NSIDRC Journal Article Alert — September 4, 2009
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.
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Sudden Infant Death
1. Broadbelt KG, Barger MA, Paterson DS, Holm IA, Haas EA, Krous HF, Kinney HC, Markianos K, Beggs AH
The Serotonin-Related FEV Gene Variant in the Sudden Infant Death Syndrome is a Common Polymorphism in the African-American Population
Pediatr Res. 2009 Aug 22. [Epub ahead of print]
Department of Pathology [K.G.B., D.S.P., H.C.K.], Program in Genomics [M.A.B., I.A.H., K.M., A.H.B.], and The Manton Center for Orphan Disease Research [I.A.H., A.H.B.], Children's Hospital Boston and Harvard Medical School, Boston, MA, 02115; Rady Children's Hospital and Health Center [E.A.H., H.F.K.], University of California, San Diego School of Medicine, San Diego, CA, 92123.
An important subset of the sudden infant death syndrome (SIDS) is associated with multiple serotonergic (5-HT) abnormalities in regions of the medulla oblongata. The mouse ortholog of the fifth Ewing variant gene (FEV) is critical for 5-HT neuronal development. A putatively rare intronic variant [IVS2-191_190insA, here referred to as c.128-(191_192)dupA] has been reported as a SIDS-associated mutation in an African-American population. We tested this association in an independent dataset: 137 autopsied cases (78 SIDS, 59 controls) and an additional 296 control DNA samples from Coriell Cell Repositories. In addition to the c.128-(191_192)dupA variant, we observed an associated single base deletion [c.128-(301-306)delG] in a subset of the samples. Neither of the two FEV variants showed significant association with SIDS in either the African-American subgroup or the overall cohort. Although we found a significant association of c.128-(191_192)dupA with SIDS when San Diego Hispanic SIDS cases were compared with San Diego Hispanic controls plus Mexican controls (p=0.04); this became non-significant after multiple testing correction. Among Coriell controls, 33/99 (33%) African-American and 0/197 (0%) of the remaining controls carry the polymorphism (c.128-(191_192)dupA). The polymorphism appears to be a common, likely non-pathogenic, variant in the African-American population.
2. Joyner BL, Gill-Bailey C, Moon RY
Infant Sleep Environments Depicted in Magazines Targeted to Women of Childbearing Age
Pediatrics. 2009 Aug 17. [Epub ahead of print]
Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC;
Objective: The goal was to evaluate pictures in magazines widely read by women of childbearing age, for adherence to American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Methods: Magazines were included in this study if they had an average female readership of >5 million, circulation of >900 000, and median age of female readers of 20 to 40 years. Twenty magazines met these criteria. An additional 8 magazines targeted toward expectant parents and parents of young children were included, for a total of 28 magazines. Pictures of infant sleep environments and sleeping infants in articles and advertisements in issues of these 28 magazines were analyzed for adherence to AAP guidelines for decreasing the risk of sudden infant death syndrome. Results: A total of 391 unique pictures from 34 magazine issues were included in the analysis. Only 57 pictures (64%) portraying sleeping infants not being held by an adult portrayed the infants in the supine position, and 14.8% of sleeping infants were portrayed as sleeping with another person. Only 36 pictures (36.4%) of infant sleep environments portrayed a safe sleep environment, as recommended by the AAP. Conclusions: More than one third of pictures of sleeping infants in magazines geared toward childbearing women demonstrated infants in an inappropriate sleep position, and two thirds of pictures of infant sleep environments were not consistent with AAP recommendations. Messages in the media that are inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.
3. Dick A, Ford R
Cholinergic and oxidative stress mechanisms in sudden infant death syndrome
Acta Paediatr. 2009 Aug 25. [Epub ahead of print]
Canterbury Cot Death Fellow, Community Paediatric Unit, Christchurch, New Zealand.
Abstract Aim: To determine whether biochemical parameters of cholinergic and oxidative stress function including red cell acetylcholinesterase (AChE), serum/plasma thyroglobulin, selenium, iron, ferritin, vitamins C, E, and A affect risk in apparent life-threatening event (ALTE), sudden infant death syndrome (SIDS), and sudden unexpected death in infancy (SUDI). To assess these biochemical parameters as a function of age; and for influence of pharmacology and epidemiology, including infant health, care, and feeding practices. Methods: A multicentre, case-control study with blood samples from 34 ALTE and 67 non-ALTE (control) infants matched for age, and 30 SIDS/SUDI and four non-SIDS/non-SUDI (post-mortem control) infants. Results: Levels/activity of the biochemical parameters were not significantly different in ALTE vs. control infants, with the exception of higher vitamin C levels in the ALTE group (p = 0.009). In ALTE and control groups, AChE and thyroglobulin levels increased and decreased respectively from birth to attain normal adult levels from 6 months. Levels of iron and ferritin were higher in the first 6 month period for all infant groups studied, intersecting with vitamin C levels peaking around 4 months of age. Conclusion: Lower AChE levels and higher combined levels of iron and vitamin C in the first 6 months of life may augment cholinergic and oxidative stress effect, particularly at the age when SIDS is most prevalent. This may contribute to risk of ALTE and SIDS/SUDI events during infancy.
