NSIDRC Journal Article Alert — August 15, 2008
Prepared by the National Sudden Infant Death Resource Center
at Georgetown University.
This journal article alert provides selected items added to
the National Library of Medicine’s PubMed database in
the last week.
Past issues of NSIDRC journal alerts are available at http://www.sidscenter.org.
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Sudden Infant Death
1. Viskari-Lähdeoja S, Hytinantti T, Andersson S, Kirjavainen
T.
Heart rate and blood pressure control in infants exposed to
maternal cigarette smoking.
Acta Paediatr. 2008 Aug 6. [Epub ahead of print]
Hospital for Children and Adolescents, Helsinki, Finland.
Aim: Exposure to maternal cigarette smoking is a major risk
factor for sudden infant death syndrome (SIDS). Foetal and
postnatal smoke-exposure may alter cardiovascular control in
infants. We studied heart rate (HR) and blood pressure (BP)
responses in smoke-exposed infants. Methods: Eleven infants
exposed to maternal cigarette smoking were studied at the age
of 12 +/- 2.1 (range 10-16) weeks. Twenty healthy, age-matched
infants from non-smoking families served as controls. During
confirmed slow-wave sleep (NREM3), 3-5 sec side motion and
45 sec 45 degrees head-up tilt tests were performed. Results:
Control infants showed consistent biphasic HR and BP responses
to side motion, with an initial 2-5% increase followed by a
2% decrease (p < 0.0001). In smoke-exposed infants, the
initial HR (p = 0.009) and BP responses (p < 0.0001) were
markedly reduced, and the subsequent decrease in BP was more
prominent (systolic blood pressure, SBP, p = 0.005; diastolic
blood pressure, DBP, p = 0.03). No differences were observed
between the groups in tilt test results, HR variability or
HR responses to spontaneous arousals. Conclusion: Maternal
cigarette smoking may alter vestibulo-mediated cardiovascular
control in early infancy. This may contribute to increased
SIDS risk.
2. Hanzer M, Zotter H, Sauseng W, Pfurtscheller K, Müller
W, Kerbl R.
Pacifier use does not alter the frequency or duration of spontaneous
arousals in sleeping infants.
Sleep Med. 2008 Aug 4. [Epub ahead of print]
Division of Neonatology, Department of Pediatrics, Medical
University of Graz, Auenbruggerplatz 30, 8036 Graz, Styria,
Austria.
OBJECTIVE: It has been reported that pacifiers might reduce
the risk of SIDS by favouring infants' arousability from sleep.
We evaluated the influence of a pacifier on the frequency and
duration of spontaneous arousals in healthy infants. METHODS:
Polygraphic recordings were performed in 14 infants with an
age of 51.7+/-19.9 days (means+/-SD) who regularly used a pacifier
during sleep. Cortical and subcortical arousals were scored
according to the recommendations of the "International
Paediatric Work Group on Arousals." The number of arousals
per 10-min-period and the duration of arousals were determined
for periods of pacifier use as well as for periods after pacifier
dislodgement and were compared with the data of 10 control
infants (age 49.8+/-16.5 days) who never used a pacifier. RESULTS:
Altogether, 211 arousals in pacifier users and 225 arousals
in non-users were scored. In pacifier users, 2.0+/-1.6 arousals
per 10-min-period with a duration of 12.2+/-3.0s occurred during
pacifier use, and 1.7+/-1.6 arousals per 10-min-period with
a duration of 12.2+/-3.1s occurred during periods without pacifier.
In pacifier non-users, 2.3+/-1.2 arousals per 10-min-period
(duration 13.9+/-2.9s) were scored. The results did not show
a significant difference concerning frequency and duration
of spontaneous arousals between pacifier users and non-users.
CONCLUSIONS: Our findings suggest that factors other than arousal
mechanisms might be responsible for the efficacy of pacifiers
in SIDS prophylaxis.
Bereavement
1. Keesee NJ, Currier JM, Neimeyer RA.
Predictors of grief following the death of one's child: the
contribution of finding meaning.
J Clin Psychol. 2008 Aug 12. [Epub ahead of print]
Memphis Veteran's Administration Medical Center.
