Resource Center Journal Article Alert — September
5, 2008
Prepared by the National Sudden and Unexpected Infant/Child
Death and Pregnancy Loss 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 Resource Center journal alerts are
available at http://www.sidscenter.org.
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 for
more details.
Sudden Infant Death
1. 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.
2. Berner J, Ringstedt T, Brodin E, Hökfelt T, Lagercrantz
H, Wickström R
Prenatal exposure to nicotine affects substance P and preprotachykinin-A
mRNA levels in newborn rat
Pediatr Res. 2008 Jul 23. [Epub ahead of print]
Department of Woman and Child Health [J.B., T.R., H.L., R.W.],
Department of Neuroscience [T.R., T.H.], Department of Physiology
and Pharmacology [E.B.], Karolinska Institutet, 171 77 Stockholm,
Sweden.
Prenatal nicotine exposure influences neuronal development
including effects on several neurotransmitter systems. It also
attenuates the ventilatory response to hypoxia, known to require
a functional substance P-ergic system. Previous studies have
shown that nicotine increases the risk for sudden infant death
syndrome (SIDS) by four-fold and that SIDS-victims have elevated
brainstem levels of substance P. We therefore studied the effect
of prenatal nicotine exposure on the levels of substance P-like
immunoreactivity by radioimmunoassay in the brain in newborn
rat pups. The expression of the substance P precursor preprotachykinin
A mRNA was also determined by real-time RT-PCR in carotid body,
in petrosal/jugular and trigeminal ganglia, in cervical and
lumbar dorsal root ganglia as well as in the brainstem. We
found that prenatal nicotine exposure increased levels of substance
P- like immunoreactivity in the brainstem without changing
levels in other parts of the brain or in the adrenals. Furthermore,
mRNA levels were increased in the carotid bodies and in the
petrosal ganglia, in contrast to the decreased levels in the
cervical dorsal root ganglia. We conclude that nicotine causes
alterations in the substance P-ergic system in the brainstem,
possibly linked to the increased risk for SIDS after prenatal
nicotine exposure.
3. Tang S, Machaalani R, Waters KA
Brain Res. 2008 Jul 19. [Epub ahead of print]
Brain-derived neurotrophic factor (BDNF) and TrkB in the piglet
brainstem after post-natal nicotine and intermittent hypercapnic
hypoxia
Department of Paediatrics and Child Health, The University
of Sydney, NSW 2006, Australia.
Brain-derived neurotrophic factor (BDNF) and its receptor
TrkB play a significant role in the regulation of cell growth,
survival and death during central nervous system development.
The expression of BDNF and TrkB is affected by noxious insults.
Two insults during the early post-natal period that are of
interest to our laboratory are exposure to nicotine and to
intermittent hypercapnic hypoxia (IHH). Piglet models were
used to mimic the conditions associated with the risk factors
for the sudden infant death syndrome (SIDS) including post-natal
cigarette smoke exposure (nicotine model) and prone sleeping
where the infant is subjected to re-breathing of expired gases
(IHH model). We aimed to determine the effects of nicotine
and IHH, alone or in combination, on pro- and rhBDNF and TrkB
expression in the developing piglet brainstem. Four piglet
groups were studied, with equal gender ratios in each: control
(n=14), nicotine (n=14), IHH (n=10) and nic+IHH (n=14). Applying
immunohistochemistry, and studying six nuclei of the caudal
medulla, we found that compared to controls, TrkB was the only
protein significantly decreased after nicotine and nic+IHH
exposure regardless of gender. For pro-BDNF and rhBDNF however,
observed changes were more evident in males than females exposed
to nicotine and nic+IHH. The implications of these findings
are that a prior nicotine exposure makes the developing brainstem
susceptible to greater changes in the neurotrophic effects
of BDNF and its receptor TrkB in the face of a hypoxic insult,
and that the effects are greater in males than females.
Other Infant Death
1. Wong A, Elder D, Zuccollo J
N Z Med J. 2008 Jul 4;121(1277):39-46
Changes in cause of neonatal death over a decade
University of Otago, Wellington, New Zealand.
