NSIDRC Journal Article Alert — April 10, 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
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Sudden Infant Death
1: Abdulrazzaq YM, Kendi AA, Nagelkerke N.
Child care practice in the United Arab Emirates: the ESACCIPS
study.
Acta Paediatr. 2008 May;97(5):590-5.
Department of Paediatrics, Faculty of Medicine and Health
Sciences, UAE University, PO Box 127666, Al Ain, United Arab
Emirates.
Aims: This study was undertaken to monitor infant care practice
associated with SIDS and establish the incidence of SIDS in
the UAE. Methods: A total of 996 families were recruited for
the study. One questionnaire was completed during the first
7 days after delivery, and was used to collect information
about the socio-demographic features, mother's medical history,
delivery status and infant's medical history, and another questionnaire
was completed after 12 weeks through telephone interviews of
the mothers. 716 completed both questionnaires. Registers at
the two hospitals, and at the Preventive Medicine Department
were studied and all infant deaths in a 5-year period were
recorded. Results: In all 18.9% of infants were placed in the
prone position. Mothers preferred supine position (49.3%) to
other positions when putting their babies to bed. Ninety eight
percent preferred that their infant slept in the same room
as the parents. On the whole, 40% occasionally shared their
beds with their infants. Swaddling the babies was quite common
(83.2%) and 91.9% of their mothers were also swaddled when
they were babies. More than 80% of all infants used bedding
duvets for their infants both in the summer and in the winter.
SIDS mortality rate was 0.66 per thousand live births and contributed
7.25% to the infant mortality rate. Conclusion: These data
provide useful baseline information on child care practice
and should be of immense benefit to the understanding of the
risks and causal mechanisms of SIDS and to the UAE health authorities
should they wish to develop strategies to reduce the risk of
SIDS.
2: Nonnis Marzano F, Maldini M, Filonzi L, Lavezzi AM, Parmigiani
S, Magnani C, Bevilacqua G, Matturri L.
Genes regulating the serotonin metabolic pathway in the brain
stem and their role in the etiopathogenesis of the sudden infant
death syndrome.
Genomics. 2008 Apr 1 [Epub ahead of print]
Department of Evolutionary and Functional Biology, University
of Parma, 43100 Parma, Italy.
Genotypes and allelic frequencies of TPH2, 5-HTTLPR, the 5-HTT
(SLC6A4) intron 2 variable-number tandem repeat (VNTR) region,
and the MAOA VNTR region were determined in brain-stem samples
of 20 "genuine" SIDS cases and compared with results
obtained from 150 healthy controls. The SNP G1463A responsible
for 80% functionality loss of TPH2 (tryptophan hydroxylase
2) was not detected, neither in SIDS infants nor in the controls.
In contrast, a strict relation was found between the 5-HTTLPR
genotype and its allelic frequencies with SIDS cases. The L/L
genotype and the long allele (L) of the promoter region of
the serotonin transporter were significantly associated (likelihood
ratio (LR) test, p<0.001) with the syndrome (L/L, 60% SIDS
vs 14% controls; L, 80% SIDS vs 42.6% controls). Polymorphisms
of the intron 2 VNTR of the same gene showed a trend for significant
differences between genotypes 10/10 and 12/12 (LR test, p=0.068),
with the L-12 haplotype being almost twofold in SIDS (44.5%)
with respect to controls (23.4%). Differences were even higher
considering the genotype combination L/L-12/12 (20% SIDS vs
2.6%), and variations among categories were statistically highly
significant (p<0.001). Although additional differences were
observed in the frequency of the MAOA (monoamine oxidase A)
VNTR genotype 3R/3R between SIDS and controls (respectively
15% vs 26%), the results were not supported by statistical
significance. Molecular polymorphisms are discussed considering
their functional role in regulating serotonin synthesis (TPH2),
neuronal reuptake (5-HTTLPR and 5-HTT intron 2), and catabolism
(MAOA) in the nervous system of Italian SIDS infants. Comparisons
are made with previous data obtained in different ethnic groups.
