NSIDRC Journal Article Alert — April 24, 2009
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
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Sudden Infant Death
1. Sakai J, Takahashi S, Funayama M
Gas dispersal potential of infant bedding of sudden death cases. (I): CO(2) accumulation around the face of infant mannequin model
Leg Med (Tokyo). 2009 Apr 15. [Epub ahead of print]
Division of Forensic Medicine, Tohoku University School of Medicine, 2-1 Seiryou-chou, Aoba-ku, Sendai, Japan.
We assessed CO(2) gas dispersal potential of bedding that had actually been used by 26 infants diagnosed with sudden unexpected infant death using a baby mannequin model. The age of victims ranged from 1 to 12 months. In some cases, the parents alleged that the infant faces were not covered with bedding when they were found. The parent's memories, however, may not have been accurate; therefore, we examined the potential for gas dispersal based on the supposition that the bedding had covered their faces. The mannequin was connected with a respirator set on the tidal volume and respiratory rates matched with the baby's age. Before measuring, CO(2) flow was regulated in 5%+/-0.1% of end-tidal PCO(2). After the model was placed on each bedding condition, measurements were performed at least five times under each respiratory condition. Four cases showed a plateau of FiCO(2) <4.8%, 15 were 4.8-12%, and the other seven were 12% or more, when they reached a plateau. Of course, our model does not take large tissue stores of CO(2) into account. However, our model could show the potential gas dispersal ability of bedding. Especially, the latter seven bedding could have high rebreathing potential if they covered the infant's faces and the probability of environmental asphyxia should be considered.
2. Morris JA, Harrison L, Brodison A, Lauder R
Sudden infant death syndrome and cardiac arrhythmias
Future Cardiol. 2009 Mar;5(2):201-7
Department of Pathology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK. jim.a.morris@mbht.nhs.uk
There is a considerable body of evidence that common bacterial toxins, absorbed from the mucosal surface or delivered as part of a transient bacteremia, have a pathogenic role in sudden infant death syndrome (SIDS). The candidate organisms are Staphylococcus aureus and Escherichia coli. Death in SIDS is rapid, with infants progressing from well, or only mildly unwell, to death in less than 20 min. This mode of death is not typical of infection but it is consistent with toxin action on cardiovascular or respiratory control. Both S. aureus and E. coli secrete toxins (cytolysins and colicins) that create channels in cell membranes and disturb ion currents. Recent evidence indicates that between 5 and 15% of SIDS cases carry potentially lethal loss-of-function mutations in cardiac channelopathy genes. However, only a minority of individuals with these mutations die of SIDS and the hypothesis proposed is that toxin-gene interaction could explain the deaths. Furthermore, channelopathy mutations predispose to sudden death at all ages and since episodes of transient bacteremia occur throughout life the idea of toxin-gene interaction could have wider applicability. These ideas can be investigated and answered in the near future using the new science of proteomics.
Bereavement
1. Büchi S, Mörgeli H, Schnyder U, Jenewein J, Glaser A, Fauchère JC, Ulrich Bucher H, Sensky T
Shared or discordant grief in couples 2-6 years after the death of their premature baby: effects on suffering and posttraumatic growth
Psychosomatics. 2009 Mar-Apr;50(2):123-30
Dept. of Psychiatry, University Hospital, Zurich, Switzerland. Stefan.Buechi@hohenegg.ch
BACKGROUND: The loss of a baby causes severe short- and long-term distress to parents and their marital relationship, but little is known about how this distress is shared between spouses. The authors hypothesized that the grief-related concordance within a couple 2 to 6 years after the loss of a premature baby could be an indicator of shared emotional distress within a couple. OBJECTIVE: The authors investigated the long-term grief experience among couples. METHOD: A group of 44 parents (22 couples) were assessed by questionnaire regarding grief, suffering, posttraumatic growth, and affective symptoms, and semistructured interviews with 6 couples added qualitative information about processes within couples. RESULTS: The extent of grief concordance was found to be related to different patterns of suffering and posttraumatic growth within couples. CONCLUSION: The emotional exchange between partners after the loss of the child appears to be crucial for a process of concordant grief, which in turn is associated with a more synchronous process of individual posttraumatic growth.
