visit; five
(45%) were diagnosed in the second trimester, and all but one
received their ultrasound diagnoses after 10 weeks of gestation.
CONCLUSION: For women without symptoms, the risk of miscarriage
after attending a first antenatal visit between 6 and 11 weeks
is low (1.6% or less), especially if they present at 8 weeks
of gestation and beyond. Our data could be used to reassure
such women that the probability of progressing to later than
20 weeks of gestation is very good. LEVEL OF EVIDENCE: III.
6: Strandberg-Larsen K, Nielsen NR, Grønbæk M,
Andersen PK, Olsen J, Andersen AM.
Binge Drinking in Pregnancy and Risk of Fetal Death.
Obstet Gynecol. 2008 Mar;111(3):602-609.
National Institute of Public Health, Copenhagen, Denmark;
Department of Epidemiology, University of California Los Angeles
School of Public Health, Los Angeles, California; Department
of Biostatistics, University of Copenhagen, Copenhagen, Denmark;
and Division of Epidemiology, University of Southern Denmark,
Odense, Denmark.
OBJECTIVE: To examine whether the frequency and timing of
binge drinking episodes (intake of five or more drinks on one
occasion) during the first 16 weeks of pregnancy increase the
risk of fetal death. METHODS: The study is based upon data
from 89,201 women who were enrolled in the Danish National
Birth Cohort from 1996 to 2002 and participated in an interview
that took place in midpregnancy (n=86,752) or after a fetal
loss (n=2,449). In total, 3,714 pregnancies resulted in fetal
death. Data were analyzed by means of Cox regression models.
RESULTS: Neither the frequency nor the timing of binge episodes
was related to the risk of early (at or before 12 completed
weeks) or late (13-21 completed weeks) spontaneous abortion.
However, three or more binge episodes showed an adjusted hazard
ratio of 1.56 (95% confidence interval 1.01-2.40) for stillbirth
(22 or more completed weeks) relative to nonbinge drinkers.
Women with an average intake of three or more drinks per week
and two or more binge drinking episodes had a hazard ratio
of 2.20 (95% confidence interval 1.73-2.80) compared with women
with no average intake and no binge drinking. CONCLUSION: Binge
drinking three or more times during pregnancy is associated
with an increased risk of stillbirth, but neither frequency
nor timing of binge drinking was associated with an increased
risk of spontaneous abortion in clinically recognized pregnancies.
LEVEL OF EVIDENCE: II.
7: Odibo AO, Gray DL, Dicke JM, Stamilio DM, Macones GA, Crane
JP.
Revisiting the Fetal Loss Rate After Second-Trimester Genetic
Amniocentesis: A Single Center's 16-Year Experience.
Obstet Gynecol. 2008 Mar;111(3):589-95.
Division of Maternal Fetal Medicine, Ultrasound and Genetics,
Department of Obstetrics and Gynecology, Washington University
in St. Louis, Missouri.
OBJECTIVE: To estimate an institution's specific fetal loss
rate after a second-trimester genetic amniocentesis. METHODS:
This is a retrospective cohort study using our prenatal diagnosis
database for all pregnant women presenting for care between
1990 and 2006. We compared the fetal loss rate in women who
underwent amniocentesis between 15 and 22 weeks of gestation
with those women who did not have any invasive procedure and
had a live fetus documented on ultrasound examination between
15 and 22 weeks. Only singleton gestations were included. Logistic
regression analysis was used to adjust for potential confounders
between the groups. RESULTS: Among 58,436 women meeting the
inclusion criteria, complete outcome data were available for
51,557 (88%), 11,746 (91%) in the amniocentesis group and 39,811
(87%) in the group that did not have amniocentesis. The fetal
loss (miscarriages and intrauterine fetal death) rate in the
amniocentesis group was 0.4% compared with 0.26% in those without
amniocentesis (relative risk 1.6, 95% confidence interval [CI]
1.1-2.2). Fetal loss less than 24 weeks (including induction
for ruptured membranes and oligohydramnios) occurred in 0.97%
of the amniocentesis group and 0.84% of the group with no procedure
(P=.33). The fetal loss rate less than 24 weeks attributable
to amniocentesis was 0.13% (95% CI -0.07 to 0.20%) or 1 in
769. The only subgroup that had a significantly higher amniocentesis
attributable fetal loss rate was women with a normal serum
screen (0.17%, P=.03). CONCLUSION: The institutional fetal
loss rate attributable to amniocentesis is 0.13%, or 1 in 769
at Washington University School of Medicine. The total fetal
loss rate was not significantly different from that observed
in patients who had no procedure. LEVEL OF EVIDENCE: II.
8: Roman H, Robillard PY, Hulsey TC, Laffitte A, Kouteich
K, Marpeau L, Barau G.
Obstetrical and neonatal outcomes in obese women.
West Indian Med J. 2007 Oct;56(5):421-6.
Department of Gynaecology et Obstetrics, University Hospital
of Rouen, Germont Avenue, 76031 Rouen, France.
OBJECTIVE: To compare the incidence of antenatal and intrapartum
complications and neonatal outcomes among pre-pregnant obese
women. METHODS: At the Sud-Reunion Hospital's maternity, Reunion
Islands, France, over a 54-month period, each obese pregnant
woman (BMI > or = 30 kg/m2) delivering a singleton after
22-weeks gestation was compared to the next age and parity-matched
woman of normal pre-pregnancy weight (BMI 18.5-25 kg/m2), who
delivered after the index case. The Students t test, Mann and
Whitney test, Chi-square test and logistic regression model
were used for statistical analysis. RESULTS: The study enrolled
2081 obese women and 2081 controls. The incidences of pre-eclampsia,
chronic and pregnancy-induced hypertension, chronic and gestational
diabetes mellitus were increased in the obese women group.
Prenatal care in obese women required a high rate of hospitalizations
as well as a high rate of insulin treatment. Obese women were
more likely to be delivered by Caesarean section. The rate
of in utero fetal death, neonatal and perinatal death was significantly
higher in the obese women group. The high BMI in relation with
both pre-eclampsia and in utero fetal death remained unchanged
after adjustment of other risk factors. CONCLUSION: Obese women
were more likely to present several obstetric complications
and to be delivered by Caesarean section. Obstetricians who
decide on a first Caesarean section in an obese woman should
be aware of the cumulated obesity and uterine scar risks that
could threaten any subsequent Caesarean section.
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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