3: Dwyer JB, Broide RS, Leslie FM.
Nicotine and brain development.
Birth Defects Res C Embryo Today. 2008 Mar;84(1):30-44.
Department of Pharmacology, University of California, Irvine,
California 92697, USA. jbdwyer@uci.edu
Preclinical studies, using primarily rodent models, have shown
acetylcholine to have a critical role in brain maturation via
activation of nicotinic acetylcholine receptors (nAChRs), a
structurally diverse family of ligand-gated ion channels. nAChRs
are widely expressed in fetal central nervous system, with
transient upregulation in numerous brain regions during critical
developmental periods. Activation of nAChRs can have varied
developmental influences that are dependent on the pharmacologic
properties and localization of the receptor. These include
regulation of transmitter release, gene expression, neurite
outgrowth, cell survival, and synapse formation and maturation.
Aberrant exposure of fetal and neonatal brain to nicotine,
through maternal smoking or nicotine replacement therapy (NRT),
has been shown to have detrimental effects on cholinergic modulation
of brain development. These include alterations in sexual differentiation
of the brain, and in cell survival and synaptogenesis. Long-term
alterations in the functional status and pharmacologic properties
of nAChRs may also occur, which result in modifications of
specific neural circuitry such as the brainstem cardiorespiratory
network and sensory thalamocortical gating. Such alterations
in brain structure and function may contribute to clinically
characterized deficits that result from maternal smoking, such
as sudden infant death syndrome and auditory-cognitive dysfunction.
Although not the only constituent of tobacco smoke, there is
now abundant evidence that nicotine is a neural teratogen.
Thus, alternatives to NRT should be sought as tobacco cessation
treatments in pregnant women.
4: Sen-Chowdhry S, McKenna WJ.
Left ventricular noncompaction and cardiomyopathy: cause, contributor,
or epiphenomenon?
Curr Opin Cardiol. 2008 May;23(3):171-5.
aInherited Cardiovascular Disease Group, The Heart Hospital,
University College London, UK bImperial College London, UK.
PURPOSE OF REVIEW: To discuss unresolved issues pertaining
to aetiology and diagnosis of isolated left ventricular noncompaction.
RECENT FINDINGS: Left ventricular noncompaction may be sporadic
or familial and is linked to mutations in mitochondrial, cytoskeletal,
Z-line, and sarcomeric proteins. Severe childhood manifestations
include fetal hydrops or sudden infant death syndrome. Adults
with severe phenotypes have a similarly guarded prognosis due
to heart failure, arrhythmia and thromboembolism. Conversely,
healthy individuals may fulfil current imaging criteria for
diagnosis. Left ventricular noncompaction is also observed
in families with hypertrophic or dilated cardiomyopathy, casting
doubt on its acceptance as a distinct disease entity. SUMMARY:
The extent of myocardial compaction may be a continuous trait
within the population. Sensitive imaging techniques may detect
subtle variations in morphology that fall within the normal
range, underscoring the need for more restrictive diagnostic
criteria, as in mitral valve prolapse. Conversely, rather than
being a root cause of myocardial dysfunction, left ventricular
noncompaction may represent a secondary consequence of a genetic
alteration, well-tolerated when the heart is otherwise normal.
In the presence of a pathogenic mutation, disruption to myocyte
function at a molecular level may be the primary disease determinant,
with noncompaction arising as a maladaptive remodelling response
that compounds the disease process through subendocardial ischaemia
and fibrosis.
Other Infant Death
1: Lawoyin TO.
Infant and maternal deaths in rural south west Nigeria: a prospective
study.
Afr J Med Med Sci. 2007 Sep;36(3):235-41.
