NSIDRC Journal Article Alert — February 26, 2010

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.

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 or Partners in Information Access for the Public Health Workforce's How to Access Journal Articles for more details.

Past issues of Resource Center Journal Alerts

Sudden Infant Death

1. Senter L, Sackoff J, Landi K, Boyd L
Studying Sudden and Unexpected Infant Deaths in a Time of Changing Death Certification and Investigation Practices: Evaluating Sleep-Related Risk Factors for Infant Death in New York City
Matern Child Health J. 2010 Feb 23. [Epub ahead of print]

New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, 2 Lafayette Street, 18th Floor, 34-A, New York, NY, 10007, USA, lsenter@health.nyc.gov.

We describe an approach for quantifying and characterizing the extent to which sudden and unexpected infant deaths (SUIDs) result from unsafe sleep environments (e.g., prone position, bedsharing, soft bedding); and present data on sleep-related infant deaths in NYC. Using a combination of vital statistics and medical examiner data, including autopsy and death scene investigation findings, we analyzed any death due to accidental threat to breathing (ATB) (ICD-10 W75 & W84), and deaths of undetermined intent (UND) (Y10-Y34) between 2000 and 2003 in NYC for the presence of sleep-related factors (SRF). Homicide deaths were excluded as were SIDS, since in NYC SIDS is not a certification option if environmental factors were possibly contributors to the death. All 19 ATB and 69 (75%) UND had SRFs as per the OCME investigation. Black infants and infants born to teen mothers had higher SRF death rates for both ATB and UND deaths. Bedsharing was the most common SRF (53%-ATB; 72%-UND deaths); the majority of non-bedsharing infants were found in the prone position (60%-ATB; 78%-UND deaths). We found a high prevalence of SRFs among ATB and UND deaths. This is the first local study to illustrate the importance of knowing how SUIDs are certified in order to ascertain the prevalence of infant deaths with SRFs. Advancing the research requires clarity on the criteria used by local medical examiners to categorize SUIDs. This will help jurisdictions interpret their infant mortality statistics, which in turn will improve education and prevention efforts.

2. Towbin JA
The A, B, C's of Sudden Infant Death Syndrome (SIDS): An Electrical Disorder?
Heart Rhythm. 2010 Feb 19. [Epub ahead of print]

The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.

3. Pryce J, Kiho L, Scheimberg I
Sudden Infant Death Associated with a Epithelial type Hepatoblastoma in a 6 Month Old Infant
Pediatr Dev Pathol. 2010 Feb 19. [Epub ahead of print]

1 Royal London Hospital.

Abstract Sudden unexpected death in infancy and childhood attributable to undiagnosed neoplasia is rare. Malignant neoplasms are very uncommon in infancy with an age-standardised incidence rate of 118.3 per million. Primary malignant liver tumours are rare, with hepatoblastoma accounting for upto two thirds of cases. Although hepatoblastoma is the commonest malignant neoplasm of the liver in childhood, it only accounts for 3.1% of childhood cancers for infants less than 12 months of age.We describe the first case of a sudden death in an apparently healthy 6 month old infant where the autopsy revealed an epithelial type hepatoblastoma with mixed fetal and embryonal patterns.

Other Infant Death

1. Barber M, Blaisdell CJ
Respiratory Causes of Infant Mortality: Progress and Challenges
Am J Perinatol. 2010 Feb 19. [Epub ahead of print]

Division of Lung Diseases, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.

A marked reduction in infant mortality due to respiratory distress syndrome (RDS) has been reported in previous studies; however, deaths due to RDS are still more common in black infants than white infants. Because advances in respiratory care may have impacted non-RDS respiratory causes of infant mortality as well, the objective of this study was to determine if specific and total non-RDS respiratory causes of infant mortality have changed over time, and if health disparities exist. We analyzed and compared infant deaths due to RDS and other respiratory diseases from 1980 to 2005 in the United States and evaluated outcomes by race and gender. Infant mortality due to non-RDS causes declined more than twofold over this time frame, but not as dramatically as the fivefold decline in RDS deaths. Black compared with white infants had twice the mortality rate due to non-RDS respiratory causes. The most common non-RDS respiratory cause of infant mortality was due to congenital malformations of the respiratory tract, which did not change dramatically over the 25 years studied. © Thieme Medical Publishers.

Miscarriage/Stillbirth/Prenatal Issues

1. Wisborg K, Ingerslev HJ, Henriksen TB
IVF and stillbirth: a prospective follow-up study
Hum Reprod. 2010 Feb 23. [Epub ahead of print]

Department of Paediatrics, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Brendstrugaardsvej 100, Skejby, DK-8200 Aarhus, Denmark.

