NSIDRC Journal Article Alert — October 1, 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. Cohen MC, Blakey S, Donn T, McGovern S, Parry L
An audit of parents'/guardians' wishes recorded after coronial
autopsies in cases of sudden unexpected death in infancy:
issues raised and future directions
Med Sci Law. 2009 Jul;49(3):179-84
Histopathology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK. Marta.Cohen@sch.nhs.uk
In the U.K., cases of sudden unexpected death in infancy are under the jurisdiction of the Coroner and consent for a post-mortem is not required. Prior to the Human Tissue Act 2006 (HTA) there was also no requirement to request retention of tissue (blocks and slides). The HTA stipulates that parental/ guardian consent is mandatory to retain or dispose of all tissues after the Coroners' purposes have been fulfilled. In 2007, in order to avoid confusion with the consent needed for hospital post-mortems, a new form was introduced by Sheffield Children's Hospital NHS Foundation Trust (SCH) called Record of parents'/guardians'wishes regarding samples taken at a Coroner's post mortem. This version specifically asks if blocks and slides may be retained as part of the medical record, or are to be disposed of, and for parental agreement (or not) for the frozen tissue, blocks and slides to be used for education, audit, quality control and medical research. One hundred and nineteen Coroners' postmortems covering the years 2006-2007 were reviewed. All parents/guardians (P/G) were contacted and the outcomes of P/G wishes recorded by SCH staff, Coroners' Officers (CO) and Police Family Liaison Officers (PFLO) were analysed and compared (44% from CO were outstanding at the time of audit). Any delay in recording P/G wishes by these three groups was also compared. In 2006, parental agreement to the use of blocks and slides for education, audit, quality control and medical research was 94%, 77% and 75% for SCH, CO and PFLO, respectively. In 2007 it was 84%, 37% and 100% for the same groups. Permission for the retention of frozen tissue given to SCH, CO and PFLO was 90%, 62% and 100% in 2006 and 90%, 44% and 100% in 2007, respectively. Cases where parents did not wish for the retention or use of tissue (including blocks and slides) were 3%, 15% and 0% in 2006 for SCH, CO and PFLO respectively, and 0% for all groups in 2007. Training of staff in all aspects of post-mortem and bereavement care is essential for ascertaining parental wishes. Families should be provided with the knowledge that allows them to make informed choices. The analysis of the results of the audit supports this view.
Other Infant Death
1. Strandberg-Larsen K, Grønbæk
M, Nybo Andersen AM, Andersen PK, Olsen J
Alcohol Drinking Pattern During Pregnancy and Risk of
Infant Mortality
Epidemiology. 2009 Sep 29. [Epub ahead of print]
From the aCentre for Alcohol Research, National Institute of Public Health, University of Southern Denmark, Denmark; bDepartment of Epidemiology, UCLA School of Public Health, Los Angeles, CA; cDivision of Epidemiology, University of Southern Denmark, Denmark; and dDepartment of Biostatistics, University of Copenhagen, Denmark.
BACKGROUND:: The safety of small amounts of alcohol drinking and occasional binge-level drinking during pregnancy remains unsettled. We examined the association of maternal average alcohol intake and binge drinking (>/=5 drinks per sitting) with infant mortality, both in the neonatal and postneonatal period. METHODS:: Participants were 79,216 mothers who were enrolled in the Danish National Birth Cohort in 1996-2002, gave birth to a live-born singleton, and provided information while they were pregnant on alcohol consumption during pregnancy. Information on infant mortality and causes of death was obtained from national registries and medical records. RESULTS:: During the first year of life, 279 children (0.35%) died, 204 during the neonatal period. Infant mortality was not associated with alcohol drinking, even at a consumption level of either 4+ drinks per week or 3+ occasions of binge drinking. Postneonatal mortality was associated with an intake of 4+ drinks per week (hazard ratio = 3.56 [95% confidence interval = 1.15-8.43]) and with 3+ binge episodes (2.69 [1.27-5.69]). When restricting analyses to term births, both infant mortality and postneonatal mortality were associated with a weekly average intake of 4+ drinks or 3+ binge episodes. CONCLUSIONS:: Among term infants, intake of at least 4 drinks of alcohol per week or binging on 3 or more occasions during pregnancy are associated with an increased risk of infant mortality, especially during the postneonatal period.