AIMS: To classify neonatal deaths at Wellington Hospital (Wellington,
New Zealand) over a 10-year period and assess changes in cause
of death over time. METHODS: Retrospective audit from 1995-2004
of live-born infants > or = 20 weeks gestation dying before
28 days of age. Deaths were classified according to the PSANZ-NDC
Classification guideline. The years 1995-1999 and 2000-2004
were compared to analyse for changes in cause of death. RESULTS:
There were 219 neonatal deaths: 67(31%) of these were term
infants and 154 preterm; 109 infants from 1995-1999 and 110
from 2000-2004. The autopsy rate was 62% and highest in term
infants (76%). Deaths due to congenital anomaly and extreme
prematurity decreased over time and deaths due to infection
increased. CONCLUSIONS: Use of the PSANZ-NDC death classification
system enables an accurate cause of death to be established
for most neonatal deaths and allows monitoring of mortality
rates over time.
2. Malloy MH
Impact of cesarean section on neonatal mortality rates among
very preterm infants in the United States, 2000-2003
Pediatrics. 2008 Aug;122(2):285-92
Department of Pediatrics, University of Texas Medical Branch,
301 University Blvd, Galveston, TX 77555-0526, USA. mmalloy@utmb.edu
OBJECTIVE: The objective of this analysis was to compare the
neonatal mortality rates for infants delivered through primary
cesarean section versus vaginal delivery, taking into consideration
a number of potentially risk-modifying conditions. METHODS:
US linked birth and infant death certificate files for 2000-2003
were used. Demographic, medical, and labor and delivery complications
were abstracted from the files with infant information. The
primary outcome examined was neonatal death (death at 0-27
days of age). Because of concern regarding misclassification
of gestational age, a procedure was used to trim away births
for which the birth weight for a specific gestational age was
incongruous. Adjusted odds ratios were calculated for the risk
of neonatal death relative to the mode of delivery (primary
cesarean section versus vaginal delivery), using logistic regression
analysis. RESULTS: There were data for 13,733 neonatal deaths
and 106,809 survivors available from the trimmed data set for
analysis for the 4-year period. More than 80% of pregnancies
with delivery between 22 and 31 weeks of gestation experienced >or=1
risk factor. Adjusted odds ratios demonstrated significantly
reduced risk of neonatal death for infants delivered through
cesarean section at 22 to 25 weeks of gestation (adjusted odds
ratios of 0.58, 0.52, 0.72, and 0.81 for 22, 23, 24, and 25
weeks, respectively). CONCLUSION: Cesarean section does seem
to provide survival advantages for the most immature infants
delivered at 22 to 25 weeks of gestation, independent of maternal
risk factors for cesarean section.
3. Rimsza ME, Newberry S
Unexpected infant deaths associated with use of cough and cold
medications
Pediatrics. 2008 Aug;122(2):e318-22
Department of Pediatrics, University of Arizona College of
Medicine, Tucson, Arizona, USA. mrimsza@aap.net
OBJECTIVE: The objective of this study was to determine whether
caregivers had given infants who died unexpectedly over-the-counter
cough and cold medications before the infant deaths to identify
sociodemographic risk factors for their use. METHODS: The Arizona
Child Fatality Review Program reviews the circumstances surrounding
every child death that occurs in the state each year. By statute,
the multidisciplinary review teams have access to all medical
charts, autopsy reports, law enforcement reports, and other
records for their review and use these data to determine the
cause of death and its preventability. The data on all infants
who died unexpectedly in 2006 and had an autopsy and postmortem
toxicologic studies were reviewed for this analysis. RESULTS:
Ten unexpected infant deaths that were associated with cold-medication
use were identified. The infants ranged in age from 17 days
to 10 months. Postmortem toxicology testing found evidence
of recent administration of pseudoephedrine, antihistamine,
dextromethorphan, and/or other cold-medication ingredients
in these infants. The families who used these medications were
poor and publicly insured, and 50% of them had limited English
proficiency. Only 4 of these infants had received medical care
for their current illness before their death. The over-the-counter
cough and cold medication had been prescribed by a clinician
for only 1 of these infants. CONCLUSIONS: Review of these infants'
deaths raises concern about the role of the over-the-counter
cough and cold medications in these deaths. These findings
support the recommendation that such medications not be given
to infants. In addition, these findings suggest that warnings
on these medications "to consult a clinician" before
use are not being followed by parents. Educational campaigns
to decrease the use of over-the-counter cough and cold medications
in infants need to be increased.
4. Boccoli J, Loidl CF, Lopez-Costa JJ, Creydt VP, Ibarra
C, Goldstein J
Intracerebroventricular administration of Shiga toxin type
2 altered the expression levels of neuronal nitric oxide synthase
and glial fibrillary acidic protein in rat brains
Brain Res. 2008 Sep 16;1230:320-33. Epub 2008 Jul 22
Laboratorio de Fisiopatogenia, Departamento de Fisiología,
Facultad de Medicina, Universidad de Buenos Aires, Paraguay
2155 piso 7, Ciudad Autónoma de Buenos Aires, 1121,
Argentina.