BACKGROUND Previous studies have indicated that the risk of stillbirth is increased in singleton pregnancies achieved after assisted reproduction technology (ART). However, no previous study fully accounted for factors with potential influence on the risk of stillbirth. Further, whether fertility treatment, the possible reproductive pathology of the infertile couples or other characteristics related to being subfertile may explain a possible association with stillbirth remains unclear. This study compares the risk of stillbirth in women pregnant after fertility treatment (IVF/ICSI and non-IVF ART) and subfertile women with that in fertile women. METHODS We used prospectively collected data from the Aarhus Birth Cohort, Denmark and included information about 20 166 singleton pregnancies (1989-2006). Outcome measure was stillbirth. RESULTS The risk of stillbirth in women who conceived after IVF/ICSI was 16.2 per thousand ( per thousand) and in women who conceived after non-IVF ART 2.3 per thousand. In fertile and subfertile women, the risk of stillbirth was 3.7 per thousand and 5.4 per thousand, respectively. Compared with fertile women, women who conceived after IVF/ICSI had more than four times the risk of stillbirth [odds ratio (OR): 4.44, 95% confidence interval (CI): 2.38-8.28], and adjustments for maternal age, BMI, education, smoking habits and alcohol and coffee intake during pregnancy had only minor impact on the findings (OR: 4.08; 95% CI: 2.11-7.93). The risk of stillbirth in women who conceived after non-IVF ART and in women who conceived spontaneously with a waiting time to pregnancy of a year or more was not significantly different from the risk in women with a shorter time to pregnancy. CONCLUSIONS Compared with fertile women, women who conceived by IVF/ICSI had an increased risk of stillbirth that was not explained by confounding. Our results indicate that the increased risk of stillbirth seen after fertility treatment is a result of the fertility treatment or unknown factors pertaining to couples who undergo IVF/ICSI.

2. Geller PA, Psaros C, Kornfield SL
Satisfaction with pregnancy loss aftercare: are women getting what they want?
Arch Womens Ment Health. 2010 Feb 23. [Epub ahead of print]

Department of Psychology, Drexel University, 245 N. 15th Street, MS 515, Philadelphia, PA, 19102, USA, pg27@drexel.edu.

While there is increasing recognition that early miscarriage represents a significant loss experience that often provokes depression and anxiety, women's dissatisfaction with some aspects of care received from healthcare professionals following a pregnancy loss and the potentially negative consequences of this are often less recognized. This review examines available literature to identify what comprises "treatment as usual," how satisfied women are with the typical services they receive from healthcare personnel, and whether these services are consistent with women's self-identified needs. Results are reviewed according to four major themes-patient satisfaction with: attitudes of healthcare providers, provision of information, interventions provided, and follow-up care. In general, women and families who have experienced a miscarriage report low levels of satisfaction in the presence of perceived negative attitudes from healthcare providers, insufficient provision of information, and inadequate follow-up care that did not focus on emotional well-being. Higher levels of satisfaction are reported among women whose providers were emotionally attuned to the magnitude of the loss, provided information, and involved women in treatment decisions when possible. Limitations of current research are reviewed and directions for future research, training, and practice are briefly discussed.

3. Kolte AM, Steffensen R, Nielsen HS, Hviid TV, Christiansen OB
Study of the structure and impact of human leukocyte antigen (HLA)-G-A, HLA-G-B, and HLA-G-DRB1 haplotypes in families with recurrent miscarriage
Hum Immunol. 2010 Feb 18. [Epub ahead of print]

Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

A 14-base pair (bp) long insertion (ins)/deletion (del) polymorphism in exon 8 in the 3'-untranslated region of the human leukocyte antigen (HLA)-G gene is suggested to affect transcription of the gene. Carriage of the G14bp ins is associated with low levels of soluble HLA-G and increases the risk of recurrent miscarriage (RM). Due to existence of strong linkage disequilibrium (LD) in the HLA region, the primary susceptibility genes for RM in the HLA-G region have not yet been identified. HLA-A, -B, -DRB1, and -G14bp polymorphisms were investigated in 29 Caucasian families with two or more siblings suffering unexplained RM. Strong positive LD was detected between the G14bp ins and HLA-A*01, -A*11, -A*31, -B*08, and DRB1*03, whereas strong negative LD was found between G14bp ins and HLA-A*02, -A*03, and -A*24. The frequency of haplotypes with HLA-G14bp ins inherited from the mother was significantly increased in probands with RM (p = 0.05). The increased compatibility between probands and their mothers for maternal G14 ins positive haplotypes suggests that maternal-fetal compatibility for chromosomal segments adjacent to HLA-G locus is a risk factor for female offspring to experience RM in their later reproductive life. Copyright © 2010. Published by Elsevier Inc.

