NSIDRC Journal Article Alert — August 28, 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. Highet AR, Goldwater PN

Staphylococcal enterotoxin genes are common in Staphylococcus aureus intestinal flora in Sudden Infant Death Syndrome (SIDS) and live comparison infant

FEMS Immunol Med Microbiol. 2009 Aug 3. [Epub ahead of print]

Department of Microbiology and Infectious Diseases, SA Pathology at the Women's and Children's Hospital, North Adelaide, SA, Australia.

Abstract Pathological and epidemiological findings in sudden infant death syndrome (SIDS) suggest an infectious aetiology with indications of involvement of staphylococcal enterotoxins (SEs). While SEA, SEB and SEC have been found in the sera and tissues of SIDS cases, little is known about the role of intestinal Staphylococcus aureus or the roles of later-described toxins SEE, SEG, SEH, SEI and SEJ in SIDS. We used a molecular-based approach to define whether the intestinal tract could be a source of SEs to support the staphylococcal toxic shock hypothesis for SIDS. Intestinal contents from 57 SIDS infants and faeces from 79 age- and gender-matched live comparison infants were cultured and tested for S. aureus and sea-b-c-e-g-h-j and TSST using PCR. High proportions of infants in both groups carried toxigenic and nontoxigenic S. aureus. Significantly greater proportions of SIDS compared with comparison babies were positive for S. aureus (68.4% vs. 40.5%) and for SE genes (43.8% vs. 21.5%), suggesting a possible role in SIDS. The results indicate that colonization by S. aureus with SE genes is common in infants; however, their detection is unlikely to be a strong predictive tool for SIDS. Other factors (including immune response) may reveal a specific susceptibility to SEs in SIDS infants.

2. Fracasso T, Vennemann M, Pfeiffer H, Bajanowski T

Organ weights in cases of sudden infant death syndrome: a German study

Am J Forensic Med Pathol. 2009 Sep;30(3):231-4

Institute of Legal Medicine, University of Münster, Germany. tony.fracasso@ukmuenster.de

Despite its decreasing incidence, sudden infant death syndrome (SIDS) still remains an important cause of death in infancy. Since Felix Platter described the case of a child suffocated because of a massive goiter (Platter E. Suffocatio a struma interna abscondita, circa iugulum. Observationum in hominis affectibus plerisque corpori et animo, functionum lesione, dolore, aliave molestia et vitio incommodantibus. Libris tres, Part IX. Basel: König and Brandmylieri; 1614), many authors have attempted to verify the existence of a correlation between the dimensions of organs of infants and SIDS. The lack of recent published norms and the difficulty in finding a suitable control group by which to compare the cases of SIDS shows the importance of this study.This article presents the organ weights of 209 male and 132 female babies whose cause of death was SIDS. The data have been collected from 2 different studies: the Westphalian Cot Death Study from 1990 to 1994 and the German National Study on SIDS from 1998 to 2001. The organ weights increased from month to month during the first year of life showing a tendency towards higher weights in males compared with females (these are, however, not statistically significant). No significant differences compared with the recently published data of Thompson and Cohle, J Forensic Sci. 2004;49:575-585 were found.The heart weights were compared with a control group of 47 babies (21 females, 26 males) died because of both natural and unnatural causes. The weight of the organs that presented macro-microscopical pathologic changes was excluded.The weights of the heart were also compared with those published by Schulz and Giordano, Arch Pathol. 1962;74:464-471 and Kelmanson, Eur J Pediatr. 1996;155:440-444. This comparison showed minor differences which are discussed in the article. We suggest that organ weights obtained in SIDS cases can be used as norms in the first year of life.

3. Hutchon DJ

Cord clamp insult may predispose to SIDS

Early Hum Dev. 2009 Aug 18. [Epub ahead of print]

Memorial Hospital, Darlington DL3 6HX, United Kingdom.

4. Kinney C, Thach BT

The sudden infant death syndrome

N Engl J Med. 2009 Aug 20;361(8):795-805.

Department of Pathology, Children's Hospital, and Harvard Medical School, Boston, MA 02115, USA. hannah.kinney@childrens.harvard.edu

Other Infant Death

1. Peters C, Becher JC, Lyon AJ, Midgley PC

Who is blaming the baby?