Shiga toxin (Stx) from enterohemorrhagic Escherichia coli
(STEC) is the main cause of hemorrhagic colitis which may derive
into Hemolytic Uremic Syndrome (HUS) and acute encephalopathy,
one of the major risk factors for infant death caused by the
toxin. We have previously demonstrated that intracerebroventricular
administration of Stx2 causes neuronal death and glial cell
damage in rat brains. In the present work, we observed that
the intracerebroventricular administration of Stx2 increased
the expression of glial fibrillary acidic protein (GFAP) leading
to astrogliosis. Confocal microscopy showed reactive astrocytes
in contact with Stx2-containing neurons. Immunocolocalization
of increased GFAP and Stx2 in astrocytes was also observed.
This insult in the brain was correlated with changes in the
expression and activity of neuronal nitric oxide synthase (nNOS)
by using the NADPH-diaphorase histochemical technique (NADPH-d
HT). A significant decrease in NOS/NADPH-d-positive neurons
and NOS/NADPH-d activity was observed in cerebral cortex and
striatum, whereas an opposite effect was found in the hypothalamic
paraventricular nucleus. We concluded that the i.c.v. administration
of Stx2 promotes a typical pattern of brain injury showing
reactive astrocytes and an alteration in the number and activity
of nNOS/NADPH-d. According to the functional state of nNOS/NADPH-d
and to brain cell morphology data, it could be inferred that
the i.c.v. administration of Stx2 leads to either a neurodegenerative
or a neuroprotective mechanism in the affected brain areas.
The present animal model resembles the encephalopathy developed
in Hemolytic Uremic Syndrome (HUS) patients by STEC intoxication.
Miscarriage/Stillbirth/Prenatal Issues
1. 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 Sep;173(3):653-64. Epub 2008 Aug 7.
Department of Obstetrics and Gynecology, Faculty of Medicine,
University of Toyama, 2630 Sugitani, Toyama, 930-0194, 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.
2. Odendaal HJ, Steyn DW, Elliott A, Burd L
Combined Effects of Cigarette Smoking and Alcohol Consumption
on Perinatal Outcome
Gynecol Obstet Invest. 2008 Aug 6;67(1):1-8. [Epub ahead of
print]
Department of Obstetrics and Gynaecology, Stellenbosch University,
Tygerberg, South Africa.
Background: An increase in various congenital abnormalities
associated with cigarette smoking and the use of alcohol during
pregnancy has been reported in many studies. These exposures
also increase the risk of pregnancy complications such as abruptio
placentae, unexplained stillbirth, preterm labor and intrauterine
growth restriction. However, very few studies have addressed
the combined effect of smoking and drinking on pregnancy outcomes.
Methods: In this review, the adverse effects of smoking or
drinking on pregnancy were obtained from publications in which
both substances were addressed in the same study population.
A special effort was made to find studies in which the combined
effect of these substances was investigated. Results: Preterm
labor occurred more frequently in women who drank and smoked
during pregnancy. This increased odds ratio was more than the
sum of the effects of either smoking or drinking, indicating
that the use of both substances by the same woman has a synergistic
effect that increases the risk of preterm labor. This synergistic
effect was also found for low birth weight and growth restriction.
Conclusions: As most of the women who drink during pregnancy
also smoke cigarettes, attention should be given to the prevention
or reduced use of both substances during pregnancy. Copyright © 2008
S. Karger AG, Basel.
3. Christiansen OB, Steffensen R, Nielsen HS, Varming K
Multifactorial Etiology of Recurrent Miscarriage and Its Scientific
and Clinical Implications
Gynecol Obstet Invest. 2008 Aug 1;66(4):257-267. [Epub ahead
of print]
Fertility Clinic 4071, Rigshospitalet, Copenhagen, Denmark.
A considerable proportion of recurrent miscarriage (RM) cases
are caused by recurrent chromosomally abnormal conceptions.
However, in younger patients and patients with multiple miscarriages,
maternal causes seem to dominate. No single biomarker with
a high predictive value of maternally caused RM has been identified.
Non-genetic biomarkers in RM may not reflect conditions in
the pregnant uterus and we rarely know whether they are causes
or consequences of miscarriage. Studies of genetic biomarkers
are probably the best way to reveal the pathophysiological
mechanisms behind RM. Epidemiological and genetic studies suggest
that RM due to maternal causes has a multifactorial background.