4. Carlo WA, M D SS, Jehan I, Chomba E
Newborn-Care Training and Perinatal Mortality in Developing Countries
N Engl J Med. 2010 Feb 18;362(7):614-623

From the University of Alabama at Birmingham, Birmingham (W.A.C.); Centre for Infectious Disease Research in Zambia (W.A.C., E.C.) and University Teaching Hospital (E.C.) - both in Lusaka, Zambia; Jawaharlal Nehru Medical College, Belgaum (S.S.G.), and Sriramchandra Bhanja Medical College, Cuttack, Orissa (S.P.) - both in India; Aga Khan University, Karachi, Pakistan (I.J.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.T.); San Carlos University, Guatemala City, Guatemala (A.G.); Institute for Clinical Effectiveness and Health Policy, Buenos Aires (F.A.); RTI International, Durham (E.M.M., H.C., T.D.H.), and University of North Carolina at Chapel Hill, Chapel Hill (C.B.) - both in North Carolina; University of Missouri at Kansas City School of Medicine, Kansas City (R.J.D.); Drexel University College of Medicine, Philadelphia (R.L.G.); University of Colorado Health Sciences Center, Denver (N.F.K.); University of Maryland School of Medicine, Baltimore (P.P.), and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda (L.L.W.) - both in Maryland; and Tulane School of Public Health and Tropical Medicine, New Orleans (P.B.).

Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98% occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. METHODS: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, "kangaroo" [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. RESULTS: The 7-day follow-up rate was 99.2%. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95% confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95% CI, 0.54 to 0.88; P=0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. CONCLUSIONS: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates.

