NSIDRC Journal Article Alert — August 21, 2009

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.

Sudden Infant Death

1. Escott A, Elder DE, Zuccollo JM

Sudden unexpected infant death and bedsharing: referrals to the Wellington Coroner 1997-2006

N Z Med J. 2009 Jul 3;122(1298):59-68

School of Medicine andHealth Sciences, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand. dawn.elder@otago.ac.nz

AIMS: To describe the factors associated with sudden unexpected infant deaths, for which there was no clear medical diagnosis, referred to the Wellington-based coronial paediatric pathology service over the decade from 1997 to 2006. METHODS: The postmortem report, Police 47 file, Coroner's findings and deceased infant's medical records were used to create a profile for each sudden and unexpected infant death. RESULTS: There were 64 deaths in the period: 54 of these occurred during sleep and did not have a clear medical diagnosis. Maori and Pacific infants and infants from low decile areas were over-represented in the group. The majority (88.7%) of infants were < 6 months of age at death. Overall, 50% of infants had been placed to sleep in a non-recommended sleep position and 38% usually slept in a non-recommended location. Bedsharing was associated with 53.7% of deaths. There was a significant association between bedsharing and being found dead on a Sunday morning (p=0.04). CONCLUSION: Sudden unexpected death in infancy is associated with unsafe sleep environments and sleep positions. Every effort should be made to ensure that information about safe infant sleep practices reaches the caregivers of those particularly at risk.

Miscarriage/Stillbirth/Prenatal Issues

1. ILi M, Huang SJ
Innate immunity, coagulation and placenta-related adverse pregnancy outcomes
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA

Maternal immunity undergoes subtle adjustment in order to tolerate the semi-allogeneic embryo and maintain the host defense against potential pathogens. Concomitantly, coagulation systems change from an anti-coagulant state to a pro-coagulant state to meet the hemostatic challenge of placentation and delivery. Innate immunity and blood coagulation systems are the first line of defense to protect a host against exogenous challenges, including alloantigens and mechanical insults, and preserve the integrity of an organism. The interactions between coagulation and immune systems have been extensively studied. Immune cells play a pivotal role in the initiation of the coagulation cascade, whereas coagulation proteases display substantial immuno-modulatory effects. Upon exogenous challenges, the immune and coagulation systems are capable of potentiating each other leading to a vicious cycle. Natural killer (NK) cells, macrophages (Mvarphis) and dendritic cells (DCs) are three major innate immune cells that have been demonstrated to play essential roles in early pregnancy. However, immune maladaptation and hemostatic imbalance have been suggested to be responsible for adverse pregnant outcomes, such as preeclampsia (PE), miscarriage, recurrent spontaneous abortion (RSA) and intrauterine growth restriction (IUGR). In this review, we will summarize the mutual regulation between blood coagulation and innate immune systems as well as their roles in the maintenance of normal pregnancy and in the pathogenesis of adverse pregnancy outcomes.

2. Pastagia M, Caplivski D

Disseminated cryptococcosis resulting in miscarriage in a woman without other immunocompromise: a case report

Int J Infect Dis. 2009 Aug 12. [Epub ahead of print]

Division of Infectious Diseases, Department of Internal Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA.

We present an unusual case of disseminated cryptococcosis involving the lungs, placenta, and gall bladder in an apparently immunocompetent pregnant woman. The infection resulted in spontaneous abortion. The patient's condition only improved after cholecystectomy and several weeks of antifungal therapy. An in-depth evaluation revealed no central nervous system involvement or immunocompromising condition other than pregnancy.

PMID: 19682936 [PubMed - as supplied by publisher]

3. Nishiura H

Excess risk of stillbirth during the 1918-1920 influenza pandemic in Japan

Eur J Obstet Gynecol Reprod Biol. 2009 Aug 11. [Epub ahead of print]

Theoretical Epidemiology, University of Utrecht, 3584 CL Utrecht, The Netherlands.

4. Persson M, Norman M, Hanson U

Obstetric and perinatal outcomes in type 1 diabetic pregnancies - a large, population-based study

Diabetes Care. 2009 Aug 12. [Epub ahead of print]

Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm.

Objective: to perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies (T1DM) and the general obstetric population in Sweden between 1991 and 2003. Research design and Methods: Population based study. Data were obtained from the Medical Birth Registry, covering more than 98% of all pregnancies in Sweden. A total of 5,089 T1DM pregnancies and 1,260,207 controls were included. Odds ratios (OR) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits and ethnicity. Results: In T1DM, preeclampsia was significantly more frequent [OR=4.47 (3.77-5.31)] as well as delivery with Cesarean section [OR=5.31 (4.97-5.69)] compared to the general population. Stillbirth [OR=3.34 (2.46-4.55)], perinatal mortality [OR=3.29 (2.50-4.33)] and major malformations [OR=2.50 (2.13-2.94)] were more common in T1DM than in controls. Risk of very preterm birth (<32 gestational weeks) was also higher among T1DM women [OR=3.08 (2.45-3.87)]. The incidence of fetal macrosomia (birth weight 2 SD or more above the mean) was much increased in the diabetes group [OR=11.45 (10.61-12.36)]. Conclusion: T1DM in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The 8-fold increased risk for fetal macrosomia in T1DM pregnancies is unexpected and warrants further investigation.

5. Mingrone R, Fulcheri E, Lavezzi AM, Matturri L

Absolute shortness of the umbilical cord and hypoplasia of the arcuate nucleus and of the parabrachial/Kölliker-Fuse complex in a case of sudden intrauterine fetal death

Eur J Obstet Gynecol Reprod Biol. 2009 Aug 9. [Epub ahead of print]

"Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Surgical, Reconstructive and Diagnostic Sciences, University of Milan, Italy.