Arch Dis Child Fetal Neonatal Ed. 2009 Sep;94(5):F377-8

Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.

Sudden unexplained collapse within the first 12 h of life is a rare but recognised event. Over a 2-year period, five infants, previously assessed as healthy, were found collapsed in our maternity unit in the care of their primiparous mothers. Two were found prone on their mother's chest, and two were in their mother's bed. The outcomes were poor, with four neonatal deaths and one death at 18 months. The rate of sudden unexplained neonatal collapse was 0.4 per 1000 live births. No cause for collapse was identified despite extensive investigations, which included postmortem in all the neonatal deaths. One infant, however, showed widespread antenatal brain damage at postmortem. It is postulated that some infants with an underlying vulnerability may maladapt to extrauterine life following an hypoxic stressor possibly caused by positional airway obstruction.

Bereavement

1. Cowchock FS, Lasker JN, Toedter LJ, Skumanich SA, Koenig HG

Religious Beliefs Affect Grieving After Pregnancy Loss

J Relig Health

Center for Spirituality, Theology and Health, Duke University Medical Center, 3825, Busse Bldg, Suite 0507, Durham, NC, 27710, USA, fcowchock@nc.rr.com.

Religious beliefs and practices may aid in coping with bereavement and grief after pregnancy loss. Data from 103 women enrolled in the original Lehigh Valley Perinatal Loss Project, and who were followed-up for at least 1 year, were evaluated for the impact of initial religious practices and beliefs on the course and severity of grief. Religious practices corresponding to standard scales of religiosity and agreement with specific beliefs were rated by the women on a Likert scale of 1-5. Neither agreement with statements corresponding to extrinsic and intrinsic religiosity or to positive religious coping, nor frequency of religious service attendance was predictive of follow-up scores on the Perinatal Grief Scale. Religious struggle, agreement with statements classified as negative religious coping, and continued attachment to the baby were all associated with more severe grief.

Miscarriage/Stillbirth/Prenatal Issues

1. Winger EE, Reed JL

A Retrospective Analysis of Fondaparinux Versus Enoxaparin Treatment in Women with Infertility or Pregnancy Loss
Am J Reprod Immunol. 2009 Aug 24. [Epub ahead of print]

Alan E. Beer Center for Reproductive Immunology & Genetics, San Francisco, CA, USA.

Problem We compared the pregnancy success rates and safety parameters of fondaparinux versus enoxaparin, combined with immunotherapy, in patients with a history of miscarriage and/or infertility and coagulant defects. Method of study A total of 127 pregnancies in 110 patients with a history of miscarriage and/or infertility were retrospectively evaluated. Of these, 29 pregnancies used fondaparinux 2.5 mg daily and 98 pregnancies used enoxaparin 30 mg twice daily. Results The pregnancy success rate was 59% (17/29; 95% CI, 41-75%) for patients receiving fondaparinux and 58% (57/98; 95% CI, 48-68%) for patients receiving enoxaparin. No difference was detected in birth weight (2.7 +/- 0.8 and 2.9 +/- 0.6 kg, respectively) or gestational age at delivery (37.3 +/- 2.2 and 37.7 +/- 2.1 weeks, respectively). No birth defects, severe bleeding-related complications, or serious allergic reactions were observed. Conclusion In patients with a history of miscarriage, infertility, and coagulant defects receiving immunotherapy, fondaparinux resulted in successful pregnancy outcomes comparable with enoxaparin therapy. Although no difference in outcome was observed in our analysis, a much larger study is required to achieve statistical power.

2. Chen A, Feresu SA, Barsoom MJ

Heterogeneity of preterm birth subtypes in relation to neonatal death

Obstet Gynecol. 2009 Sep;114(3):516-22

From the 1Department of Preventive Medicine and Public Health, Creighton University School of Medicine; 2Department of Epidemiology, College of Public Health, University of Nebraska Medical Center; and 3Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, Nebraska.