This study examined the relative contribution of objective
risk factors and meaning-making to grief severity among 157
parents who had lost a child to death. Participants completed
the Core Bereavement Items (CBI; Burnett, Middleton, Raphael, & Martinek,
1997), Inventory of Complicated Grief (ICG; Prigerson et al.,
1995), questions assessing the process and degree of sense-making
and benefit-finding, and the circumstances surrounding their
losses. Results showed that the violence of the death, age
of the child at death, and length of bereavement accounted
for significant differences in normative grief symptoms (assessed
by the CBI). Other results indicated that the cause of death
was the only objective risk factor that significantly predicted
the intensity of complicated grief (assessed by the ICG). Of
the factors examined in this study, sense-making emerged as
the most salient predictor of grief severity, with parents
who reported having made little to no sense of their child's
death being more likely to report greater intensity of grief.
Implications for clinical work are discussed.
2. Price SK.
Stepping back to gain perspective: pregnancy loss history,
depression, and parenting capacity in the early childhood
longitudinal study, birth cohort (ECLS-B).
Death Stud. 2008;32(2):97-122.
School of Social Work, Virginia Commonwealth University, 1001
W. Franklin St. P.O. Box 842027, Richmond, VA 23284-2027, USA
Previous empirical studies of pregnancy loss have predominantly
focused on complex grief response and emergent problems associated
with future parenting in self-selected samples of bereaved
women. This article presents findings from a retrospective
secondary data analysis conducted with a racially and ethnically
diverse sample of currently parenting women in the United States
(N = 10,688) that examined the relationships among pregnancy
loss history, current maternal depressive symptoms, and mother-infant
interaction with the enrolled child.Study findings underscore
a racial-ethnic disparity in pregnancy loss history for African
American women, whereas current maternal depressive symptoms
remain fairly constant across racial-ethnic groups. Multiple
loss history is associated with a slight elevation in overall
symptoms of depression, but there is no relationship between
pregnancy loss history and current mother-infant interaction
in the study sample. An important limitation in this study
is that the Early Childhood Longitudinal Study, Birth Cohort
(ECLS-B) data does not allow for inferences specific to the
type of loss, gestational age of fetus, time since loss, or
whether the loss was spontaneous or induced. However, study
findings highlight areas of incongruity between clinical and
population-based research that deserve further investigation.
Ultimately, the findings from this population-based research
contribute to a wider perspective regarding maternal response
to reproductive loss that can inform future research and targeted
bereavement support.
Miscarriage/Stillbirth/Prenatal Issues
1. Póvoa AM, Costa F, Rodrigues T, Patrício
B, Cardoso F.
Prevalence of hypertension during pregnancy in Portugal.
Hypertens Pregnancy. 2008; 27(3):279-84.
Department of Gynecology and Obstetrics, Hospital Sao Joao-EPE,
Faculdade de Medicina da Universidade do Porto, Portugal
OBJECTIVE: To estimate the prevalence of maternal hypertensive
disorders in Portugal and to assess their impact on obstetric
outcomes. METHODS: A national survey on hypertension in pregnancy
was conducted in Portuguese public maternity wards and included
6726 pregnancies. RESULTS: Six percent of women presented with
a hypertensive disorder during pregnancy or puerperium: 1.5%
with chronic hypertension, 2.5% with gestational hypertension,
1.4% with preeclampsia, 0.2% with superimposed preeclampsia,
0.1% with eclampsia, and 0.1% with HELLP syndrome. Preterm
birth, small-for-gestational-age infants and fetal death were
significantly more frequent among women with preeclampsia/eclampsia
and HELLP syndrome. CONCLUSION: In Portugal, the prevalence
of hypertensive disorders diagnosed during pregnancy seems
to be lower than that reported in most countries, but these
disorders have a significant effect on pregnancy outcomes.
2. Mayet S, Groshkova T, Morgan L, MacCormack T, Strang J.
Drugs and pregnancy--outcomes of women engaged with a specialist
perinatal outreach addictions service.
Drug Alcohol Rev. 2008 Sep;27(5):497-503.
National Addiction Centre, Institute of Psychiatry, King's
College London, London, UK.
Substance misuse during pregnancy may result in harm to both
mother and child. The aims of this study were to assess changes
in outcomes of women seen by a specialist perinatal addictions
outreach service (1989-1991 versus 2002-2005) and compare outcomes
to the local hospital maternity population (2004-2005). A cross-sectional
audit of health-care records was conducted comparing the outcomes
of women in 2002-2005 with earlier data from 1989-1991 and
the local maternity population (2004-2005). The service was
attended by 126 women, of whom 83% of opioid-dependent women
started/continued opioid maintenance treatment. Of 118 babies
delivered, there were two stillbirths and one early neonatal
death, 20% were premature, 28% were low birth weight, 21% required
the Special Care Baby Unit and 21% of babies born to opioid-dependent
mothers were treated for neonatal abstinence syndrome (NAS).