Department of Community Medicine, College of Medicine, University
College Hospital Ibadan, Nigeria. toolawoyin@yahoo.com
Baseline data on neonatal, infant and maternal deaths including
factors associated with infant mortality in a rural community
are needed to assess the progress being made towards achieving
lower rates in Nigeria. In this community-based prospective
study, baseline data on births and deaths were collected as
they occurred for 6 consecutive years and perinatal risk factors
associated with these deaths identified. There were 972 live
births in the study period. Maternal mortality ratio (MMR)
for the period was 2160 per 100,000 and infant and neonatal
mortality rates of 65.8 and 32.9 per 1000 live births were
obtained. MMR was highest in mothers aged 40 years and above
and lower in mothers 15-34 years. Of infants deaths, 18.8%
occurred on the first day of life and 32.8% of deaths occurred
within one week of birth. Malaria/fever (23.4%), LBW (17.2%),
and Vaccine preventable diseases (neonatal tetanus and measles)
(12.5%) were the commonest known causes of infant deaths. Perinatal
risk factors for infant deaths included being first birth order
(RR = 3.1, 2.1-4.7), birth outside the health care facility
(RR = 2.5, 1.4-4.3), no attendant at delivery (RR = 2.5, 1.4-4.4);
low weight at birth (RR = 2.46 1.01-5.9) and traditional birth
attendants at delivery (RR = 1.7, 1.2-2.6). Babies born to
fathers who were between the ages of 25-34 years had borderline
protection (RR = 0.76, 0.6-1.01). Delivery and perinatal events
have a significant impact on infant survival and more needs
to be done to integrate infant survival with maternal survival
strategies and this should be done at the primary care level.
The community must also be educated and empowered to use the
facilities for promotive, preventive and curative care.
2: Kitsantas P.
Ethnic differences in infant mortality by cause of death.
J Perinatol. 2008 Apr 3 [Epub ahead of print]
1Department of Health Administration and Policy, The College
of Health and Human Services, George Mason University, Fairfax,
VA, USA.
Objective:The purpose of this study was to examine ethnic
differences among non-Hispanic black and white births in the
distribution of maternal risk factors of infant mortality across
specific causes of death.Study Design:The data were obtained
from the North Carolina linked birth/infant death files (1989
to 1997). Logistic regression models were built to assess the
risk distribution of demographic, behavioral and health related
variables in relation to causes of infant death, which included
congenital anomalies, short gestation/low birth weight (LBW),
sudden infant death syndrome, infections and obstetric conditions.Result:Infants
born to black women had the highest rates for all causes of
mortality compared to those born to white women. Having at
least one prior live birth now dead was associated with congenital
anomalies, obstetric conditions and short gestation/LBW related
deaths in both ethnic groups. Deaths caused by infections were
more likely to occur among white young (<20) women. White
women enrolled in Medicaid had an increased risk of infant
deaths due to short gestation/LBW when compared to those with
no Medicaid, while young black mothers (<20 years old) were
less likely to experience an infant death due to short gestation/LBW
and obstetric conditions.Conclusion:This study provides evidence
that maternal sociodemographic risk factors somewhat vary by
infant cause of death and ethnicity. This suggests that race-specific
approaches may be necessary to reduce infant mortality rates.
The differences, however, in the risk distribution of factors
across the two ethnic groups were limited indicating that the
heterogeneity in the mortality rates may be due to unmeasured
factors.
3: Noguchi A.
Lowering the premature birth rate: what the u.s. Experience
means for Japan.
Keio J Med. 2008 Mar;57(1):45-9.
Department of Pediatrics, Saint Louis University, School of
Medicine.
Premature birth rate and low birth weight rate are increasing
in industrialized countries including USA and Japan. The Infant
mortality rate (IMR) is three times and 50-75 times greater
for infants born at 32-36 weeks and <32 weeks respectively
than term-born counterparts. In the U.S., the IMR is greater
than in Japan particularly among black infants and simply the "lower
socioeconomic class" is not the answer. Premature birth
is heterogeneous in origin and idiopathic in 70% of the cases.
