NSIDRC Journal Article Alert — March 21, 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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Sudden Infant Death
1: Nucifora G, Benettoni A, Allocca G, Bussani R, Silvestri
F.
Arrhythmogenic right ventricular dysplasia/cardiomyopathy as
a cause of sudden infant death.
J Cardiovasc Med (Hagerstown). 2008 Apr;9(4):430-431.
aPediatric Cardiology Unit, IRCCS, Istituto per l?Infanzia,
Burlo Garofolo, Trieste, Italy bDepartment of Pathological
Anatomy, University of Trieste Medical School, Trieste, Italy.
Arrhythmogenic right ventricular dysplasia/cardiomyopathy
is a rarely described cause of sudden death among infants.
We report the case of a 4-month-old male infant who died suddenly
in his sleep. Postmortem examination revealed the presence
of arrhythmogenic right ventricular dysplasia/cardiomyopathy.
Other Infant Death
1: Wang K, Yamauchi K, Li P, Kato H, Kobayashi M, Kato K,
Shimizu Y.
Cost-effectiveness of implantable cardioverter-defibrillators
in Brugada syndrome treatment.
J Med Syst. 2008 Feb;32(1):51-7.
Department of Medical Information and Management Science,
Graduate School of Medicine, Nagoya University, 65 Tsurumai,
Showa-Ku, 466-8550 Nagoya, Japan. wangkai@med.nagoya-u.ac.jp
Brugada syndrome is characterized by an ST-segment elevation
in the right precordial ECG leads and a high incidence of sudden
death in patients with structurally normal hearts. Some trials
have demonstrated that the cost-effectiveness of ICD implantation
treatment in patients with structurally abnormal hearts is
more favorable than that of control treatment. We used Treeage
pro 2005 to estimate costs and survival among the Brugada syndrome
patients who received either an ICD or were treated by control
therapy of Ito-blocking properties (quinidine) or beta-blockers
(propranolol). In conclusion, our analysis suggests that prophylactic
Brugada syndrome who are at high risk of sudden death. ICD
treatment has shown a cost-effectiveness ratio below $9591
per QALY gained from trials of defibrillator vs beta-blockers
for Unexplained Death in Thailand (DEBUT). The control therapy
of quinidine may be a good choice for patients who are infants
or living in developing countries.
2: Udjo EO.
A re-look at recent statistics on mortality in the context
of HIV/AIDS with particular reference to South Africa.
Curr HIV Res. 2008 Mar;6(2):143-51.
Bureau of Market Research, University of South Africa, South
Africa. udjoe@unisa.ac.za
Since the outbreak of the HIV epidemic in the 1980s, various
organisations and researchers have produced statistics on HIV/AIDS
including HIV prevalence, incidence, number of AIDS cases,
AIDS-related mortality as well as life expectancy at birth
in the context of HIV/AIDS. Until recently HIV-prevalence statistics
as well as models projecting the impact of HIV/AIDS utilised
HIV-prevalence statistics based on women attending antenatal
clinics as population-based prevalence statistics were non-existent.
Among others, the extrapolation of HIV-prevalence statistics
from surveillance sites to the general population has been
questioned. Recent statistics on HIV-prevalence from population-based
surveys strongly suggest that HIV-prevalence in many countries
may not be as high as earlier estimated and projected. In addition,
model estimates of HIV/AIDS-prevalence and impact on mortality
often use conventional model life tables such as the Coale-Demeny
Regional, UN, and Brass standard life tables, which in the
case of South Africa give female life expectancy at birth plummeting
from about 65 years in the mid-1990s to around 49-50 years
in 2005. The standard life tables often employed in these estimates
do not take account of the 'hump' in the mortality curve due
to AIDS-related deaths as these standard mortality schedules
were developed prior to the HIV/AIDS epidemic. Given this background,
this paper provides a critical look at recent statistics on
infant mortality rates and life expectancies at birth in the
context of HIV/AIDS in parts of Southern and Eastern Africa
with particular reference to South Africa.
Miscarriage/Stillbirth/Prenatal Issues
1: Perricone R, De Carolis C, Kröegler B, Greco E, Giacomelli
R, Cipriani P, Fontana L, Perricone C.