The risk of RM in each patient is probably determined by the
interaction of many genetic variants and environmental factors
but only few of these have so far been identified. The genetic
biomarkers for RM can probably be classified into three groups:
(1) variants associated with excessive inflammatory responses
and autoimmunity; (2) variants of importance for insulin and
androgen sensitivity and turn-over, and (3) variants associated
with thrombophilia. Identification of these markers will require
whole genome association studies comprising thousands of individuals.
Acknowledgement of the multifactorial background for RM has
important implications for the management of patients in clinical
practice. Copyright © 2008 S. Karger AG, Basel.
4. Pittschieler S, Brezinka C, Jahn B, Trinka E, Unterberger
I, Dobesberger J, Walser G, Auckenthaler A, Embacher N, Bauer
G, Luef G
Spontaneous abortion and the prophylactic effect of folic acid
supplementation in epileptic women undergoing antiepileptic
therapy
J Neurol. 2008 Jul 25. [Epub ahead of print]
Dept. of Neurology, Medical University Innsbruck, Anichstrasse
35, 6020, Innsbruck, Austria.
BACKGROUND : Antiepileptic drugs (AEDs) like phenytoin (PHE),
carbamazepine (CBZ), barbiturates and valproic acid (VPA) interfere
with folic acid absorption and metabolism, which in turn can
be the cause of adverse pregnancy outcome. OBJECTIVE : To study
the prophylactic effect of folic acid supplementation with
regard to spontaneous abortion and preterm delivery (fetal
demise after week 20 of gestational age) in pregnant women
receiving AED therapy, as well as benefits of most common dosage
and preconceptional commencement. METHODS : Prospective examination
of 104 patients, registered in EURAP from 1999-2004 at a single
center and a retrospective analysis of data from our epilepsy
databank completed with medical records and patients interviews
of the Department of Neurology of Innsbruck University Hospital
from 1971 to 1999. RESULTS : 388 pregnancies in 244 patients
were analyzed. Pregnancies with folic acid supplementation
showed significant reduction of spontaneous abortion. With
regard to monotherapies, in the group of women taking VPA,
supplementation of folic acid had significant benefit. Other
examined monotherapies (CBZ, PHE, and PB) known to interfere
with folic acid showed no significant results. CONCLUSIONS
: This study confirms the prophylactic effect of folic acid
supplementation on spontaneous abortion. For AED therapy, folic
acid supplementation should be part of the therapy of every
pregnant epileptic woman, especially for those treated with
VPA.
5. Latini C, Frontini A, Morroni M, Marzioni D, Castellucci
M, Smith PG
Remodeling of uterine innervation
Cell Tissue Res. 2008 Aug 2. [Epub ahead of print]
Institute of Normal Human Morphology - Anatomy, Faculty of
Medicine, Polytechnic University of Marche, Via Tronto 10/A,
60020, Ancona, Italy.
This minireview reports current hypotheses concerning the
remodeling of sympathetic innervation in rodent and human uterus
during the estrous cycle and gestation. Neural modulation in
this organ is related to sexual hormone concentrations, and
a reduction in nerve density is observed when estrogen levels
are high during the estrous cycle. Estrogen receptor alpha
is considered to be the major receptor mediating the action
of estrogen. In the uterus, the expression of neurotrophins,
such as nerve growth factor, which are involved in the survival
and growth of nerve fibers, changes in response to steroid
levels. Despite much research, further studies are necessary
to clarify various aspects of nerve growth control under diverse
physiological conditions. These studies could be of importance,
since alterations of the biological mechanisms of uterus innervation
may play significant roles in various pathologies, such as
infertility and spontaneous abortion.
6. Plunkett BA, Fitchev P, Doll JA, Gerber SE, Cornwell M,
Greenstein EP, Crawford SE
Decreased expression of pigment epithelium derived factor (PEDF),
an inhibitor of angiogenesis, in placentas of unexplained stillbirths
Reprod Biol. 2008 Jul;8(2):107-20
Northwestern University Feinberg School of Medicine, 250 E.
Superior St., Suite 05-2175, Chicago, IL 60611, USA. p-beth@northwestern.edu.