Increased utilization of assisted reproductive technology only
accounts for a part of the recent trend. Evidence suggests
environmental factors play a significant role, and genetic-environmental
interaction is plausible. A chronic psychosocial stress of
pregnant women has been postulated to be modifying the endocrine
milieu thereby influencing pregnancy outcomes. In a preliminary
observation in St. Louis, homeless pregnant women with high
behavioral and social risks, when accommodated in a shelter
home designed for these women, produced significantly less
numbers of premature and low birth weight infants as compared
with the general population. Furthermore, in a randomized controlled
study in Washington DC, psychobehavioral intervention specifically
targeting smoking (primary and secondary), intimate partner
violence (IPV), and depression among black pregnant women significantly
decreased the rate of miscarriage and low birth weight. These
reports may have significant implication to the Japanese situation.
Increasing number of Japanese women at reproductive age are
exposed to smoking, may have underling psychosocial stress
and may suffer from subclinical depression and/or from IPV.
Detailed epidemiological studies of women before and during
the reproductive age with regard to risk factors can lead to
an effective intervention strategy against premature birth
in Japan.
Bereavement
1: Love AW.
Progress in understanding grief, complicated grief, and caring
for the bereaved.
Contemp Nurse. 2007 Dec;27(2):73-83.
1. Deputy Head, School of Psychological Science, La Trobe
University, Bundoora VIC, Australia.
Abstract Grief occurs with loss of symbolically important
connections and involves intense emotional reactions and changes
to our experiences of self, the world, and the future. Individual
responses reflect factors such as personality and life history,
social context and cultural practices, and the symbolic magnitude
of the loss. Grieving can be a relatively slow and uneven process,
so applying prescriptive stages or goals to individuals' experiences
can be unhelpful. Although most people are resilient in the
face of loss and do not require special interventions, health
professionals can contribute by empathic use of communication
skills to facilitate the grieving process.A minority will struggle
with their grief and experience prolonged, intense, or problematic
reactions. Psychiatric comorbidities including depression and
anxiety disorders can occur, and a distinct diagnosis of complicated
grief disorder has been proposed. Health professionals can
identify complicated grief reactions and ensure patients receive
specialised treatment, including intensive grief therapy and
medication where indicated. Assessment methods are summarised
to assist health professionals in providing a continuum of
care for those who are grieving.
Miscarriage/Stillbirth/Prenatal Issues
1: Mongiovì M, Pipitone S.
Supraventricular tachycardia in fetus: how can we treat ?
Curr Pharm Des. 2008;14(8):736-42.
Division of Cardiology, P.O. Casa del Sole A.U.S.L. n.6 -
Palermo, Italy. mongiovi40@hotmail.com
The normal fetal cardiac rhythm is characterized by a regular
heart rate ranging between 100 and 160 -180 beats/min with
a normal 1: 1 atrioventricular electromechanical relationship
during each cardiac cycle. Fetal tachycardia occurring in approximately
0.5% of all pregnancies and it is an important cause of fetal
morbidity and mortality. A fetal tachycardic heart is at risk
for developing low cardiac output, hydrops and ultimately fetal
death or significant neurological morbidity. Different conditions
can play a role to determine the natural history of tachycardic
fetus as gestational age, underlying pathophysiology of the
arrhythmia, fetal heart rate, duration of the tachyarrhythmia,
and presence or absence of cardiac dysfunction. Reliable diagnosis
in utero of fetal arrhythmia is possible by ultrasound examination
of the fetal heart. In fact pulsed wave Doppler guided by two-dimensional
echocardiography provided important information on cardiac
rhythm as it study the blood flow from different chambers.
With the introduction of the latest myocardial deformation
methodology, the fetal tachyarrhythmias can be diagnosed more
accurately. Precise diagnosis of cardiac arrhythmias in the
fetus is crucial for a managed therapeutic approach. The choice
of management is correlated to many factors: gestational age,
underlying pathophysiology of the arrhythmia, fetal heart rate,
duration of the tachyarrhythmia, and presence or absence of
cardiac dysfunction. A large review of fetal arrhythmias was
been reported in our work.
2: Triche EW, Hossain N, Paidas MJ.
Genetic influences on smoking cessation and relapse in pregnant
women.
