NSIDRC Journal Article Alert — March 14, 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.

Other Infant Death

1: Parkinson AJ.
The international polar year 2007-2008; the Arctic human health legacy.
Alaska Med. 2007 Apr-Jun;49(2):43-5.

Arctic Investigations Program, Centers for Disease Control & Prevention, USA.

Life expectancy in Arctic populations has greatly improved over the last 50 years. Much of this improvement can be attributed to health research that has resulted in a reduction in morbidity and mortality from infectious diseases, such as tuberculosis, and the vaccine-preventable diseases of childhood. However, despite these improvements in health indicators of Arctic residents, life expectancy and infant mortality remain higher in indigenous Arctic residents in the US Arctic, northern Canada, and Greenland when compared to Arctic residents of Nordic countries. The International Polar Year (IPY) represents a unique opportunity to focus world attention on Arctic human health and to further stimulate Circumpolar cooperation on emerging Arctic human health concerns. The Arctic Human Health Initiative (AHHI) is an Arctic Council IPY initiative that aims to build and expand on existing Arctic Council and International Union for Circumpolar Health (IUCH) human health research activities. The human health legacy of the IPY will be increased visibility of the human health concerns of Arctic communities, revitalization of cooperative Arctic human health research focused on those concerns, the development of health policies based on research findings, and the subsequent implementation of appropriate interventions, prevention and control measures at the community level.

2: Wilson AL.
The state of South Dakota's child: 2007.
S D Med. 2008 Jan;61(1):7-11.

South Dakota State University, USA.

The year 2006 brought a 4 percent increase in births to the state that was almost entirely attributed to an increase in white newborns. The rate of low birth weight births decreased for newborns weighing less than 1,500 grams but increased for those weighing 1,500 to 2,500 grams. The state's rate of low birth weight, however, remained less than the persistently climbing U.S. rate. The incidence of prenatal care beginning in the last trimester of pregnancy, or no prenatal care, increased and is of concern in light of recent findings from a South Dakota report that shows how failure to receive this care is related to infant mortality. The state's overall infant mortality rate decreased from its 2005 rate. This decrease is attributable to a decrease in the rate of neonatal deaths for the state's white population. Rates of neonatal death increased for the minority population and post-neonatal mortality increased for both the white and minority population. How these findings are related to social and economic disparities is discussed.

3: Edmond KM, Kirkwood BR, Tawiah CA, Agyei SO.
Impact of early infant feeding practices on mortality in low birth weight infants from rural Ghana.
J Perinatol. 2008 Mar 6 [Epub ahead of print]

[1] 1Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK [2] 2Honorary Consultant in Paediatrics, University College London Hospital, London, UK.

Objective: To assess the impact of early infant feeding practices on low birth weight- (LBW) specific neonatal mortality in rural Ghana.Study Design: A total of 11 787-breastfed babies were born between July 2003 and June 2004 and survived to day 2. Overall, 3411 (30.3%) infants had weight recorded within 48 h. Two hundred and ninety-six (8.7%) infants were <2.5 kg and 15 died in the neonatal period. Associations were examined using multivariate logistic regression.Result: Initiation of breastfeeding after day 1 was associated with a threefold increase in mortality risk (adjusted odds ratio (adjOR) 3.23, 95% confidence interval (95% CI) (1.07-9.82)) in infants aged 2 to 28 days. Prelacteal feeding was associated with a threefold significantly increased mortality risk (adjOR 3.12, 95% CI (1.19-8.22)) in infants aged 2 to 28 days but there was no statistically significant increase in risk associated with predominant breastfeeding (adjOR 1.91, 95% CI (0.60-6.09)). There were no modifications of these effects by birth weight. The sample size was insufficient to allow assessment of the impact of partial breastfeeding.Conclusion: Improving early infant feeding practices is an effective, feasible, low-cost intervention that could reduce early infant mortality in LBW infants in developing countries. These findings are especially relevant for sub-Saharan Africa where many LBW infants are born at home, never taken to a health facility and mortality rates are unacceptably high.Journal of Perinatology advance online publication, 6 March 2008; doi:10.1038/jp.2008.19.

4: Yeboah-Antwi K, Addo-Yobo E, Adu-Sarkodie Y, Carlin JB, Plange-Rhule G, Osei Akoto A, Weber MW, Hamer DH.
Clinico-epidemiological profile and predictors of severe illness in young infants (0-59 days) in Ghana.
Ann Trop Paediatr. 2008 Mar;28(1):35-43.

Center for International Health & Development, Boston University School of Public Health, USA.

