NSIDRC Journal Article Alert — May 9, 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. Yiallourou SR, Walker AM, Horne RS
Effects of sleeping position on development of infant cardiovascular control
Arch Dis Child. 2008 May 2 [Epub ahead of print]

Monash University, Australia

OBJECTIVE: Sudden Infant Death Syndrome (SIDS) is associated with prone sleeping and circulatory failure has been hypothesised as a factor in the fatal event. We aimed to determine the effect of prone sleeping on heart rate (HR) and blood pressure (BP) control over the first 6 mo of life. SUBJECTS: Term infants (N=20) were studied longitudinally at 2-4 wk, 2-3 mo and 5-6 mo with daytime polysomnography. MAIN OUTCOME MEASURES: A photoplethysmographic cuff (FinometerTM) on the infant's wrist measured (MAP), systolic (SAP), diastolic (DAP) arterial pressure and HR during quiet sleep (QS) and active sleep (AS) in both the supine and prone positions. RESULTS: BP in QS was lower compared to AS (by 3-9 mmHg) in both positions and at all three ages (p<0.05). At 2-3 mo a change from supine to prone in QS induced a fall in SAP (6 mmHg, p<0.05) and a rise in HR (4 bpm, p<0.05). An overall effect of PNA on BP was identified (ANOVA) with MAP and DAP consistently averaging less (by 1-9 mmHg) at 2-3 mo in both sleep states and sleeping positions compared with both other ages. CONCLUSIONS: Infant BP is modified by sleep state and sleeping position. A tendency for BP to fall in the prone position appears to be prevented by elevated HR, except at 2-3 mo in QS. An uncompensated fall in BP in the prone position at 2-3 mo (when SIDS risk is greatest) could increase the possibility of circulatory failure and SIDS in vulnerable infants.

2. Van Norstrand DW, Tester DJ, Ackerman MJ
Overrepresentation of the proarrhythmic, sudden death predisposing sodium channel polymorphism S1103Y in a population-based cohort of African-American sudden infant death syndrome
Heart Rhythm. 2008 May;5(5):712-5. Epub 2008 Feb 16

Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905, USA

BACKGROUND: The S1103Y-SCN5A polymorphism has been implicated as a proarrhythmic, sudden death predisposing risk factor in African Americans, including one postmortem investigation of African-American infants with sudden infant death syndrome (SIDS). OBJECTIVE: The purpose of this study was to assess whether the relatively African-American-specific common polymorphism S1103Y in the SCN5A-encoded cardiac sodium channel is overrepresented in SIDS among African Americans. METHODS: Seventy-one cases from a population-based cohort of unexplained infant deaths among African Americans (37 females and 34 males, average age 3 +/- 2 months, age range birth to 11 months) were submitted to the Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory for postmortem genetic testing. Polymerase chain reaction and a restriction digest assay were performed to genotype this cohort for S1103Y. RESULTS: Targeted mutational analysis of exon 18 in SCN5A of the African-American SIDS cohort (n = 71) revealed the S1103Y polymorphism in 16 (22.5%) of 71 African-American cases of SIDS compared to 135 (11.6%) of 1,161 ostensibly healthy adult African Americans (P = .01). CONCLUSION: This study provides an independent assessment of the prevalence of S1103Y-SCN5A among African-American infants with sudden, unexpected, unexplained death prior to their first birthday. Further scrutiny and quantification of the risk apparently associated with S1103Y appear warranted.

3. Blair PS, Mitchell EA, Heckstall-Smith EM, Fleming PJ
Head Covering - A major modifiable risk factor for Sudden Infant Death Syndrome: A systematic review
Arch Dis Child. 2008 May 1 [Epub ahead of print]