J Obstet Gynaecol. 2008 Feb;28(2):155-60.
Yale University School of Medicine, New Haven, CT, USA.
Cigarette smoking during pregnancy continues to be a significant
public health concern. Maternal smoking during pregnancy has
been associated with low birth weight (<2500 g), fetal growth
restriction, placental problems, pre-term delivery and spontaneous
abortion. Mothers who smoke during pregnancy are twice as likely
to give birth to low birth weight infants, and smoking during
pregnancy is estimated to be responsible for 20-30% of all
low birth weight infants. Smoking during pregnancy not only
affects placental function, thus causing obstetrical complications,
but nicotine also crosses the placenta and acts as a neuroteratogen.
This in turn, elevates the risk of cognitive and auditory processing
deficits, and has also been found to be negatively associated
with long-term consequences on offspring behaviour. In addition,
smoking has negative long-term health consequences for both
mother and child, including respiratory conditions, cancer
and cardiovascular problems. This review provides insight into
the genetic influences on smoking behaviour in pregnant women.
In particular, the roles of genes in the neurotransmitter pathways
are highlighted. It also emphasises the need for further research
in this area, and provides rationale for the importance of
focusing on pregnant women who are highly motivated to quit
when researching smoking behaviours in women.
3: Heazell AE, Frøen JF.
Methods of fetal movement counting and the detection of fetal
compromise.
J Obstet Gynaecol. 2008 Feb;28(2):147-54.
Division of Human Development, Maternal and Fetal Health Research
Centre, St Mary's Hospital, University of Manchester, UK.
Maternal perception of fetal movements is widely used as a
marker of fetal viability and well-being. A reduction in fetal
movements is associated with fetal hypoxia, increased incidence
of stillbirth and fetal growth restriction (FGR). Therefore,
a reduction in fetal movements has been proposed as a screening
tool for FGR or fetal compromise. The problem of this approach
is that there is no widely accepted definition of reduced fetal
activity or 'alarm limits', and pregnant women are currently
given a wide range of non-evidence-based advice. We have reviewed
the background of published definitions and their potential
usefulness in screening. A formal meta-analysis of these studies
is not possible due to variation in methodology and definitions
of reduced fetal movements. Assessment of fetal movements using
formal fetal movement counting has shown equivocal results.
Importantly, in all studies, there was a decrease in perinatal
mortality suggesting a beneficial role for raising maternal
awareness of fetal movements. Most studies implemented limits
to define reduced fetal movements based on small groups of
high risk pregnancies and obsolete counting methodology. A
single case-control study developed 'normal limits' in a low
risk population, and successfully implemented it prospectively
for screening. At present, there is no evidence that any absolute
definition of reduced fetal movements is of greater value than
maternal subjective perception of reduced fetal movements in
the detection of intrauterine fetal death or fetal compromise.
Further investigation is required to determine an effective
method of identifying patients with reduced fetal movements
and to determine the best subsequent management.
4: McCaughey C, McKenna J, McKenna C, Coyle PV, O'Neill HJ,
Wyatt DE, Smyth B, Murray LJ.
Human Seroprevalence to Coxiella burnetii (Q fever) in Northern
Ireland.
Zoonoses Public Health. 2008;55(4):189-94.
Regional Virus Laboratory, Kelvin Building, Belfast Health
and Social Care Trust, Royal Victoria Hospital, Belfast BT12
6BA, UK.
Despite the widespread prevalence of infection with Coxiella
burnetii, there have been few large population-based studies
examining the epidemiology of this infection. The aim of this
study was to examine the distribution and determinants of C.
