NSIDRC Journal Article Alert — November 21, 2008
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
Past issues of Resource Center 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.
Readers: Owing to the Thanksgiving holiday, the NSIDRC Journal Article Alert will not be published next week. Publication will resume the following week. Happy Thanksgiving!
Sudden Infant Death
1. Jequier Gygax M, Roulet-Perez E, Meagher-Villemure K, Jakobs C, Salomons GS, Boulat O, Superti-Furga A, Ballhausen D, Bonafé L Sudden unexpected death in an infant with L-2-hydroxyglutaric aciduria Eur J Pediatr. 2008 Nov 13. [Epub ahead of print]
Child Neurology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Inherited metabolic disorders are the cause of a small but significant number of sudden unexpected deaths in infancy. We report a girl who suddenly died at 11 months of age, during an intercurrent illness. Autopsy showed spongiform lesions in the subcortical white matter, in the basal ganglia, and in the dentate nuclei. Investigations in an older sister with developmental delay, ataxia, and tremor revealed L: -2-hydroxyglutaric aciduria and subcortical white matter changes with hyperintensity of the basal ganglia and dentate nuclei at brain magnetic resonance imaging. Both children were homozygous for a splice site mutation in the L2HGDH gene. Sudden death has not been reported in association with L: -2-hydroxyglutaric aciduria so far, but since this inborn error of metabolism is potentially treatable, early diagnosis may be important.
Other Infant Death
1. Williamson DM, Abe K, Bean C, Ferré C, Henderson Z, Lackritz E Current Research in Preterm Birth J Womens Health (Larchmt). 2008 Nov 12. [Epub ahead of print]
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Abstract Preterm birth is one of the leading causes of infant mortality and the leading cause of infant morbidity in the United States. It accounts for >70% of neonatal deaths and almost half of long-term neurological disabilities. The Centers for Disease Control and Prevention (CDC) is collaborating with state health departments, universities, communities, and healthcare providers to understand why preterm births occur and how to address preterm birth risk factors. These collaborations include identification of genetic and other biological markers for the early detection of women at high risk of preterm birth; improving understanding of the relationships among psychosocial stress, immune and inflammatory responses, and preterm risk; and designing community strategies to improve the health of pregnant women. By conducting public health research activities that explore the genetic, biological, clinical, behavioral, social, and community determinants of preterm birth, CDC will continue to elucidate the complex interactions of these factors and how they influence preterm birth.
Bereavement
1. Roehrs C, Masterson A, Alles R, Witt C, Rutt P J Caring for families coping with perinatal loss Obstet Gynecol Neonatal Nurs. 2008 Nov-Dec;37(6):631-9
School of Nursing, University of Northern Colorado, Greeley, CO 80639, USA. carol.roehrs@unco.edu
OBJECTIVE: To describe support needs and comfort level of labor nurses caring for families experiencing perinatal loss. DESIGN: Qualitative descriptive study. SETTING: A western hospital birthing unit. PARTICIPANTS: Ten labor nurses. METHOD: Participants completed online surveys and follow-up interviews; data saturation was reached. Content analysis produced themes and recommendations related to providing perinatal bereavement care. Participants reviewed and confirmed accuracy of the results. RESULTS: Nurses are generally comfortable but find it difficult to provide perinatal bereavement care. Strategies for coping include focusing on needed care, talking to nursing peers, and spending time with their own family members. Nurses take turns providing care depending on "who is best able to handle it that day" and prefer not to be assigned a laboring patient in addition to the grieving parents. Developing clinical expertise is necessary to gain the comfort level and the skills necessary to care for these vulnerable families. Orientation experiences and nursing staff debriefing would help. Needed education includes grief training, communication techniques, and guidelines for the extensive paperwork. CONCLUSIONS: Initial and ongoing education of nurses about perinatal bereavement care is needed. Effective strategies for coping during and after providing care would support nurses in meeting the emotional challenge of providing high quality perinatal bereavement care.
Miscarriage/Stillbirth/Prenatal Issues
1. Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA; for the MRgFUS Study Group Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids Fertil Steril. 2008 Nov 13. [Epub ahead of print]
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.
OBJECTIVE: To report all pregnancies to date after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for the conservative treatment of clinically significant uterine fibroids. DESIGN: Prospective registry of all known pregnancies occurring after MRgFUS maintained by the device manufacturer and reported to the Food and Drug Administration. SETTING: World experience of pregnancies after treatment with reports from 13 sites in seven countries. PATIENT(S): Fifty-one reproductive-age women with uterine leiomyomas. INTERVENTION(S): Women underwent MRgFUS treatment for symptomatic uterine leiomyomas before this report. MAIN OUTCOME MEASURE(S): Pregnancy outcomes and complications. RESULT(S): Fifty-four pregnancies in 51 women have occurred after MRgFUS treatment of uterine leiomyomas. The mean time to conception was 8 months after treatment. Live births occurred in 41% of pregnancies, with a 28% spontaneous abortion rate, an 11% rate of elective pregnancy termination, and 11 (20%) ongoing pregnancies beyond 20 gestational weeks. The mean birth weight was 3.3 kg, and the vaginal delivery rate was 64%. CONCLUSION(S): Preliminary pregnancy experience after MRgFUS is encouraging, with a high rate of delivered and ongoing pregnancies.
