NSIDRC Journal Article Alert — July 2, 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.
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Other Infant Death
1. Wu MH
Sudden death in pediatric populations
Korean Circ J. 2010 Jun;40(6):253-7. Epub 2010 Jun 29
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Sudden death (SD) in children is rarer than in adults. In
the pediatric population, SD accounts for less than one tenth
of deaths from all causes. SD in infants is a separate entity
commonly termed "sudden infant death syndrome (SIDS)".
Previous studies on SD in pediatric patients primarily focused
on infants and showed that the incidence of SIDS was much lower
in Asian countries than in Western ones. However, these differences
diminished after educational campaigns such as the back to
sleep act in the late 1980s to early 1990s. The incidence of
SIDS from Western reports has decreased from 2.69 to around
0.5-0.24 per 1,000 live births. Beyond infancy, the annual
incidence of SD ranges from 1.3 to 7.5 per 100,000. In 2009,
two population-based studies, one from Taiwan and the other
from the US, explored the epidemiological profile of SD in
children. The child health care indexes of these two countries
are similar, but the annual incidence of pediatric SD was 7.5
and 2.7 per 100,000 in the USA and Taiwan, respectively. The
implications of ethic-related differences requires further
confirmation. Around 40% of pediatric SD could be from cardiac
causes, either diagnosed or undiagnosed. Risk stratification
for cardiac SD and patient selection for implantable cardioverter-defibrillator
(ICD) therapy are recommended. However, the adoption of ICD
as primary prevention for SD in children is still a challenging
issue. Early detection of undiagnosed cardiac risk may be facilitated
by cardiac screening either in newborns or the school-age population
to better manage the risk of SD. However, the efficacy of such
screening remains still controversial.
Miscarriage/Stillbirth/Prenatal Issues
1. Facchinetti F, Alberico S, Benedetto C, Cetin I, Cozzolino
S, Di Renzo GC, Del Giovane C, Ferrari F, Mecacci F, Menato
G, Tranquilli AL, Baronciani D
A multicenter, case-control study on risk factors for antepartum
stillbirth
J Matern Fetal Neonatal Med. 2010 Jun 29. [Epub ahead of print]
Mother-infant Department, University of Modena and Reggio Emilia, Modena, Italy.
Objective. As the influence of socio-demographic variables, lifestyle and medical conditions on the epidemiology of stillbirth (SB) is modified by population features, we aimed at investigating the role played by these factors on the incidence of SB in a developed country. Study design. Multivariate logistic regression analysis (OR with 95% CI) was utilized in a prospective multicentre nested case-control study to compare in a 1:2 ratio stillborn of >22 weeks gestation with matched for gestational age live-born (LB) infants. Intrapartum SB were excluded. Results. Two hundred fifty-four consecutive SBs and 497 LBs were enrolled. Socio-demographic variables were equally distributed. Fetal malformations (7.96, 2.69-23.55), severe intrauterine growth restriction (IUGR) (birthweight </=5(th) %ile) (4.32, 2.27-8.24), BMI > 25 (2.87, 1.90-4.33), and preeclampsia (PE, 0.40, 0.21-0.77) were recognized as independent predictors for SB. At term, only BMI > 25 was associated with SB (7.70, 2.9-20.5). Conclusion. Fetal malformations, severe IUGR and maternal BMI > 25 were associated with a significant increase in the risk of SB; PE presented instead a protective role. Maternal BMI > 25 was the only risk factor for SB identified in term pregnancies.
PMID: 20586545 [PubMed - as supplied by publisher]
2. Chao SM, Donatoni G, Bemis C, Donovan K, Harding C, Davenport
D, Gilbert C, Kasehagen L, Peck MG
Integrated Approaches to Improve Birth Outcomes: Perinatal
Periods of Risk, Infant Mortality Review, and the Los Angeles
Mommy and Baby Project
Matern Child Health J. 2010 Jun 26. [Epub ahead of print]
Los Angeles County, Department of Public Health, Maternal, Child, and Adolescent Health Programs, Los Angeles County, CA, USA.
This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the LAMB case-control study (279 controls, 87 cases) identified additional factors associated with LBW births: high blood pressure before and during pregnancy, pregnancy weight gain falling outside of the recommended range, smoking during pregnancy, and feeling unhappy during pregnancy. PT birth was significantly associated with having a previous LBW/PT birth, not taking multivitamins before pregnancy, and feeling unhappy during pregnancy. In response to these findings, community stakeholders gathered to develop strategic actions for targeted prevention to address infant mortality. Subsequently, key funders infused resources into the community, resulting in expanded case management of high-risk women, increased family planning services and local resources, better training for nurses, and public health initiatives to increase awareness of infant safety. Community readiness, mobilization, and alignment in addressing a public health concern in Los Angeles County enabled the integration of PPOR analytic methods into the established IMR structure and [the design and implementation of a population-based l study (LAMB)] to monitor the factors associated with adverse birth outcomes. PPOR proved an effective approach for identifying risk and social factors of greatest concern, the magnitude of the problem, and mobilizing community action to improve infant mortality in the Antelope Valley.