University of Bristol, United Kingdom

BACKGROUND: Some victims of sudden infant death syndrome (SIDS) are found with their heads covered with bedclothes but the significance is uncertain. The aim of this review is to describe the prevalence of head covering, the magnitude of the risk and how the suggested causal mechanisms fit with current epidemiological evidence. METHODS: Systematic review of population-based age-matched controlled studies. RESULTS: Controlled observations of head covering for the final sleep were found in ten studies. The pooled prevalence in SIDS victims was 24.6% [95% CI: 22.3-27.1%] compared to 3.2% [95% CI: 2.7-3.8%] amongst the controls. The pooled univariate odds ratio (OR) was 9.6 [95% CI: 7.9-11.7] and the pooled adjusted OR from studies mainly conducted after the fall in SIDS rate was 16.9 [95% CI: 12.6-22.7]. The risk varied in strength but was significant across all studies. In a quarter of cases and controls head covering had occurred at least once previously (pooled adjusted OR=1.1 [95% CI: 0.9-1.4]). The population attributable risk (27.1% [95% CI: 24.7%-29.4%]) suggests avoiding head covering might reduce SIDS deaths by more than a quarter. CONCLUSIONS: The epidemiological evidence does not fully support postulated causal mechanisms such as hypoxia, hypercapnoea and thermal stress, but neither does it support the idea that head covering is part of some terminal struggle. Head covering is a major modifiable risk factor associated with SIDS deaths and parental advice to avoid these circumstances should be emphasised.

4. Moore BM, Fernbach KL, Finkelstein MJ, Carolan PL
Impact of Changes in Infant Death Classification on the Diagnosis of Sudden Infant Death Syndrome
Clin Pediatr (Phila). 2008 Apr 30 [Epub ahead of print]

This study evaluates the hypothesis that a decline in sudden infant death syndrome in Minnesota is associated with increases in other categories of sudden unexpected infant death. Matched birth and death certificates, autopsy reports, and home visit questionnaires were reviewed for 722 sudden unexpected infant deaths that occurred from January 1, 1996 through December 31, 2002. Descriptive data and cause of death were recorded. Cause of death was compared for 2 periods: early (1996-1998) and late (2000-2002). The age of the infant at death, sex, race, and infant death rates were similar between the 2 periods (P = .637). Sudden infant death syndrome declined by 50.1% (P < .001). Overlay deaths increased 235.5% (P < .01). Asphyxia related deaths increased 259.6% (P < .001). Injury-related deaths increased 840.0% (P < .001). A decline in sudden infant death syndrome in Minnesota was associated with increased deaths in categories that are asphyxial in nature and are potentially preventable.

5. Edston E, Perskvist N
Histiocytoid cardiomyopathy and ventricular non-compaction in a case of sudden death in a female infant
Int J Legal Med. 2008 Apr 30 [Epub ahead of print]

Department of Forensic Medicine, Artillerigatan 12, 581 33, Linköping,
Sweden, eried@imk.liu.se

A case of sudden infant death with histiocytoid cardiomyopathy and ventricular non-compaction was investigated with immunohistochemical methods. Histiocytoid cardiomyopathy is thought to be a developmental defect of the cardiomyocytes of the conduction system. In contrast to
mature cardiomyocytes, the histiocytoid cells showed only weak reactions to desmin and myosin antibodies. They lacked cross-striation but reacted strongly to enolase and myoglobin antibodies. The protein Pax-7, seen only in cells undergoing differentiation, and the proliferation marker Ki-67 were not expressed in the histiocytoid cells. In areas of altered myocardium, clusters of CD4-, CD8-, and CD68-positive inflammatory cells were seen as well an abundance of mast cells. With the TUNEL method, it was found that many of the histiocytoid cells were undergoing apoptosis. Our results confirm that the histiocytoid cells are defective cardiomyocytes. The apoptotic and inflammatory changes point to a degenerative process rather than defective maturation of cardiomyocytes as has been suggested in some earlier studies. Ventricular non-compaction is a developmental defect of the subendocardial tissue
with hypertrabeculation and weak development of the papillary muscles. Only one case combined with histiocytoid cardiomyopathy has been described previously. A causal connection between the two conditions cannot be established until more cases have been analyzed.

Other Infant Death

1. Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, Winikoff B
Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial
Pediatrics

Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th St, New York, NY 10032, USA. nlsloan@gmail.com

OBJECTIVE: We adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh, where the incidence of home delivery, low birth weight, and neonatal and infant mortality is high and neonatal intensive care is unavailable. This trial tested
whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5%, infant mortality rate by 25%, and low birth weight neonatal mortality rate by 30%. METHODS: Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were randomly assigned to community-based kangaroo mother care, and half were not. One village per union was randomly selected proportionate to union population size. A baseline survey of 39,888 eligible consenting women collected sociodemographic information. Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages. A total of 4165 live births were identified and enrolled. Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care, feeding, growth, health, and vital status. RESULTS: Forty percent overall and approximately 65% of newborns who died were
not weighed at birth, and missing birth weight was differential by study group. There was no difference in overall neonatal mortality rate or infant mortality rate. Except for care seeking, community-based kangaroo mother care behaviors were more common in the intervention than control group, but implementation was weak compared with the pilot study. CONCLUSIONS: The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival.