BACKGROUND: Young infant mortality has remained high and relatively unchanged compared with deaths of older infants. Strategies to reduce infant mortality, however, are mostly targeted at the older child. OBJECTIVES: To describe the clinical profile of sick young infants presenting to a hospital and to define important signs and symptoms that will enable health workers to detect young infants with severe illness requiring hospital admission. METHODS: Young infants aged 0-59 days presenting to a paediatric out-patient clinic were evaluated by a nurse using a standardised list of signs and symptoms. A paediatrician independently evaluated these children and decided whether they needed hospitalisation. RESULTS: A total of 685 young infants were enrolled, 22% of whom were <7 days of age. The commonest reasons for seeking care were jaundice in the 0-6-day group, skin problems in the 7-27-day group and cough in the 28-59-day group. The primary clinical diagnoses for admissions were sepsis in the 0-6- and 7-27-day groups and pneumonia in the 28-59-day group. Clinical signs and symptoms predicting severe illness requiring admission were general (history of fever, difficult feeding, not feeding well and temperature >37.5 degrees C) and respiratory (respiratory rate >/=60/min, severe chest in-drawing). CONCLUSION: General and respiratory signs are important predictors for severe illness in young infants. Training peripheral health workers to recognise these signs and to refer to hospital for further assessment and management might have a significant impact on young infant mortality.

Miscarriage/Stillbirth/Prenatal Issues

1: Ben-David G, Sheiner E, Levy A, Erez O, Mazor M.
An increased risk for non allo-immunization related intrauterine fetal death in RhD-negative patients.
J Matern Fetal Neonatal Med. 2008 Apr;21(4):255-9.

Departments of Obstetrics and Gynecology.

Objective. To investigate immediate perinatal outcome of RhD-negative patients carrying RhD-positive fetuses who received antenatal Rh immunoglobulin for the prevention of RhD-mediated hemolytic disease of the fetus and newborn. Methods. A retrospective population-based analysis was conducted comparing pregnancies of all RhD-negative women who received antenatal Rh immunoglobulin prophylaxis (anti-D), to RhD-positive parturients, during the years 1988-2003. All women were RhD-negative without evidence of RhD sensitization. Patients received anti-D during the 28-30th week of pregnancy, and an additional dosage within 72 hours following delivery after confirmation of the newborn's RhD status. Results. Of 145,437 deliveries during the study period, 6.8% were of RhD-negative women (n = 9961). Perinatal mortality rate was significantly higher among the RhD-negative women who received antenatal prophylaxis rhesus immunoglobulin as compared with the controls (17/1000 vs. 12/1000, OR = 1.3, 95%CI 1.2-1.6; p < 0.001). This higher mortality rate was related to a higher rate of intrauterine fetal demise (IUFD) (10/1000 vs. 6/1000, OR = 1.5, 95%CI 1.2-1.9; p < 0.001). The association remained significant after controlling for RhD isoimmunization leading to hydrops fetalis, using the Mantel-Haenszel technique (weighted OR = 1.3; 95% CI 1.1-1.5; p = 0.001). The rate of RhD isoimmunization was 0.6% (n = 58). Using a multivariable analysis with IUFD as the outcome variable, controlling for known confounders for fetal demise, RhD-negative status was an independent risk factor for IUFD. Conclusion. RhD-negative women carrying RhD-positive newborns are at an increased risk for IUFD despite Rh immunoprophylaxis.

2: Gan C, Zou Y, Wu S, Li Y, Liu Q.
The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome.
Int J Gynaecol Obstet. 2008 Mar 4 [Epub ahead of print]

West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Seven prospective cohort studies (12484 cases) were included in this review of the respective effects on the next pregnancy of medical and surgical abortion in early pregnancy. The incidence of miscarriage and postpartum hemorrhage was significantly lower in the pregnancy following a medical abortion. No other significant differences were found. With respect to the outcome of the next pregnancy, first-trimester medical abortions may thus be safer than the surgical option.

3: Nothnagle M, Prine L, Goodman S.
Benefits of comprehensive reproductive health education in family medicine residency.
Fam Med. 2008 Mar;40(3):204-7.

Department of Family Medicine, Brown University/Memorial Hospital of Rhode Island.

Given the high prevalence of unintended pregnancy and early pregnancy failure, family physicians frequently encounter these clinical problems. Early abortion care and miscarriage management are within the scope of family medicine, yet few family medicine residency programs' curricula routinely include training in these skills. Comprehensive reproductive health education for family physicians could benefit patients by improving access to safe care for unintended pregnancy and early pregnancy loss and by improving continuity of care, especially for rural and low-income women. By promoting reflection on conflicts between personal beliefs and responsibility to patients, training in options counseling and abortion care fosters patient-centered care and informed decision making. Managing pregnancy loss and termination also improves skills in patient-centered counseling and primary care gynecology. Multiple studies document the feasibility and success of several training models for abortion and miscarriage management in family medicine. Incorporating comprehensive reproductive health care into family medicine residency training enables family physicians to provide a full range of reproductive health services.

Prepared by the
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