Intravenous immunoglobulin therapy in pregnant patients affected
with systemic lupus erythematosus and recurrent spontaneous
abortion.
Rheumatology (Oxford). 2008 Mar 17 [Epub ahead of print]
Department of Rheumatology, University of Rome Tor Vergata,
S. Giacomo Hospital, ASL RMA, Gynaecology and Obstetrics, Department
of Rheumatology, University of L’Aquila, L’Aquila
and Department of Internal Medicine, University of Rome Tor
Vergata, Rome, Italy.
Objectives. We aimed to test the maternal and fetal outcome
of SLE patients who suffered from recurrent spontaneous abortion
(RSA) treated with intravenous immunoglobulin (IVIg) alone
during pregnancy and whether the clinical response to IVIg
treatment is accompanied by modifications of SLE-associated
antibodies and of complement levels. Methods. Twelve SLE-RSA
pregnant patients were treated with high-dose IVIg and compared
with 12 SLE-RSA pregnant patients treated with prednisolone
and NSAIDs. They were evaluated for the clinical response [lupus
activity index-pregnancy (LAI-P) scale] and for ANA, anti-dsDNA,
anti Ro/SS-A or La/SS-B, aCL, LAC, C4, C3 before and during
pregnancy, and before and after each treatment course. Pregnancy
outcome in the two groups was also evaluated. Results. The
groups characteristics were homogeneous at the beginning of
pregnancy. A beneficial clinical response following IVIg treatment
was noted in all patients and mean LAI-P decreased from 0.72
+/- 0.43 at the beginning of pregnancy to 0.13 +/- 0.19 at
the end of pregnancy (P < 0.0001). Antibodies and complement
levels tended to normalize in most of the patients. These clinical
and laboratory improvements were significant with respect to
the control group. Pregnancy was successfully carried out in
12/12 (100%) SLE-RSA patients with a mean Apgar score of 8.92.
Three patients in the control group got aborted (25%). Conclusions.
IVIg has a high response rate among SLE-RSA pregnant patients
and may be considered safe and effective.
2: Brier N.
Grief Following Miscarriage: A Comprehensive Review of the
Literature.
J Womens Health (Larchmt). 2008 Mar 17 [Epub ahead of print]
Department of Psychiatry and Pediatrics, Albert Einstein College
of Medicine of Yeshiva University, Children's Evaluation and
Rehabilitation Center, Bronx, New York.
ABSTRACT Objective: The literature exploring the relationship
between miscarriage and grief is sparse. This paper summarizes
the literature on grief subsequent to an early miscarriage
to elucidate the nature, incidence, intensity, and duration
of grief at this time and to identify potential moderators.
Methods: An electronic search of the Medline and Psych Info
databases was conducted. Studies were selected for inclusion
if they related to early miscarriage, used a standardized measure
to assess perinatal grief, and specified the assessment intervals
employed. Qualitative studies were included when helpful to
develop hypotheses. Results: Descriptions of grief following
miscarriage are highly variable but tend to match descriptions
of grief used to characterize other types of significant losses.
A sizable percentage of women seem to experience a grief reaction,
with the actual incidence of grief unclear. Suggestively, grief,
when present, seems to be similar in intensity to grief after
other types of major losses and is significantly less intense
by about 6 months. Few conclusions can be drawn in regard to
potential moderators of grief following a miscarriage. Conclusions:
Although additional research is clearly needed, guidelines
for coping with grief following miscarriage can be based on
the data available on coping with other significant types of
losses. Given the range of potential meanings for this primarily
prospective and symbolic loss, practitioners need to encourage
patients to articulate the specific nature of their loss and
assist in helping them concretize the experience.
3: Pritts EA, Parker WH, Olive DL.
Fibroids and infertility: an updated systematic review of the
evidence.
Fertil Steril. 2008 Mar 11 [Epub ahead of print]
Wisconsin Fertility Institute, Middleton, Wisconsin.
OBJECTIVE: To investigate the effect of fibroids on fertility
and of myomectomy in improving outcomes. DESIGN: Systematic
literature review and meta-analysis of existing controlled
studies. SETTING: Private center for Reproductive endocrinology
and infertility. PATIENT(S): Women with fibroids and infertility.