OBJECTIVE: To investigate the heterogeneity of preterm labor, preterm premature rupture of membranes (PROM), and indicated preterm birth in overall and gestational-age-specific neonatal death risk. METHODS:: We used 2001 U.S. linked birth/infant death (birth cohort) data sets for this analysis. We categorized three preterm birth subtypes according to reported preterm PROM, induction of labor, cesarean delivery, and pregnancy and labor complications. We used Cox proportional hazard models to calculate covariates adjusted hazard ratios (HRs) for neonatal death (0-27 days of life) among preterm neonates born at 24-27, 28-31, 32-33, and 34-36 weeks of gestation, with preterm labor being the referent. RESULTS:: There were 3,763,306 singleton live births at 24-44 weeks of gestation in the data set. Preterm PROM, indicated preterm birth, and preterm labor had neonatal death risk of 2.7%, 1.8%, and 1.1%, respectively. Compared with preterm labor, preterm PROM had shorter gestational age and lower birth weight, so did indicated preterm birth but to a lesser extent. Preterm PROM and indicated preterm birth after 28 weeks of gestation were associated with higher neonatal death risk than preterm labor. At 34-36 weeks of gestation, the HR of preterm PROM was 1.53 (95% confidence interval 1.20-1.95), and the HR of indicated preterm birth was 2.06 (95% confidence interval 1.83-2.33). The increased risk from preterm PROM and indicated preterm birth was not limited to early neonatal death in the first 7 days. CONCLUSION:: Preterm PROM and indicated preterm birth had higher risk of neonatal death than preterm labor, indicating heterogeneity in gestational age distribution and gestational-age-specific neonatal death risk. LEVEL OF EVIDENCE: II.

3. Steel A, Fakokunde A, Yoong W

Management of complicated second stage of labour in stillbirths: a review of the literature and lessons learnt from two cases in the UK

J Obstet Gynaecol. 2009 Aug;29(6):464-6

Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London N18 1QX, UK. annajoseph111@hotmail.com

The stillbirth rate for singletons in the UK is approximately 5.3/1,000 births/year. Macrosomic babies are associated with obstructed labour and shoulder dystocia. Some 3.3% of stillborns weigh over 4 kg, when such problems are likely to be encountered. In developed countries, caesarean section is regarded as being more civilised than destructive operations for obstructed labour prior to full cervical dilatation in an interuterine death. However, when the cervix is fully dilated or severe shoulder dystocia is encountered, fetal destructive operations have half the maternal mortality rate of that associated with caesarean section, with fewer long-term sequelae. A significant obstacle in performing destructive operations in developed countries is the lack of skilled practitioners. It is difficult to acquire these skills in the UK, however simulated training can be provided with manikins. We feel mothers should be informed of the alternative of a destructive operation, potentially avoiding unnecessary caesarean section.

4. Manoukian AA, Ha CE, Seaver LH, Bhagavan NV

A neonatal death due to medium-chain acyl-CoA dehydrogenase deficiency: utilization of the neonatal metabolic screen in a functional approach to sudden unexplained infant death

Am J Forensic Med Pathol. 2009 Sep;30(3):284-6

Clinical Laboratories of Hawaii, Inc, Department of Pathology, John A. Burns School of Medicine, Honolulu, Hawaii. Anthony.Manoukian@Hawaiilabs.com

We report a perinatal death due to medium-chain acyl-CoA dehydrogenase deficiency, which was referred to the Coroner's Physician as sudden unexplained infant death. Detailed death investigation including the autopsy findings, and newborn biochemical and molecular studies revealed the cause and natural manner of death. This disorder affects fatty acid oxidation and results in decreased tolerance for fasting, which can be life threatening. This case illustrates the critical role of newborn screening in the investigation of perinatal death. A brief historical perspective of the origins of newborn biochemical screening is also presented.

5. Anumba DO, El Gelany S, Elliott SL, Li TC

Serum relaxin levels are reduced in pregnant women with a history of recurrent miscarriage, and correlate with maternal uterine artery Doppler indices in first trimester

Eur J Obstet Gynecol Reprod Biol. 2009 Aug 18

Section of Endocrinology and Reproduction, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, 4th Floor, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.