Fewer babies required treatment for NAS in 2002-2005 compared
to 1989-1991 (21% versus 44%). There were higher rates of miscarriage
(3% versus <1%), low birth weight (28% versus 9%) and premature
babies (20% versus 9%) compared to the local maternity population
(2004-2005). Integrated perinatal addictions treatment may
deliver benefits; however, engaging women into treatment earlier
and reducing substance use before conception remains the objective.
3. Garrisi JG, Colls P, Ferry KM, Zheng X, Garrisi MG, Munné S.
Effect of infertility, maternal age, and number of previous
miscarriages on the outcome of preimplantation genetic diagnosis
for idiopathic recurrent pregnancy loss.
Fertil Steril. 2008 Aug 8. [Epub ahead of print]
The Institute for Reproductive Medicine and Science, Saint
Barnabas Medical Center, Livingston, New Jersey.
OBJECTIVE: To determine whether preimplantation genetic diagnosis
(PGD) would decrease spontaneous abortion rates in patients
with idiopathic recurrent pregnancy loss (RPL). DESIGN: Controlled
clinical study. SETTING: IVF center and PGD reference laboratory.
PATIENT(S): Patients with RPL with no known etiology. INTERVENTION(S):
Preimplantation genetic diagnosis by fluorescence in situ hybridization
analyzing nine chromosomes. MAIN OUTCOME MEASURE(S): The spontaneous
abortion rate after PGD was compared to the patients' own expected
risk of abortion. Patients were evaluated according to the
number of previous losses, fertility, and maternal age. RESULT(S):
Preimplantation genetic diagnosis significantly reduced spontaneous
abortions in patients with RPL, especially for patients with
more than two previous losses (12.8% vs. 35.9% expected). The
PGD significantly reduced the rate of spontaneous abortion
in both fertile (15.2% vs. 33.8% expected) and infertile patients
(13.0% vs. 29.5%), which also achieved similar delivery rates
(37% and 34%, respectively). The beneficial effect of PGD was
less pronounced in patients <35 years than in patients >/=35
years old (13.6% vs. 34.0% expected). Overall, the PGD reduced
the miscarriage rate to a similar baseline of 14%-16% across
all maternal ages. CONCLUSION(S): Preimplantation genetic diagnosis
improves pregnancy outcome for women with idiopathic RPL, especially
those with more than two previous losses, and >35 years
of age, and that improvement is not affected by fertility status.
4. Lazzarin N, Vaquero E, Exacoustos C, Bertonotti E, Romanini
ME, Arduini D.
Low-dose aspirin and omega-3 fatty acids improve uterine artery
blood flow velocity in women with recurrent miscarriage due
to impaired uterine perfusion.
Fertil Steril. 2008 Aug 8. [Epub ahead of print]
Department of Obstetrics and Gynecology, Ospedale Fatebenefratelli
Isola Tiberina, University of Rome "Tor Vergata,",
Rome, Italy; Fatebenefratelli Association for Research, Ospedale
Fatebenefatelli Isola Tiberina, Rome, Italy.
OBJECTIVE: To determine the effect of different therapeutic
approaches on uterine artery blood flow in women with recurrent
miscarriage (RM) and impaired uterine perfusion. DESIGN: Prospective,
randomized study. SETTING: Department of Obstetrics and Gynecology,
University of Rome "Tor Vergata," Italy. PATIENT(S):
Sixty women with unexplained RM and impaired uterine perfusion.
INTERVENTION(S): Patients were randomly assigned to three different
therapeutic regimens: 20 patients received a daily dose of
100 mg of aspirin (LDA); 20 patients were treated with omega-3
fatty acids (Omega(3)), 4 g daily; and 20 patients received
LDA plus Omega(3). MAIN OUTCOME MEASURE(S): Doppler measurement
of uterine artery pulsatility index (PI) was performed, in
the midluteal phase of the cycle, before and after 2 months
of therapy. RESULT(S): All therapeutic regimens induced an
improvement in uterine perfusion with a significant reduction
of uterine artery PI values. LDA alone or in combination with
Omega(3) was found to achieve the highest improvement of uterine
blood flow. Omega-3 supplementation was less effective, as
reflected by the lower PI values. CONCLUSION(S): LDA and Omega(3)
are effective in improving uterine artery blood flow velocity
in women with RM due to abnormal uterine perfusion. Further
studies are needed to determine whether the improvement of
uterine perfusion may lead to a better pregnancy outcome.