Other Infant Death
1. Supporting Staff Recovery and Reintegration After a Critical Incident Resulting in Infant Death
Adv Neonatal Care. 2009 Aug;9(4):172-173
Miscarriage/Stillbirth/Prenatal Issues
1. Wada Y, Sakamaki Y, Kobayashi D, Ajiro J, Moro H, Murakami S, Ooki I, Kikuchi A, Takakuwa K, Tanaka K, Sato T, Nakano M, Narita I
HELLP syndrome, multiple liver infarctions, and intrauterine fetal death in a patient with systemic lupus erythematosus and antiphospholipid syndrome
Intern Med. 2009;48(17):1555-8. Epub 2009 Sep 1
Clinical Nephrology and Rheumatology, Department of Medicine II, Niigata University Graduate School of Medical and Dental Sciences, Niigata. yoko.wada@gmail.com
We report a case of HELLP syndrome, multiple liver infarctions, and intrauterine fetal death in a woman in the 17th week of pregnancy with SLE and APS who had been in remission on a regimen of low-dose prednisolone and aspirin. An increase in the dosage of corticosteroid together with intravenous heparin infusion led to improvement of the clinical symptoms, laboratory parameters, and multifocal low-density liver lesions detected by computed tomography. Early onset and signs of severe organ involvement are the characteristic features of HELLP syndrome associated with APS, and patients that are at risk should be followed up carefully.
2. Mo D, Saravelos S, Metwally M, Makris M, Li TC
Treatment of recurrent miscarriage and antiphospholipid syndrome with low-dose enoxaparin and aspirin
Reprod Biomed Online. 2009 Aug;19(2):216-20
Faculty of Pharmaceutical Sciences, University of British Colombia, Vancouver, Canada.
The aim of this retrospective, observational study was to determine the impact of low-dose enoxaparin (20 mg) in conjunction with low-dose aspirin on the pregnancy outcome of women with antiphospholipid syndrome and recurrent miscarriage. The study was conducted in a tertiary referral teaching hospital. A total of 35 women with antiphospholipid syndrome were treated with low-dose enoxaparin and aspirin as soon as pregnancy was confirmed. The outcome of pregnancy was analysed. The miscarriage rate was 7/35 (20%) whereas the live birth rate was 28/35 (80%). In conclusion, low-dose (20 mg) enoxaparin in conjunction with low-dose aspirin treatment produced encouraging results. The findings in this study suggest that there is a case for randomized controlled trials to compare low-dose (20 mg) enoxaparin with higher doses.
3. Favre N, Abergel A, Blanc P, Sapin V, Roszyk L, Gallot D
Unusual presentation of severe intrahepatic cholestasis of pregnancy leading to fetal death
Obstet Gynecol. 2009 Aug;114(2 Pt 2):491-3
CHU Clermont-Ferrand, Maternal Fetal Medicine Unit, Féedération de Gynécologie-Obstétrique, the Department of Hepatology, Hôtel-Dieu, and the UMR CNRS 6247 GReD, Clermont Université, Clermont-Ferrand, France.
BACKGROUND: We report an unusual presentation of intrahepatic cholestasis of pregnancy complicated by fetal death and associated with homozygous bile salt export pump polymorphism. CASE: A secundigravida presented at 31 weeks of pregnancy with discrete pruritus and highly elevated bile acid levels (223 micromol/L) suggestive of intrahepatic cholestasis of pregnancy, despite normal serum aminotransferase levels. She had a 6-year history of ulcerative colitis, and her previous pregnancy (3 years before) had been uneventful. Initial contractions and vaginal bleeding subsided spontaneously, and corticosteroids were administered for fetal lung maturation. However, in utero fetal death occurred 9 hours after normal cardiotocography. Follow-up confirmed progressive decrease of bile acid level, but the aminotransferase levels remained elevated. Molecular biology revealed a homozygous mutation for bile salt export pump protein. CONCLUSION: This case illustrates an unusual presentation of very severe intrahepatic cholestasis of pregnancy in a homozygous patient carrying bile salt export pump mutation.