Miscarriage/Stillbirth/Prenatal Issues

1. Zhang X, Decker A, Platt RW, Kramer MS
How big is too big? The perinatal consequences of fetal macrosomia
Am J Obstet Gynecol. 2008 May;198(5):517.e1-6

Department of Pediatrics, McGill University Faculty of Medicine,
Montreal, QC, Canada

OBJECTIVE: The objective of the study was to examine the birthweight at which risks of perinatal death, neonatal morbidity, and cesarean delivery begin to rise and the causes and timing (antenatal, early or late neonatal, or postneonatal) of these risks. STUDY DESIGN: This was a cohort study based on 1999-2001 US-linked stillbirth, live birth, and infant death records. Singletons weighing 2500 g or larger born to white non-Hispanic mothers at 37-44 weeks of gestation were selected (n = 5,983,409). RESULTS: Infants with birthweights from 4000 to 4499 g were not at increased risk of mortality or morbidity vs those at 3500-3999 g, whereas those 4500-4999 g had significantly increased risks of stillbirth, neonatal mortality (especially because of birth asphyxia), birth injury, neonatal asphyxia, meconium aspiration, and cesarean delivery. Births at 5000 g or larger had even higher risks, including risk of sudden infant death syndrome. CONCLUSION: Birthweight greater than 4500 g, and especially greater than 5000 g, is associated with increased risks of perinatal and infant mortality and morbidity.

2. Mobeen N, Jehan I, Banday N, Moore J, McClure EM, Pasha O, Wright LL,
Goldenberg RL
Periodontal disease and adverse birth outcomes: a study from Pakistan
Am J Obstet Gynecol. 2008 May;198(5):514.e1-8

Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

OBJECTIVE: Periodontal disease may increase the risk of adverse birth outcomes; however, results have been mixed. Few studies have examined periodontal disease in developing countries. We describe the relationship between periodontal disease and birth outcomes in a
community setting in Pakistan. STUDY DESIGN: This was a prospective cohort study. Enrollment occurred at 20-26 weeks of gestation. A study dentist performed the periodontal examination to assess probing depth, clinical attachment level, gingival index, and plaque index. Outcomes included stillbirth, neonatal death, perinatal death, < 32 weeks preterm birth, 32-36 weeks preterm birth, and low birthweight and are presented for increasing periodontal disease severity by quartiles. RESULTS: Dental examinations and outcome data were completed for 1152 women: 81% of the women were multiparous, with a mean age of 27 years; 33% of the women had no education. Forty-seven percent of the women had dental caries; 27% of the women had missing teeth, and 91% of the women had had no dental care in the last year. Periodontal disease was common: 76% of the women had > or = 3 teeth with a probing depth of > or = 3 mm; 87% of the women had > or = 4 teeth with a clinical attachment level of > or = 3 mm; 56% of the women had > or = 4 teeth with a plaque index of 3; and 60% of the women had > or = 4 teeth with a gingival index of 3. As the measures of periodontal disease increased from the 1st to 4th quartile, stillbirth and neonatal and perinatal death also increased, with relative risks of approximately 1.3. Early preterm birth increased, but the results were not significant. Late preterm birth and low birthweight were not related to measures of periodontal disease. CONCLUSION: Pregnant Pakistani women have high levels of moderate-to-severe dental disease. Stillbirth and neonatal and perinatal deaths increased with the severity of periodontal disease.

3. Lagerberg RE
Malaria in pregnancy: a literature review
J Midwifery Womens Health. 2008 May-Jun;53(3):209-15

Center for Community Health and Education, New York-Presbyterian Hospital, NewYork, NY, USA. rl2392@columbia.edu

Pregnant women are more likely than nonpregnant women to become infected with malaria and to have severe infection. The effects of malaria during pregnancy include spontaneous abortion, preterm delivery, low birth weight, stillbirth, congenital infection, and maternal death. Malaria is
caused by the four species of the protozoa of the genus Plasmodium, which is transmitted by the bite of the female Anopheline mosquito, congenitally, or through exposure to infected blood products. This article reviews the epidemiology, pathology, clinical symptoms, diagnosis, and treatment of malaria in pregnant women. Interventions to prevent malaria include intermittent preventive treatment, insecticide-treated nets, and case management of malaria infection and
anemia.