5. Ghi T, Casadio P, Kuleva M, Perrone AM, Savelli L, Giunchi
S, Meriggiola MC, Gubbini G, Pilu G, Pelusi C, Pelusi G.
Accuracy of three-dimensional ultrasound in diagnosis and classification
of congenital uterine anomalies.
Fertil Steril. 2008 Aug 8. [Epub ahead of print]
Department of Obstetrics and Gynecology, University Hospital
of Bologna, Italy.
OBJECTIVE: To assess the accuracy of three-dimensional (3D)
ultrasound in the diagnosis of congenital uterine anomalies.
DESIGN: Prospective study. SETTING: University hospital. PATIENT(S):
Nulliparae with three or more consecutive miscarriages. INTERVENTION(S):
All women underwent 3D transvaginal ultrasound study of the
uterine cavity. MAIN OUTCOME MEASURE(S): Women with negative
ultrasound findings subsequently underwent office hysteroscopy,
whereas a combined laparoscopic-hysteroscopic assessment was
performed in cases of suspected Müllerian anomaly. RESULT(S):
A specific Müllerian malformation was sonographically
diagnosed in 54 women of the 284 included in the study group.
All negative ultrasound findings were confirmed at office hysteroscopy.
Among the women with abnormal ultrasound findings, the presence
of a Müllerian anomaly was endoscopically confirmed in
all. Concordance between ultrasound and endoscopy around the
type of anomaly was verified in 52 cases, including all those
with septate uterus and two out of three with bicornuate uterus.
CONCLUSION(S): Volume transvaginal ultrasound appears to be
extremely accurate for the diagnosis and classification of
congenital uterine anomalies and may conveniently become the
only mandatory step in the assessment of the uterine cavity
in patients with a history of recurrent miscarriage.
6. Nakashima A, Shiozaki A, Myojo S, Ito M, Tatematsu M, Sakai
M, Takamori Y, Ogawa K, Nagata K, Saito S.Granulysin Produced
by Uterine Natural Killer Cells Induces Apoptosis of Extravillous
Trophoblasts in Spontaneous Abortion.
Am J Pathol. 2008 Aug 7. [Epub ahead of print]
From the Department of Obstetrics and Gynecology,* Faculty
of Medicine, University of Toyama, Toyama; the StemCell Institute
Inc., Tokyo; the R&D Center, BML, Saitama; and the 21st
Century COE Program, University of Toyama, Toyama, Japan.
Immune changes are known to occur in recurrent spontaneous
abortion, but it is unclear whether either maternal natural
killer (NK) cells or T cells attack fetus-derived trophoblasts.
To clarify the immunological causes of spontaneous abortion,
we examined the relationship between cytotoxic granule proteins
in decidual lymphocytes, such as granulysin, granzyme B, and
perforin, and the induction of apoptosis in extravillous trophoblasts
(EVTs). The number of granulysin-positive CD56(bright) NK cells
increased significantly in the decidua basalis during spontaneous
abortion compared with normal pregnancy; however, granzyme
B- and perforin-positive cells did not change. Interestingly,
the expression of granulysin was also detected in the nuclei
of EVTs in spontaneous abortion samples. When IL-2-stimulated
CD56(bright) NK cells were cocultured with EVT cells (HTR-8/SV40neo),
granulysin was found initially in the cytoplasm and then accumulated
in the nuclei of the HTR-8/SV40neo cells. Furthermore, transfected
cells expressing a GFP-granulysin fusion protein induced apoptosis
in HTR-8/SV40neo cells independently of caspases. Our results
suggest that granulysin-positive uterine NK cells attack EVTs;
subsequently, the uNK-derived granulysin actively accumulates
in the nuclei of EVTs, causing the death of EVTs due to apoptosis.
These data support a new apoptosis pathway for trophoblasts
via uNK-derived granulysin, suggesting that granulysin is involved
in spontaneous abortion.
Prepared by the
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