3. Bjuresten K, Landgren BM, Hovatta O, Stavreus-Evers A
Luteal phase progesterone increases live birth rate after frozen
embryo transfer
Fertil Steril. 2010 Jun 24. [Epub ahead of print]
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
OBJECTIVE: To see if progesterone support has a beneficial effect on live birth rate after frozen embryo transfer in natural cycles. DESIGN: Prospective randomized controlled trial. SETTING: University-based hospital. SUBJECT(S): Four hundred thirty-five women undergoing embryo transfer in natural cycles. INTERVENTION(S): The women received either vaginal progesterone, 400 mg twice a day from the day of embryo transfer in natural cycles, or no progesterone support. MAIN OUTCOME MEASURE(S): Live birth rate, biochemical pregnancy rate, pregnancy rate, and spontaneous abortion rate. RESULT(S): Live birth rate were significantly greater in women receiving vaginal progesterone as luteal phase support after frozen-thawed embryo transfer in natural cycles compared with those who did not take progesterone. There were no differences in biochemical pregnancy rate, pregnancy rate, or spontaneous abortion rate. CONCLUSION(S): Progesterone supplementation improves live birth rate after embryo transfer in natural cycles. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
4. Miller EC, Cao H, Wu Wen S, Yang Q, Lafleche J, Walker
M
The risk of adverse pregnancy outcomes is increased in preeclamptic
women who smoke compared with nonpreeclamptic women who do
not smoke
Am J Obstet Gynecol. 2010 Jun 24. [Epub ahead of print]
OMNI Research Group, Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Canada; Queen's University School of Medicine, Kingston, ON, Canada.
OBJECTIVE: Maternal smoking and preeclampsia independently increase the risk of adverse pregnancy outcomes; however, smoking decreases the risk of preeclampsia. We sought to estimate the risk of adverse pregnancy outcomes among preeclamptic women who smoke and hypothesized that this risk would be increased, compared with nonpreeclamptic women who smoke or preeclamptic women who do not smoke. STUDY DESIGN: With the use of the Niday Perinatal Database and multiple logistic regressions, we estimated the risk of adverse pregnancy outcomes in nonpreeclamptic women who smoke, preeclamptic women who do not smoke, and preeclamptic women who smoke in relation to nonpreeclamptic women who do not smoke. RESULTS: The incidence of adverse pregnancy outcomes was more than twice as high among preeclamptic women who smoke as among nonpreeclamptic women who do not smoke. The following data were observed: small-for-gestational-age infant (odds ratio [OR], 3.40; 95% CI, 2.27-4.89), preterm birth (OR, 5.77; 95% CI, 4.50-7.35), very preterm birth (OR, 5.44; 95% CI, 3.51-8.11), abruption (OR, 6.16; 95% CI, 3.05-11.01), Apgar <4 at 5 minutes (OR, 3.11; 95% CI, 1.48-5.72), and stillbirth (OR, 3.39; 95% CI, 1.33-6.99). CONCLUSION: Smoking decreases the risk of preeclampsia, but smokers with preeclampsia have an increased risk for adverse pregnancy outcomes. Copyright © 2010 Mosby, Inc. All rights reserved.
5. Bhattacharya S, Prescott GJ, Black M, Shetty A
Recurrence risk of stillbirth in a second pregnancy
BJOG. 2010 Jun 24. [Epub ahead of print]
Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen, UK.
Please cite this paper as: Bhattacharya S, Prescott G, Black M, Shetty A. Recurrence risk of stillbirth in a second pregnancy. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02641.x. Objective To examine the risk of recurrence of stillbirth in a second pregnancy. Design Retrospective cohort study. Setting Scotland, UK. Population All women who delivered their first and second pregnancies in Scotland between 1981 and 2005. Methods All women delivering for the first time between 1981 and 2000 were linked to records of their second pregnancy using routinely collected data from the Scottish Morbidity Returns. Women who had an intrauterine death in their first pregnancy formed the exposed cohort, whereas those who had a live birth formed the unexposed cohort. Main outcome measure Stillbirth in a second pregnancy. Results After adjusting for confounding factors, the odds of recurrence of stillbirth in a second pregnancy were found to be 1.94 (99% CI 1.29-2.92) compared with women who had had a live birth in their first pregnancy. Other factors associated with recurrence of stillbirth in a second pregnancy included placental abruption (adjusted OR 1.96; 99% CI 1.60-2.41), preterm delivery (adjusted OR 7.45; 99% CI 5.91-9.39) and low birthweight (adjusted OR 6.69; 99% CI 5.31-8.42). A Bayesian analysis using minimally informative normal priors found the risk of recurrence of stillbirth in a second pregnancy to be 1.59 (99% CI 1.10-2.33). Conclusions Women who have stillbirth in their first pregnancy have a higher risk of recurrence in their next pregnancy.
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