burnetii past infection in Northern Ireland (NI). Coxiella
burnetii phase II specific IgG antibodies were measured by
enzyme-linked immunosorbent assay in stored serum from 2394
randomly selected subjects, aged 12-64, who had participated
in population-based surveys of cardiovascular risk factors
performed in 1986 and 1987. The overall prevalence of C. burnetii
antibody positivity was 12.8%. The prevalence of sero-positivity
was slightly higher in males than that in females (14.3% versus
11.2%, P = 0.02). Sero-positivity was low in children (<10%),
increasing to 19.5% and 16.4% in males and females, respectively,
in the 25-34 age group and subsequently remaining fairly steady
with increasing age. Sero-positivity among farmers, at 48.8%,
was significantly higher than the general population. More
sero-positive than sero-negative women had a history of a miscarriage
or still-birth (19.5% versus 9.8%, P < 0.001). In conclusion,
this study demonstrated a high prevalence of evidence of past
C. burnetii infection in NI. Associations between past C. burnetii
infection and age, sex, social class, occupation and reproductive
history were seen. We estimate that 20% of Q fever infections
in NI occur in farmers.
5: Matalliotakis I, Cakmak H, Dermitzaki D, Zervoudis S, Goumenou
A, Fragouli Y.
Increased rate of endometriosis and spontaneous abortion in
an in vitro fertilization program: No correlation with epidemiological
factors.
Gynecol Endocrinol. 2008 Apr;24(4):194-8.
Division of Reproductive Endocrinology and Infertility, Department
of Obstetrics and Gynecology, Yale University School of Medicine,
New Haven, Connecticut, USA.
Background. There are conflicting data concerning endometriosis
and spontaneous abortion (SAB). The aim of the present study
was to evaluate if there was any association between endometriosis
and SAB. Moreover, we investigated risk factors in women with
endometriosis and SAB. Methods. The medical files of 457 married
women with endometriosis and 200 infertile women without endometriosis
were studied retrospectively. All cases were diagnosed by laparoscopy.
Data concerning demographic variables and menstrual characteristics
were recorded from 226 women with endometriosis, which were
divided into two groups. Group 1 included 126 cases with endometriosis
and SAB, and Group 2 comprised 100 parous women with endometriosis
and without SAB. Statistical comparisons between groups were
made using the chi(2) test and odds ratios (OR) and 95% confidence
intervals (CI). Results. The proportion of SAB was significantly
higher in women with endometriosis than in infertile women
without endometriosis (126/457 (27.6%) vs. 36/200 (18.0% );
OR = 1.7, 95% CI 1.1 = 2.6; p = 0.01). The frequency of nulligravid
women was significantly higher in women with endometriosis
than in the control group (OR = 1.9, 95% CI 1.4 - 2.81; p =
0.001). Mean age, age at onset of endometriosis, race, height,
weight, body mass index, medical history of allergies, and
family histories of endometriosis and cancer were similar in
women with endometriosis and SAB and in parous women with endometriosis
but without SAB. Moreover, the two groups were similar in age
at menarche, length of cycle, duration and amount of flow,
and the severity of disease. The incidence of infertility was
significantly higher in women with SAB (p < 0.001). Conclusion.
These data suggest but do not prove that the risk of SAB is
increased in women with endometriosis. The epidemiological
risk factors of endometriosis are not associated with an increase
in the abortion rate.
6: Chan SS, Lau AP, To KF, Leung TY, Lau TK, Leung TN.
Umbilical cord ulceration causing foetal haemorrhage and stillbirth.
Hong Kong Med J. 2008 Apr;14(2):148-51.
Department of Obstetrics and Gynaecology, The Chinese University
of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
We report a case of umbilical cord ulceration associated with
obstruction of the duodeno-jejunal junction by a peritoneal
band. Umbilical cord ulceration is a rare condition; a literature
review identified a total of 17 cases only. In all cases, the
ulceration was associated with congenital intestinal obstruction.
Cord ulceration usually presents as sudden foetal deterioration
due to foetal haemorrhage. This condition is associated with
high perinatal mortality and morbidity. The causes of this
condition are still unknown, and prenatal diagnosis is difficult.
Awareness of the possible association between umbilical cord
ulceration and intestinal obstruction, and of the need to deliver
such pregnancies immediately when an abnormal foetal heart
rate pattern develops might be the only means of preventing
intrauterine death and improving neonatal outcomes.
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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