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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	Center Resources Bereavement Support Bibliographies Child Care and SIDS Definitions En Español First Responders For Families Infant Mortality Journal Alerts MCH Alert Multimedia Pregnancy Loss Professional Resources Safe Sleep Environment Statistics Training Toolkit Partner SIDS/ID Centers National SIDS & Infant Death Program Support Center / First Candle National SIDS & Infant Death Project IMPACT National Center for Cultural Competence SIDS/ID Project For more information on maternal and child health topics, visit the MCH Library	NSIDRC Journal Article Alert — February 26, 2010 Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University. More about PubMed Copyright and Disclaimers 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. 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 or Partners in Information Access for the Public Health Workforce's How to Access Journal Articles for more details. Past issues of Resource Center Journal Alerts Sudden Infant Death 1. Senter L, Sackoff J, Landi K, Boyd L Studying Sudden and Unexpected Infant Deaths in a Time of Changing Death Certification and Investigation Practices: Evaluating Sleep-Related Risk Factors for Infant Death in New York City Matern Child Health J. 2010 Feb 23. [Epub ahead of print] New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, 2 Lafayette Street, 18th Floor, 34-A, New York, NY, 10007, USA, lsenter@health.nyc.gov. We describe an approach for quantifying and characterizing the extent to which sudden and unexpected infant deaths (SUIDs) result from unsafe sleep environments (e.g., prone position, bedsharing, soft bedding); and present data on sleep-related infant deaths in NYC. Using a combination of vital statistics and medical examiner data, including autopsy and death scene investigation findings, we analyzed any death due to accidental threat to breathing (ATB) (ICD-10 W75 & W84), and deaths of undetermined intent (UND) (Y10-Y34) between 2000 and 2003 in NYC for the presence of sleep-related factors (SRF). Homicide deaths were excluded as were SIDS, since in NYC SIDS is not a certification option if environmental factors were possibly contributors to the death. All 19 ATB and 69 (75%) UND had SRFs as per the OCME investigation. Black infants and infants born to teen mothers had higher SRF death rates for both ATB and UND deaths. Bedsharing was the most common SRF (53%-ATB; 72%-UND deaths); the majority of non-bedsharing infants were found in the prone position (60%-ATB; 78%-UND deaths). We found a high prevalence of SRFs among ATB and UND deaths. This is the first local study to illustrate the importance of knowing how SUIDs are certified in order to ascertain the prevalence of infant deaths with SRFs. Advancing the research requires clarity on the criteria used by local medical examiners to categorize SUIDs. This will help jurisdictions interpret their infant mortality statistics, which in turn will improve education and prevention efforts. 2. Towbin JA The A, B, C's of Sudden Infant Death Syndrome (SIDS): An Electrical Disorder? Heart Rhythm. 2010 Feb 19. [Epub ahead of print] The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. 3. Pryce J, Kiho L, Scheimberg I Sudden Infant Death Associated with a Epithelial type Hepatoblastoma in a 6 Month Old Infant Pediatr Dev Pathol. 2010 Feb 19. [Epub ahead of print] 1 Royal London Hospital. Abstract Sudden unexpected death in infancy and childhood attributable to undiagnosed neoplasia is rare. Malignant neoplasms are very uncommon in infancy with an age-standardised incidence rate of 118.3 per million. Primary malignant liver tumours are rare, with hepatoblastoma accounting for upto two thirds of cases. Although hepatoblastoma is the commonest malignant neoplasm of the liver in childhood, it only accounts for 3.1% of childhood cancers for infants less than 12 months of age.We describe the first case of a sudden death in an apparently healthy 6 month old infant where the autopsy revealed an epithelial type hepatoblastoma with mixed fetal and embryonal patterns. Other Infant Death 1. Barber M, Blaisdell CJ Respiratory Causes of Infant Mortality: Progress and Challenges Am J Perinatol. 2010 Feb 19. [Epub ahead of print] Division of Lung Diseases, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. A marked reduction in infant mortality due to respiratory distress syndrome (RDS) has been reported in previous studies; however, deaths due to RDS are still more common in black infants than white infants. Because advances in respiratory care may have impacted non-RDS respiratory causes of infant mortality as well, the objective of this study was to determine if specific and total non-RDS respiratory causes of infant mortality have changed over time, and if health disparities exist. We analyzed and compared infant deaths due to RDS and other respiratory diseases from 1980 to 2005 in the United States and evaluated outcomes by race and gender. Infant mortality due to non-RDS causes declined more than twofold over this time frame, but not as dramatically as the fivefold decline in RDS deaths. Black compared with white infants had twice the mortality rate due to non-RDS respiratory causes. The most common non-RDS respiratory cause of infant mortality was due to congenital malformations of the respiratory tract, which did not change dramatically over the 25 years studied. © Thieme Medical Publishers. Miscarriage/Stillbirth/Prenatal Issues 1. Wisborg K, Ingerslev HJ, Henriksen TB IVF and stillbirth: a prospective follow-up study Hum Reprod. 