INTERVENTION(S): A systematic literature review, raw data extraction
and data analysis. MAIN OUTCOME MEASURE(S): Clinical pregnancy
rate, spontaneous abortion rate, ongoing pregnancy/live birth
rate, implantation rate, and preterm delivery rate in women
with and without fibroids, and in women who underwent myomectomy.
RESULT(S): Women with subserosal fibroids had no differences
in their fertility outcomes compared with infertile controls
with no myomas, and myomectomy did not change these outcomes
compared with women with fibroids in situ. Women with intramural
fibroids appear to have decreased fertility and increased pregnancy
loss compared with women without such tumors, but study quality
is poor. Myomectomy does not significantly increase the clinical
pregnancy and live birth rates, but the data are scarce. Fibroids
with a submucosal component led to decreased clinical pregnancy
and implantation rates compared with infertile control subjects.
Removal of submucous myomas appears likely to improve fertility.
CONCLUSION(S): Fertility outcomes are decreased in women with
submucosal fibroids, and removal seems to confer benefit. Subserosal
fibroids do not affect fertility outcomes, and removal does
not confer benefit. Intramural fibroids appear to decrease
fertility, but the results of therapy are unclear. More high-quality
studies need to be directed toward the value of myomectomy
for intramural fibroids, focusing on issues such as size, number,
and proximity to the endometrium.
4: Sayed AR, Bourne D, Pattinson R, Nixon J, Henderson B.
Decline in the prevalence of neural tube defects following
folic acid fortification and its cost-benefit in South Africa.
Birth Defects Res A Clin Mol Teratol. 2008 Mar 12 [Epub ahead
of print]
School of Public Health and Family Medicine, University of
Cape Town, South Africa.
BACKGROUND: In October 2003 South Africa embarked on a program
of folic acid fortification of staple foods. We measured the
change in prevalence of NTDs before and after fortification
and assessed the cost benefit of this primary health care intervention.
METHODS: Since the beginning of 2002 an ecological study was
conducted among 12 public hospitals in four provinces of South
Africa. NTDs as well as other birth defect rates were reported
before and after fortification. Mortality data were also collected
from two independent sources. RESULTS: This study shows a significant
decline in the prevalence of NTDs following folic acid fortification
in South Africa. A decline of 30.5% was observed, from 1.41
to 0.98 per 1,000 births (RR = 0.69; 95% CI: 0.49-0.98; p =
.0379). The cost benefit ratio in averting NTDs was 46 to 1.
Spina bifida showed a significant decline of 41.6% compared
to 10.9% for anencephaly. Additionally, oro-facial clefts showed
no significant decline (5.7%). An independent perinatal mortality
surveillance system also shows a significant decline (65.9%)
in NTD perinatal deaths, and in NTD infant mortality (38.8%).
CONCLUSIONS: The decrease in NTD rates postfortification is
consistent with decreases observed in other countries that
have fortified their food supplies. This is the first time
this has been observed in a predominantly African population.
The economic benefit flowing from the prevention of NTDs greatly
exceeds the costs of implementing folic acid fortification.
Birth Defects Research (Part A), 2008. (c) 2008 Wiley-Liss,
Inc.
5: Dane B, Dane C, Cetin A, Kiray M, Sivri D, Yayla M.
Pregnancy outcome in fetuses with increased nuchal translucency.
J Perinatol. 2008 Mar 13 [Epub ahead of print]
1Division of Perinatology, Department of Gynecology and Obstetrics,
Haseki Training and Research Hospital, Istanbul, Turkey.
Objective:The aim of this study was to examine fetal and neonatal
outcomes in the setting of nuchal translucency (NT) >/=3
mm at routine first-trimester screening.Study Design:A nested
case-series study within a retrospective cohort of women screened
for Down syndrome at 11-14 weeks of gestation. Crown-rump length,
NT values and additional anomalies at first and early second
trimesters were recorded. Follow-up information was obtained
by a review of medical records and self-report from patients.