OBJECTIVES: Defective implantation is a mechanism for recurrent pregnancy loss (RPL). We sought to determine whether the serum expression of human relaxin-2 (RLX) is impaired in women with a history of RPL. STUDY DESIGN: Employing a prospective case-controlled design we studied 20 pregnant women with a history of RPL and 20 age-matched women with no history of RPL (NRPL). We measured serum relaxin-2 levels by ELISA at 6-8, 10-12, 20, and 34 weeks gestation and in cord blood, and maternal uterine artery Doppler resistance index (RI) at >/=10 weeks gestation. RESULTS: Relaxin rose to a peak at 12 weeks, and gradually declined towards term. At all gestations, women with a history of RPL had lower RLX levels than women without. At 10-12 weeks gestation, uterine artery RI correlated with serum RLX for both RPL and NRPL. In the NRPL group at 10-12 weeks the presence of a notched waveform was associated with higher RLX levels than the absence of a notch (mean 2.1ng/ml vs. 1.3ng/ml, P<0.05) and also at 20 weeks (2.1ng/ml vs. 0.95ng/ml, P<0.05) but no such difference was seen in the RPL group. Umbilical venous RLX was 4-fold higher in the RPL group than the NRPL group. CONCLUSION: Women with a history of RPL demonstrate attenuated levels of serum RLX across all pregnancy trimesters. How dysregulated RLX metabolism may contribute to adverse pregnancy outcome in RPL requires further investigation.

6. Kano T, Mori T, Kimura A

Gender ratio distortion in abortuses and live births from patients with recurrent spontaneous abortion
Am J Reprod Immunol. 2009 Sep;62(3):125-7

Kano Medical Corporation Clinic, Osaka, Japan.

PROBLEM: Gender ratio of live birth in humans is approximately 1.05 and males are born a slightly more, while gender ratio of fertilization should be 1.00, suggesting that female fetus might be more sensitive to abortion than male fetus during pregnancy. METHOD OF STUDY: We examined karyotype of abortuses from patients with recurrent spontaneous abortion (RSA), who had at least one live birth before or after the treatment of RSA. RESULTS: Chromosomal abnormality was not frequent (14.6%) in the abortuses from the RSA patients. Among abortuses without chromosomal abnormality, male karyotype was rare (9.2%), and this gender ratio distortion was more prominent in RSA cases not carrying autoantibodies (3.5%) than that in the RSA cases carrying autoantibodies (26.3%), with statistical significance (P = 0.009). CONCLUSION: These observations suggested that the aborted fetuses from RSA of unknown etiology, i.e. no chromosomal abnormality and no autoantibody, were preferentially female.

7. Getahun D, Lawrence JM, Fassett MJ, Strickland D, Koebnick C, Chen W, Jacobsen SJ

The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes

Am J Obstet Gynecol. 2009 Aug 17. [Epub ahead of print]

Department of Research and Evaluation, West Los Angeles Medical Center, Kaiser Permanente Southern California, Pasadena, CA.

OBJECTIVE: We sought to examine the association between first-pregnancy stillbirth and subsequent adverse perinatal outcomes. STUDY DESIGN: This cohort study examined the first 2 singleton deliveries at 20-44 weeks' gestation from 1991-2008 (n = 71,315) using birth certificate, hospitalization, and outpatient encounter files. Multivariable logistic regression models were used to assess the association. RESULTS: Stillbirth was observed in 5.3 of 1000 first deliveries. There was an increased risk of ischemic placental disease (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1), fetal distress (OR, 2.8; 95% CI, 1.7-4.5), chorioamnionitis (OR, 2.3; 95% CI 1.5-4.3), extreme preterm birth (OR, 4.2; 95% CI, 1.8-9.9), and early neonatal mortality (OR, 8.3; 95% CI, 3.7-18.6) in pregnancies after stillbirth vs pregnancies after live birth. Interpregnancy intervals <2 and >/=4 years after stillbirth increased the risk of ischemic placental disease and spontaneous preterm birth. Risks varied by stillbirth subtype. CONCLUSION: A first-pregnancy stillbirth may increase adverse perinatal outcomes in subsequent pregnancy.

---

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

 

Accessibility  •  Copyright © Georgetown University  •  (866) 866-7437 (toll free)  •  (202) 687-7466 (local)

2115 Wisconsin Avenue, NW, Suite 601  •  Washington, DC 20007  •  info@sidscenter.org  •  (202) 784-9777 (fax)