2. Nabukera SK, Wingate MS, Kirby RS, Owen J, Swaminathan S, Alexander GR, Salihu HM Interpregnancy interval and subsequent perinatal outcomes among women delaying initiation of childbearing J Obstet Gynaecol Res. 2008 Dec;34(6):941-7
Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Aim: While delayed initiation of childbearing is associated with adverse perinatal outcomes, whether or not risk persists and whether interpregnancy interval (IPI) affects the subsequent pregnancy remains unclear. Objectives: To examine second-pregnancy perinatal outcomes for women initiating childbearing age >/=30 compared to those initiating childbearing aged 20-29, specifically examining the distribution of adverse perinatal outcomes, and their associations with the interpregnancy interval. Methods: Retrospective cohort study using the Missouri maternally linked files 1978-1997. Perinatal outcomes included fetal death, low birthweight, preterm birth and small-for-gestational age. Predictor variables included maternal age at first pregnancy and IPI between the first and second pregnancy. Results: With an increasing maternal age at first pregnancy, rates of very low birthweight (P = 0.0095), preterm delivery (P = 0.0126), moderately preterm (P = 0.0458), and extremely preterm (P = 0.0008) in the second pregnancy increased, while the rate of small-for-gestational age (P < 0.0001) declined. Interpregnancy intervals <6 and >/=60 months were associated with a higher rate of adverse outcomes after controlling for maternal age at first pregnancy. Intervals of 12-17 months had the lowest rate of adverse outcomes for mothers 35+. Maternal age >/=35 years at first pregnancy and IPI <6 months were independent risk factors for an adverse outcome in the second pregnancy, however no statistical interaction between these factors was observed. Conclusion: Delayed initiation of childbearing is associated with a persistent risk of adverse perinatal outcomes in the second pregnancy, with a short IPI contributing to this risk. As numbers of women delaying childbearing beyond age 30 increase, providers should consider these risks in counseling women about their reproductive plans.
3. Sinha P, Kaushik S, Kuruba N, Beweley S Vasa praevia: a missed diagnosis J Obstet Gynaecol. 2008 Aug;28(6):600-3
Conquest Hospital, St Leonard's on Sea, East Sussex, UK. prabha.sinha@esht.nhs.uk
Vasa praevia is an uncommon obstetric complication, which if undiagnosed is associated with a high fetal mortality because of the rapid haemorrhage from tearing of fetal vessels resulting in fetal exsanguinations. Antenatal diagnosis in most cases is not made and therefore prevention of fetal death is not possible. Outcome depends primarily on prenatal diagnosis and caesarean delivery at 36 weeks or even earlier. Advances in ultrasound have led to an improved ability to diagnose this condition. Evaluation of high-risk patients with transvaginal colour flow Doppler ultrasound should be considered and should be included in the protocol for routine obstetrics scan. We report three cases of vasa praevia presenting as ante-partum and intra-partum bleeding. Two of them had associated suspected low-lying placenta. This occurred within 4 years (2002-2006) in a small DGH with a delivery rate of 1,800 per year. The purpose of writing these case reports is to warn others of the need for vigilance antenatally, especially with a low-lying placenta, velamentous insertion of cord, IVF and multiple pregnancy. Colour Doppler should be used to visualise blood vessels in these high-risk cases and elective caesarean section should be performed at 35-36 weeks in cases diagnosed as vasa praevia.
4. King-Hele S, Webb R, Mortensen PB, Appleby L, Pickles A, Abel KM Risk of stillbirth and neonatal death linked with maternal mental illness: A national cohort study Arch Dis Child Fetal Neonatal Ed. 2008 Nov 10. [Epub ahead of print]
University of Manchester, United Kingdom
BACKGROUND: Babies of mothers with psychotic disorders are known to have higher rates of poor obstetric outcome, including higher mortality rates. This population-based study investigates risks of cause-specific perinatal death linked to a range of maternal psychiatric illness. AIMS: To estimate risks of stillbirth and neonatal death by specific causes in babies of mothers with histories of severe mental illness, relative to the general population. METHODS: We identified a cohort of 1.45 million live births and 7,021 stillbirths during 1973-1998 from Danish national registers. These registers were linked to identify babies who were stillborn or died neonatally following exposure to maternal psychiatric illness. RESULTS: Risks of stillbirth and neonatal death were raised for virtually all causes of death, in relation to all maternal psychiatric illnesses. For most causes of death, offspring of women with schizophrenia and related disorders had no greater risks of stillbirth or neonatal death compared with other maternal disorders (e.g. stillbirth due to immaturity: relative risks (95%confidence interval) schizophrenia and related disorders: 1.1(0.4-3.5), affective disorders: 2.0(1.2-3.5)). There was a stronger elevation in risk of fatal congenital malformation associated with a history of maternal affective disorder (stillbirth 2.4(1.1-5.1), neonatal death (NND) 2.2(1.4-3.3)) or schizophrenia and related disorders (stillbirth 2.4(0.8-7.6), NND 2.2(1.1-4.1)) than with maternal alcohol/drug-related disorders (stillbirth 1.2(0.4-3.8), NND 1.1(0.6-2.2)). CONCLUSIONS: Higher risk of perinatal loss may be linked to factors associated with maternal psychiatric illness in general such as insufficient attendance for antenatal care and unhealthy lifestyles rather than maternal mental illness per se.
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center Georgetown University 2115 Wisconsin Avenue, N.W., Suite 601 Washington, DC 20007 (866) 866-7437 toll free (202) 687-7466 local (202) 784-9777 fax info@sidscenter.org http://www.sidscenter.org