Bereavement
1. Gudmundsdottir M
Embodied grief: bereaved parents' narratives of their
suffering body
Omega (Westport). 2009;59(3):253-69
School of Nursing, University of California, San Francisco, CA 94143-0606, USA. maria.gudmundsdottir@nursing.ucsf.edu
Experiences and symptoms emanating from the bereaved person's body are commonly considered to be psychosomatic reactions to loss. The lingering of such experiences is thought to reflect a maladaptive coping style that needs to be addressed to access the psychological pain underlying the symptoms. In this interpretive, phenomenological study of 15 family members in seven families who lost a child to sudden, unexpected death, stories of embodied grief are explored to further understand the grieving body. The findings of this study illuminate the many ways parents experience their grieving body and they underscore the importance of witnessing and acknowledging stories of the body in clinical work with bereaved parents who are learning to live in a world without their beloved child.
Miscarriage/Stillbirth/Prenatal
Issues
1. Pathak R, Mustafa MD, Ahmed RS, Tripathi
AK, Guleria K, Banerjee BD
Association between Recurrent Miscarriages
and Organochlorine Pesticide Levels
Clin Biochem. 2009 Oct 2. [Epub ahead of
print]
Environmental Biochemistry and Immunology Laboratory, Department of Biochemistry.
Objectives: Recurrent miscarriage (RM) is a challenging medical problem because of its unknown pathogenesis and etiology in most of the cases. Recent studies suggest role of persistent environmental pollutants such as organochlorine pesticides (OCPs) in the etiology of RM. The present study was conducted to investigate possible associations of OCPs in the pathogenesis of RM. Design and methods: Blood OCP levels were analyzed in women with RM (cases) and women with normal full term delivery with live birth (controls) by using a gas chromatograph equipped with an electron capture detector. Results: A statistically significant association (p=0.01) was observed between blood gamma-HCH levels and women with recurrent miscarriages. Conclusions: This study suggests that high blood levels of gamma-HCH may be associated with risk of RM.
2. Gloria-Bottini
F, Nicotra M, Magrini A, Bottini E
Immunologic factors and reproductive success
in women with primary repeated spontaneous
abortion
Fertil Steril. 2009 Sep 30. [Epub ahead
of print]
Division of Human Population Biopathology and Environmental Pathology, Department of Biopathology and Imaging Diagnostics, University of Rome "Tor Vergata," School of Medicine, Rome, Italy.
In 109 women with primary RSA the presence of at least one live-born infant within 5 years of follow-up has been found positively associated with ACA intensity.
3.
Gray R, Bonellie SR, Chalmers J, Greer I, Jarvis S, Kurinczuk
JJ, Williams C
Contribution of smoking during pregnancy
to inequalities in stillbirth and infant
death
in Scotland 1994-2003:
retrospective population based study
using hospital maternity records
BMJ. 2009 Oct 1;339:b3754. doi: 10.1136/bmj.b3754
National Perinatal Epidemiology Unit, University of Oxford, UK. ron.gray@npeu.ox.ac.uk
OBJECTIVE: To quantify the contribution of smoking during pregnancy to social inequalities in stillbirth and infant death. DESIGN: Population based retrospective cohort study. SETTING: Scottish hospitals between 1994 and 2003. PARTICIPANTS: Records of 529 317 singleton live births and 2699 stillbirths delivered at 24-44 weeks' gestation in Scotland from 1994 to 2003. MAIN OUTCOME MEASURES: Rates of stillbirth and infant, neonatal, and post-neonatal death for each deprivation category (fifths of postcode sector Carstairs-Morris scores); contribution of smoking during pregnancy ("no," "yes," or "not known") in explaining social inequalities in these outcomes. RESULTS: The stillbirth rate increased from 3.8 per 1000 in the least deprived group to 5.9 per 1000 in the most deprived group. For infant deaths, the rate increased from 3.2 per 1000 in the least deprived group to 5.4 per 1000 in the most deprived group. Stillbirths were 56% more likely (odds ratio 1.56, 95% confidence interval 1.38 to 1.77) and infant deaths were 72% more likely (1.72, 1.50 to 1.97) in the most deprived compared with the least deprived category. Smoking during pregnancy accounted for 38% of the inequality in stillbirths and 31% of the inequality in infant deaths. CONCLUSIONS: Both tackling smoking during pregnancy and reducing infants' exposure to tobacco smoke in the postnatal environment may help to reduce stillbirths and infant deaths overall and to reduce the socioeconomic inequalities in stillbirths and infant deaths perhaps by as much as 30-40%. However, action on smoking on its own is unlikely to be sufficient and other measures to improve the social circumstances, social support, and health of mothers and infants are needed.
Prepared by the
National Sudden and Unexpected Infant/Child Death and Pregnancy
Loss Resource Center
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