2. White P, Ferszt G
Exploration of nurse practitioner practice with clients who are grieving
J Am Acad Nurse Pract. 2009 Apr;21(4):231-40
Simmons College, School of Health Sciences, Nursing Programs, Boston, MA 02115, USA. patricia.white@simmons.edu
PURPOSE: Nurse practitioners (NPs) have provided care to clients in primary care settings for more than 40 years. Although NP practice standards have identified grief as a health concern that needs to be addressed, little is known about the practice of NPs with this population. The purpose of this study was to describe the clinical practice of NPs in primary care with clients who were grieving the death of a significant person. DATA SOURCES: This descriptive exploratory qualitative study explored NPs' assessment, plan of care, and evaluation of healthcare outcomes for their clients who were grieving. Semi-structured audiotaped interviews with nine NPs providing primary care to clients were completed. The data were analyzed using qualitative content analysis. CONCLUSIONS: The NPs' descriptions of their clinical practice yielded important information about their assessment, intervention, and evaluation of grieving clients. Descriptions of assessments by NPs provided important data that were categorized as physical complaints, overall functioning, and emotional well-being or coping. Descriptions of interventions included validation of clients' grief, prescriptions, and teaching or referral. Descriptions of outcomes included relief of physical complaints and stabilized chronic illness, improvements in overall functioning, and improvements in clients' emotional well-being and coping. IMPLICATIONS FOR PRACTICE: For NPs to be able to provide effective care to clients grieving the death of a loved one, they need a better understanding of theoretical models and current research related to grief. Further studies are needed to provide insight into the practice of NPs with this population.
Miscarriage/Stillbirth/Prenatal Issues
1. Hasan R, Olshan AF, Herring AH, Savitz DA, Siega-Riz AM, Hartmann KE
Self-reported Vitamin Supplementation in Early Pregnancy and Risk of Miscarriage
Am J Epidemiol. 2009 Apr 16. [Epub ahead of print]
Miscarriage is a common and poorly understood adverse pregnancy outcome. In this study, the authors sought to evaluate the relation between self-reported use of prenatal vitamins in early pregnancy and the risk of miscarriage. Between 2000 and 2008, 4,752 US women were prospectively enrolled in Right From the Start. Information about vitamin use was obtained from a first-trimester interview. Discrete-time hazard models were used, candidate confounders were assessed, and the following variables were included in the model: study site, maternal age, gravidity, marital status, education, race/ethnicity, smoking, and use of progesterone in early pregnancy. Approximately 95% of participants reported use of vitamins during early pregnancy. A total of 524 women had a miscarriage. In the final adjusted model, any use of vitamins during pregnancy was associated with decreased odds of miscarriage (odds ratio = 0.43, 95% confidence interval: 0.30, 0.60) in comparison with no exposure. These results should be viewed in the context of a potentially preventive biologic mechanism mitigated by possible confounding by healthy behaviors and practices that are also associated with vitamin supplement use during pregnancy.
2. Raghupathy R, Al-Mutawa E, Al-Azemi M, Makhseed M, Azizieh F, Szekeres-Bartho J
Progesterone-induced blocking factor (PIBF) modulates cytokine production by lymphocytes from women with recurrent miscarriage or preterm delivery
J Reprod Immunol. 2009 Apr 14 [Epub ahead of print]
Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
Spontaneous miscarriage and preterm delivery are common complications of pregnancy. Pro-inflammatory cytokines have been shown to be associated with recurrent spontaneous miscarriage (RSM) and preterm delivery (PTD) and these have led to exploration of ways to downregulate pro-inflammatory cytokines and/or to upregulate anti-inflammatory cytokines. Progesterone-induced blocking factor (PIBF) is a molecule with inhibitory effects on cell-mediated immune reactions. We have ascertained the effects of PIBF on secretion of selected type 1 and type 2 cytokines by peripheral blood mononuclear cells from healthy non-pregnant women, women undergoing normal pregnancy, women with unexplained RSM and women with PTD. Peripheral blood mononuclear cells from 30 women with a history of unexplained RSM, 18 women undergoing PTD, 11 women with normal pregnancy and 13 non-pregnant healthy women were stimulated with a mitogen in the absence and presence of PIBF after which the levels of cytokines released into culture supernatants were determined by ELISA. Production of the type 2 cytokines IL-4, IL-6 and IL-10 by lymphocytes from the RSM and PTD groups and of IL-4 and IL-10 by lymphocytes from healthy pregnant women was significantly increased upon exposure to PIBF, while the levels of type 1 cytokines were not affected. Ratios of type 1:type 2 cytokines were decreased, suggesting a shift towards Th2 bias. PIBF did not affect cytokine production by lymphocytes from non-pregnant women. Thus, PIBF acts on lymphocytes in pregnancy to induce a type 1 to type 2 cytokine shift by upregulating the production of type 2 cytokines.
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