2010 Feb 23. [Epub ahead of print] Department of Paediatrics, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Brendstrugaardsvej 100, Skejby, DK-8200 Aarhus, Denmark. BACKGROUND Previous studies have indicated that the risk of stillbirth is increased in singleton pregnancies achieved after assisted reproduction technology (ART). However, no previous study fully accounted for factors with potential influence on the risk of stillbirth. Further, whether fertility treatment, the possible reproductive pathology of the infertile couples or other characteristics related to being subfertile may explain a possible association with stillbirth remains unclear. This study compares the risk of stillbirth in women pregnant after fertility treatment (IVF/ICSI and non-IVF ART) and subfertile women with that in fertile women. METHODS We used prospectively collected data from the Aarhus Birth Cohort, Denmark and included information about 20 166 singleton pregnancies (1989-2006). Outcome measure was stillbirth. RESULTS The risk of stillbirth in women who conceived after IVF/ICSI was 16.2 per thousand ( per thousand) and in women who conceived after non-IVF ART 2.3 per thousand. In fertile and subfertile women, the risk of stillbirth was 3.7 per thousand and 5.4 per thousand, respectively. Compared with fertile women, women who conceived after IVF/ICSI had more than four times the risk of stillbirth [odds ratio (OR): 4.44, 95% confidence interval (CI): 2.38-8.28], and adjustments for maternal age, BMI, education, smoking habits and alcohol and coffee intake during pregnancy had only minor impact on the findings (OR: 4.08; 95% CI: 2.11-7.93). The risk of stillbirth in women who conceived after non-IVF ART and in women who conceived spontaneously with a waiting time to pregnancy of a year or more was not significantly different from the risk in women with a shorter time to pregnancy. CONCLUSIONS Compared with fertile women, women who conceived by IVF/ICSI had an increased risk of stillbirth that was not explained by confounding. Our results indicate that the increased risk of stillbirth seen after fertility treatment is a result of the fertility treatment or unknown factors pertaining to couples who undergo IVF/ICSI. 2. Geller PA, Psaros C, Kornfield SL Satisfaction with pregnancy loss aftercare: are women getting what they want? Arch Womens Ment Health. 2010 Feb 23. [Epub ahead of print] Department of Psychology, Drexel University, 245 N. 15th Street, MS 515, Philadelphia, PA, 19102, USA, pg27@drexel.edu. While there is increasing recognition that early miscarriage represents a significant loss experience that often provokes depression and anxiety, women's dissatisfaction with some aspects of care received from healthcare professionals following a pregnancy loss and the potentially negative consequences of this are often less recognized. This review examines available literature to identify what comprises "treatment as usual," how satisfied women are with the typical services they receive from healthcare personnel, and whether these services are consistent with women's self-identified needs. Results are reviewed according to four major themes-patient satisfaction with: attitudes of healthcare providers, provision of information, interventions provided, and follow-up care. In general, women and families who have experienced a miscarriage report low levels of satisfaction in the presence of perceived negative attitudes from healthcare providers, insufficient provision of information, and inadequate follow-up care that did not focus on emotional well-being. Higher levels of satisfaction are reported among women whose providers were emotionally attuned to the magnitude of the loss, provided information, and involved women in treatment decisions when possible. Limitations of current research are reviewed and directions for future research, training, and practice are briefly discussed. 3. Kolte AM, Steffensen R, Nielsen HS, Hviid TV, Christiansen OB Study of the structure and impact of human leukocyte antigen (HLA)-G-A, HLA-G-B, and HLA-G-DRB1 haplotypes in families with recurrent miscarriage Hum Immunol. 2010 Feb 18. [Epub ahead of print] Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. A 14-base pair (bp) long insertion (ins)/deletion (del) polymorphism in exon 8 in the 3'-untranslated region of the human leukocyte antigen (HLA)-G gene is suggested to affect transcription of the gene. Carriage of the G14bp ins is associated with low levels of soluble HLA-G and increases the risk of recurrent miscarriage (RM). Due to existence of strong linkage disequilibrium (LD) in the HLA region, the primary susceptibility genes for RM in the HLA-G region have not yet been identified. HLA-A, -B, -DRB1, and -G14bp polymorphisms were investigated in 29 Caucasian families with two or more siblings suffering unexplained RM. Strong positive LD was detected between the G14bp ins and HLA-A01, -A11, -A31, -B08, and DRB103, whereas strong negative LD was found between G14bp ins and HLA-A02, -A03, and -A24. The frequency of haplotypes with HLA-G14bp ins inherited from the mother was significantly increased in probands with RM (p = 0.05). The increased compatibility between probands and their mothers for maternal G14 ins positive haplotypes suggests that maternal-fetal compatibility for chromosomal segments adjacent to HLA-G locus is a risk factor for female offspring to experience RM in their later reproductive life. Copyright © 2010. Published by Elsevier Inc. 4. Carlo WA, M D SS, Jehan I, Chomba E Newborn-Care Training and Perinatal Mortality in Developing Countries N Engl J Med. 2010 Feb 18;362(7):614-623 From the University of Alabama at Birmingham, Birmingham (W.A.C.); Centre for Infectious Disease Research in Zambia (W.A.C., E.C.) and University Teaching Hospital (E.C.) - both in Lusaka, Zambia; Jawaharlal Nehru Medical College, Belgaum (S.S.G.), and Sriramchandra Bhanja Medical College, Cuttack, Orissa (S.P.) - both in India; Aga Khan University, Karachi, Pakistan (I.J.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.T.); San Carlos University, Guatemala City, Guatemala (A.G.); Institute for Clinical Effectiveness and Health Policy, Buenos Aires (F.A.); RTI International, Durham (E.M.M., H.C., T.D.H.), and University of North Carolina at Chapel Hill, Chapel Hill (C.B.) - both in North Carolina; University of Missouri at Kansas City School of Medicine, Kansas City (R.J.D.); Drexel University College of Medicine, Philadelphia (R.L.G.); University of Colorado Health Sciences Center, Denver (N.F.K.); University of Maryland School of Medicine, Baltimore (P.P.), and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda (L.L.W.) - both in Maryland; and Tulane School of Public Health and Tropical Medicine, New Orleans (P.B.). Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98% occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. METHODS: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, "kangaroo" [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. RESULTS: The 7-day follow-up rate was 99.2%. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95% confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95% CI, 0.54 to 0.88; P=0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. CONCLUSIONS: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates. 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 — February 26, 2010

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