4. Altay MM, Yaz H, Haberal A
The assessment of the gestational sac diameter, crown-rump length, progesterone and fetal heart rate measurements at the 10th gestational week to predict the spontaneous abortion risk.
J Obstet Gynaecol Res. 2009 Apr;35(2):287-92
Ankara Etlik Maternity and Women's Health Academic and Research Hospital, Ankara, Turkey. altay_metin@yahoo.com
AIM: The assessment of the first trimester ultrasonographic and progesterone measurements to predict spontaneous abortion risk. METHODS: Ninety-nine women at the 10th week of pregnancy were included in this prospective study. Their ages, progesterone (P) levels, mean gestational sac diameters (MGSD), crown-rump lengths (CRL), MGSD-CRL measurements and fetal heart rates (FHR) were recorded. These variables were compared by abortion status. RESULTS: Patients were followed up until the 20th weeks, and 8 (8.08%) aborted. We evaluated the variables by receiver operator characteristic curve to predict abortion. Only the areas under the curve for P levels (0.29) and for MGSD--CRL (0.16) were statistically significant We. also made logistic regression analysis to predict abortion. P level and FHR were statistically significant (P < 0.01) when the threshold value was 50%. Negative predictive value of the model was 98.9%, and positive predictive value was 50%. Overall, this model can correctly classify 94.9% of the groups. We determined threshold values for MGSD-CRL (> or =10 mm) and P (> or =25 ng/mL) to predict abortion, but not for FHR. Interestingly, 14 patients with FHR > or =175 beats/min did not abort. For the MGSD-CRL threshold, we can predict that the pregnancy will continue with 95.78% probability, with 67% sensitivity and 89% specificity. For the P threshold, the pregnancy will continue with 97.85% probability, with 80% sensitivity and 80% specificity. CONCLUSION: MGSD-CRL and P could predict patients with low abortion risk. However, at the 10th week of pregnancy, FHR > or =175 beats/min should be evaluated for this purpose by future studies with larger sample sizes.
5. D'Uva M, Di Micco P, Strina I, Ranieri A, Alviggi C, Mollo A, Fabozzi F, Cacciapuoti L, di Frega MT, Iannuzzo M, De Placido G
Etiology of hypercoagulable state in women with recurrent fetal loss without other causes of miscarriage from Southern Italy: new clinical target for antithrombotic therapy
Biologics. 2008 Dec;2(4):897-902
Dipartimento Universitario di Scienze Ostetriche Ginecologiche e Medicina della Riproduzione, Area Funzionale di Medicina della Riproduzione ed Endoscopia Ginecologica, Università degli Studi di Napoli Federico II, via Pansini 5 Building 9, 80131, Naples, Italy.
BACKGROUND: Recurrent fetal loss (RPL) is one of the most common cause of sterility. Several studies identified thrombophilia as the principal cause of recurrent pregnancy loss. However, reported studies often do not evaluate other causes of miscarriages in their inclusion and exclusion criteria. So the aim of our study was to investigate the role of inherited thrombophilia in patients with RPL and without other causes of RPL. PATIENTS AND METHODS: Patients with 2 or more first trimester abortion or with 1 or more late pregnancy loss were considered for this study. In order to evaluate the causes of RPL we looked for chromosomal, endocrine, chronic inflammatory, and infectious alterations. 90 patients affected by unexplained RPL were enrolled and tested for hemostatic alterations. These women were tested for inherited and/or acquired thrombophilia by MTHFR C677T gene polymorphism, factor V Leiden gene polymorphism, PTHRA20210G gene polymorphism, protein S deficiency, protein C deficiency, antithrombin III deficiency, lupus anticoagulant, and anticardiolipin antibodies Ig G and Ig M. RESULTS: Acquired and/or inherited thrombophilia are strongly associated with RPL when other common causes of miscarriage were excluded. 78% of tested women showed hemostatic abnormalities. Several women with combined thrombophilic defects were also identified by our data. CONCLUSION: After a thorough evaluation of other causes of miscarriage women affected by RPL should be tested for thrombophilia. Our data demonstrated 78% of women with one or combined thrombophilic conditions. Differences with previous studies should be related to difference in the inclusion and exclusion criteria and ethnic background. Because these patients often also show a hypercoagulable state, it an antithrombotic treatment before and during pregnancy may improve their clinical outcome (ie, secondary prevention of miscarriage and primary thromboprophylaxis).
Prepared by the
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Loss Resource Center
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