4. Henley A, Schott J
The death of a baby before, during or shortly after birth: Good practice from the parents' perspective
Semin Fetal Neonatal Med. 2008 Apr 29 [Epub ahead of print]

Sonneggstrasse 9, 4125 Riehen, Switzerland

This chapter is adapted from Pregnancy Loss and the Death of a Baby: Guidelines for Professionals (3rd edition) by Judith Schott, Alix Henley and Nancy Kohner, published by Sands (the UK Stillbirth and Neonatal Death charity) in 2007. The article highlights those aspects of care given to families facing perinatal loss that parents value and those that add, often inadvertently, to their distress. It is based on research findings and on views expressed by parents.

5. Ma S
Paternal Race/Ethnicity and Birth Outcomes
Am J Public Health. 2008 Apr 29 [Epub ahead of print]

Johns Hopkins University.

Objectives. I sought to identify whether there were associations between paternal race/ethnicity and birth outcomes among infants with parents of different races/ethnicities. Methods. Using the National Center for Health Statistics 2001 linked birth and infant death file, I compared birth outcomes of infants of White mothers and fathers of different races/ethnicities by matching and weighting racial/ethnic groups following a propensity scoring approach so other characteristics were distributed identically. I applied the same analysis to infants of Black parents and infants with a Black mother and White father. Results. Variation in risk factors and outcomes was found in infants of White mothers by paternal race/ethnicity. After propensity score weighting,
the disparities in outcomes by paternal or parental race/ethnicity could be largely attributed to nonracial parental characteristics. Infants whose paternal race/ethnicity was unreported on their birth certificates had the worst outcomes. Conclusions. The estimated effect of maternal race/ethnicity on birth outcomes was more than 3 times as large as that of paternal race/ethnicity after I controlled for all covariates. Unreported paternal race/ethnicity had a strong association with outcomes, which might be a source of bias in existing data and a marker
for identifying infants at risk.

6. Díaz JM, Canal C, Giménez I, Guirado L, Facundo C, Solà R, Ballarín J
Pregnancy in recipients of kidney transplantation: effects on the mother and the child
Nefrologia. 2008;28(2):174-177.

When the field of transplantation was first developing, physicians worried about the teratogenicity of immunosuppressive medications and considered pregnancy ill-advised. The purpose of this study is to analyze pregnancy after kidney transplantation and their consequences on mother, graft and child. We rewiew ten pregnant women with kidney transplantation, average of 29 years old and 44 months post-kidney transplantation. The mean glomerular filtration rate was 64 ml/min and the immunosuppression was with prednisone and tacrolimus. We analyze outcomes of differents variables before and during pregnancy, and after labour. Pregnancy finished in nine of ten patients. Three patients needed cesarean section and only one patient had a miscarriage on the first term. Blood arterial pressure increased at the end of pregnancy and the creatinine level was stable with a few increase of proteinuria at the third term. We increased the tacrolimus dose to obtain the correct blood levels and any rejection was detected. We had only one patient with preeclampsia that we solved with a cesarean section. Labours were a mean of 37.2 weeks and the mean birth weight of infant was 2809 grams. Two newborns had prematurity without structural malformations. Pregnancy after kidney transplantation is safe with prednisone and tacrolimus when the renal function is good, proteinuria doesn't exist and blood pressure is controlled.

7. Pãunescu MM, Feier V, Pãunescu M, Dorneanu F, Sisak A, Ambros-Rudolph CM
Dermatoses of pregnancy
Acta Dermatovenerol Alp Panonica Adriat. 2008 Mar;17(1):4-11

Department of Dermatology, Victor Babes University of Medicine and Pharmacy, Str Mãrã e ti 5, Timisoara, Romania. magdalenapaunescu@yahoo.com

The dermatoses of pregnancy represent a heterogeneous group of pruritic inflammatory skin diseases related to pregnancy and/or the postpartum period. Whereas some dermatoses are distressing only to the mother because of severe pruritus, others are associated with fetal risks including fetal distress, prematurity, and stillbirth. Early diagnosis and prompt treatment are essential for improving maternal and fetal prognosis. This review discusses the various pregnancy dermatoses in detail and offers an algorithmic approach to their diagnosis and management.

Prepared by the
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