Adverse outcomes included fetal death and termination of pregnancy
due to structural or chromosomal anomalies.Result:A total of
1930 pregnant women were screened between 11 and 14 weeks of
gestation. The prevalence of increased fetal NT (>/=3 mm)
was 1.4% (n=27). Among these, 12 showed increased fetal NT
as an isolated finding. In this group, 2 women experienced
fetal demise (16%) and 10 delivered healthy babies. In the
group with additional abnormalities (n=15), 9 (60%) were found
to have chromosomal abnormalities, all of which were terminated.
For all cases with increased fetal NT, total incidence of adverse
outcome was 62%.Conclusion:At first-trimester ultrasonography,
a fetal NT >/=3 mm was associated with a high incidence
of chromosomal abnormalities in the presence of associated
abnormalities. For cases with the increased fetal NT at first-trimester
fetal assessment and follow-up is necessary to detect possible
adverse outcomes.Journal of Perinatology advance online publication,
13 March 2008; doi:10.1038/jp.2008.14.
6: Dighe M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS.
Sonography in first trimester bleeding.
J Clin Ultrasound. 2008 Mar 11 [Epub ahead of print]
Department of Radiology, University of Washington Medical
Center, Seattle, WA 98195.
Vaginal bleeding is the most common cause of presentation
to the emergency department in the first trimester. Approximately
half of patients with first trimester vaginal bleeding will
lose the pregnancy. Clinical assessment is difficult, and sonography
is necessary to determine if a normal fetus is present and
alive and to exclude other causes of bleeding (eg, ectopic
or molar pregnancy). Diagnosis of a normal intrauterine pregnancy
not only helps the physician in terms of management but also
gives psychologic relief to the patient. Improved ultrasound
technology and high-frequency endovaginal transducers have
enabled early diagnosis of abnormal and ectopic pregnancies,
decreasing maternal morbidity and mortality. The main differential
considerations of first trimester bleeding are spontaneous
abortion, ectopic pregnancy, or gestational trophoblastic disease.
This article reviews the causes of first trimester bleeding
and the sonographic findings, including normal features of
first trimester pregnancy. (c) 2008 Wiley Periodicals, Inc.
J Clin Ultrasound, 2008.
7: Quarello E, Stirnemann J, Nassar M, Nasr B, Bernard JP,
Leleu-Huard F, Ville Y.
Outcome of anaemic monochorionic single survivors following
early intrauterine rescue transfusion in cases of feto-fetal
transfusion syndrome.
BJOG. 2008 Apr;115(5):595-601.
Department of Obstetrics and Gynecology, Centre Hospitalier
Intercommunal de Poissy, Poissy, France. e.quarello@orange.fr <e.quarello@orange.fr>
OBJECTIVE: To evaluate the outcome of severely anaemic monochorionic
(MC) twins surviving the death of their co-twin following early
intrauterine rescue transfusion in cases of feto-fetal transfusion
syndrome (FFTS). STUDY DESIGN: We reviewed all MC pregnancies
complicated with FFTS following primary management, in which
a single intrauterine fetal death (IUFD) was diagnosed with
certainty within 24 hours between January 1999 and December
2006. We included MC survivors who presented ultrasound or
Doppler features of fetal anaemia following the death of their
co-twin. Intrauterine transfusion (IUT) was given to all survivors
who were anaemic. RESULTS: Nineteen MC twin pregnancies presented
a single intrauterine death (IUD) associated with an anaemic
co-twin. Median gestational age at IUD was 23 [20-28] weeks.
The median interval between IUD and IUT was 12 [8-24] hours.
There were 58% (11/19) healthy survivors. Perinatal death rate
was 26% (5/19) including 16% (3/19) intrauterine and 10% (2/19)
neonatal deaths. Abnormal prenatal cerebral findings developed
in 21% (4/19) cases, always within 1 month after the death
of the co-twin. Considering occlusive techniques and other
management separately, there were 64% (7/11) and 50% (4/8)
healthy survivors, respectively, and perinatal death occurred
in 36% (4/11) and 12.5% (1/8) of fetuses, respectively. Prenatal
fetal cerebral lesions developed in 9% (1/11) of cases following
occlusive techniques and in 37.5% (3/8) of fetuses when managed
differently. The median gestational age at delivery in the
survivors was 31 [25-38] weeks. CONCLUSION: In cases of FFTS
with single anaemic survivors, early IUT could be offered following
extensive counselling and close follow up.
Prepared by the
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