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


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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. Escott A, Elder DE, Zuccollo JM Sudden unexpected infant death and bedsharing: referrals to the Wellington Coroner 1997-2006 N Z Med J. 2009 Jul 3;122(1298):59-68 School of Medicine andHealth Sciences, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand. dawn.elder@otago.ac.nz AIMS: To describe the factors associated with sudden unexpected infant deaths, for which there was no clear medical diagnosis, referred to the Wellington-based coronial paediatric pathology service over the decade from 1997 to 2006. METHODS: The postmortem report, Police 47 file, Coroner's findings and deceased infant's medical records were used to create a profile for each sudden and unexpected infant death. RESULTS: There were 64 deaths in the period: 54 of these occurred during sleep and did not have a clear medical diagnosis. Maori and Pacific infants and infants from low decile areas were over-represented in the group. The majority (88.7%) of infants were < 6 months of age at death. Overall, 50% of infants had been placed to sleep in a non-recommended sleep position and 38% usually slept in a non-recommended location. Bedsharing was associated with 53.7% of deaths. There was a significant association between bedsharing and being found dead on a Sunday morning (p=0.04). CONCLUSION: Sudden unexpected death in infancy is associated with unsafe sleep environments and sleep positions. Every effort should be made to ensure that information about safe infant sleep practices reaches the caregivers of those particularly at risk. Miscarriage/Stillbirth/Prenatal Issues 1. ILi M, Huang SJ Innate immunity, coagulation and placenta-related adverse pregnancy outcomes Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA Maternal immunity undergoes subtle adjustment in order to tolerate the semi-allogeneic embryo and maintain the host defense against potential pathogens. Concomitantly, coagulation systems change from an anti-coagulant state to a pro-coagulant state to meet the hemostatic challenge of placentation and delivery. Innate immunity and blood coagulation systems are the first line of defense to protect a host against exogenous challenges, including alloantigens and mechanical insults, and preserve the integrity of an organism. The interactions between coagulation and immune systems have been extensively studied. Immune cells play a pivotal role in the initiation of the coagulation cascade, whereas coagulation proteases display substantial immuno-modulatory effects. Upon exogenous challenges, the immune and coagulation systems are capable of potentiating each other leading to a vicious cycle. Natural killer (NK) cells, macrophages (Mvarphis) and dendritic cells (DCs) are three major innate immune cells that have been demonstrated to play essential roles in early pregnancy. However, immune maladaptation and hemostatic imbalance have been suggested to be responsible for adverse pregnant outcomes, such as preeclampsia (PE), miscarriage, recurrent spontaneous abortion (RSA) and intrauterine growth restriction (IUGR). In this review, we will summarize the mutual regulation between blood coagulation and innate immune systems as well as their roles in the maintenance of normal pregnancy and in the pathogenesis of adverse pregnancy outcomes. 2. Pastagia M, Caplivski D Disseminated cryptococcosis resulting in miscarriage in a woman without other immunocompromise: a case report Int J Infect Dis. 2009 Aug 12. [Epub ahead of print] Division of Infectious Diseases, Department of Internal Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA. We present an unusual case of disseminated cryptococcosis involving the lungs, placenta, and gall bladder in an apparently immunocompetent pregnant woman. The infection resulted in spontaneous abortion. The patient's condition only improved after cholecystectomy and several weeks of antifungal therapy. An in-depth evaluation revealed no central nervous system involvement or immunocompromising condition other than pregnancy. PMID: 19682936 [PubMed - as supplied by publisher] 3. Nishiura H Excess risk of stillbirth during the 1918-1920 influenza pandemic in Japan Eur J Obstet Gynecol Reprod Biol. 2009 Aug 11. [Epub ahead of print] Theoretical Epidemiology, University of Utrecht, 3584 CL Utrecht, The Netherlands. 4. Persson M, Norman M, Hanson U Obstetric and perinatal outcomes in type 1 diabetic pregnancies - a large, population-based study Diabetes Care. 2009 Aug 12. [Epub ahead of print] Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm. Objective: to perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies (T1DM) and the general obstetric population in Sweden between 1991 and 2003. Research design and Methods: Population based study. Data were obtained from the Medical Birth Registry, covering more than 98% of all pregnancies in Sweden. A total of 5,089 T1DM pregnancies and 1,260,207 controls were included. Odds ratios (OR) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits and ethnicity. Results: In T1DM, preeclampsia was significantly more frequent [OR=4.47 (3.77-5.31)] as well as delivery with Cesarean section [OR=5.31 (4.97-5.69)] compared to the general population. Stillbirth [OR=3.34 (2.46-4.55)], perinatal mortality [OR=3.29 (2.50-4.33)] and major malformations [OR=2.50 (2.13-2.94)] were more common in T1DM than in controls. Risk of very preterm birth (<32 gestational weeks) was also higher among T1DM women [OR=3.08 (2.45-3.87)]. The incidence of fetal macrosomia (birth weight 2 SD or more above the mean) was much increased in the diabetes group [OR=11.45 (10.61-12.36)]. Conclusion: T1DM in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The 8-fold increased risk for fetal macrosomia in T1DM pregnancies is unexpected and warrants further investigation. 5. Mingrone R, Fulcheri E, Lavezzi AM, Matturri L Absolute shortness of the umbilical cord and hypoplasia of the arcuate nucleus and of the parabrachial/Kölliker-Fuse complex in a case of sudden intrauterine fetal death Eur J Obstet Gynecol Reprod Biol. 2009 Aug 9. [Epub ahead of print] "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Surgical, Reconstructive and Diagnostic Sciences, University of Milan, Italy. 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
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NSIDRC Journal Article Alert — August 21, 2009

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