Normal placental vascular development depends upon the complex
interactions between angiogenic inducers and inhibitors within
the placenta. Alterations within the placental microenvironment
can promote an imbalance in angiogenic mediators which may
be associated with adverse perinatal outcomes. The purpose
of this study was to investigate the placentas of infants with
unexplained stillbirth as compared to live-born infants and
to determine whether alterations in angiogenic inducer vascular
endothelial growth factor (VEGF) or inhibitor pigment epithelium-derived
factor (PEDF) are associated with altered angiogenesis, vascular
remodeling and stillbirth. Placentas of 22 unexplained stillbirths
and 44 age-matched live-born controls were scored for microvascular
density (MVD), vasculopathy and microvascular permeability.
A subset was scored for expression of angiogenic inducer VEGF
and inhibitor pigment epithelium-derived factor. Stillborn
placentas demonstrated higher MVD than controls (mean+SD: 116.6+/-46.3
v. 60.8+/-13.5, respectively, p<0.001). Vasculopathy was
present in 10/22 (45%) stillbirths compared to 0/44 (0%) controls
(p<0.001); increased vascular permeability was present in
15/22 (68%) cases and 5/44 (11%) controls (p<0.001). PEDF
expression was significantly lower in stillborn placentas (1.7+/-0.3)
than live-born controls (3.6+/-0.8, p<0.01) while VEGF expression
was similar (3.3+/-0.7 v. 3.7+/-0.4, respectively, p>0.05).
In conclusion, we found that unexplained stillbirth is associated
with loss of angiogenic inhibitor PEDF, vasculopathy and heightened
angiogenesis in the placenta.
7. Yang H, Qiu L, Di W, Zhao A, Chen G, Hu K, Lin Q
Fertil Steril. 2008 Aug 1. [Epub ahead of print]
Proportional change of CD4(+)CD25(+) regulatory T cells after
lymphocyte therapy in unexplained recurrent spontaneous abortion
patients
Department of Obstetrics and Gynecology, Renji Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China.
OBJECTIVE: To investigate the proportional changes of CD4(+)CD25(+)
regulatory T cells in peripheral blood after lymphocyte therapy
in unexplained recurrent spontaneous abortion (URSA) patients.
DESIGN: Prospective cohort study. SETTING: University Hospital.
PATIENT(S): Twenty-five URSA patients. INTERVENTION(S): Measurements
of CD4(+)CD25(+) regulatory T cells in peripheral blood before
and after paternal or third-party lymphocyte immunization.
MAIN OUTCOME MEASURE(S): The proportion of CD4(+)CD25(bright)
regulatory T cells and the percentage of CD25(bright) cells
in the CD4(+) T-cell population. RESULT(S): The proportion
of CD4(+)CD25(bright) T cells in peripheral blood from URSA
patients was increased significantly after paternal or third-party
lymphocyte immunization therapy, whereas the percentage of
CD4(+)CD25(dim) cells were decreased significantly. The percentage
of CD4(+)CD25(bright) cells in the CD4(+) T-cell population
was significantly increased, and the proportion of CD4(+)CD25(bright)
T cells was significantly higher in successfully pregnant women
than in those with pregnancy loss after lymphocyte therapy.
CONCLUSION(S): Allogeneic lymphocyte therapy can enhance the
percentage of CD4(+)CD25(bright) regulatory T cells in peripheral
blood, therefore CD4(+)CD25(+) regulatory T cells may serve
as a novel biomarker for monitoring allogeneic lymphocyte therapy
in URSA patients.
8. Joó JG, Beke A, Papp Z, Rigó J, Papp C
Pathol Res Pract. 2008 Jul 30. [Epub ahead of print]
Single umbilical artery in fetopathological investigations
1st Department of Obstetrics and Gynecology, Faculty of General
Medicine, Semmelweis University, 1088 Budapest, Hungary
Single umbilical artery (SUA) is a relatively common malformation
that may call attention to the possibility of associated malformations
(often chromosome aberrations). The current study aimed at
surveying malformations associated with SUA on the basis of
fetopathological investigations, analyzing the role of history,
summarizing the clinically important factors emerging together
with this malformation. In this study, we processed the details
of 204 cases in which SUA was confirmed fetopathologically
after miscarriage or induced abortion between 1990 and 2007.
In our sample, SUA occurred in 7.38% of the cases. The history
was positive in almost 30% of the cases. The majority of the
cases had a positive obstetric and the minority of them a positive
genetic history. The highest association of SUA with other
malformations was found for craniospinal ones, but an association
with cardiovascular malformations should also be mentioned.
Regarding the individual types of malformation, SUA was most
commonly associated with hydrocephalus, but Potter's sequence,
trisomy 21, and atrioventricular septal defect also reached
a higher rate in associated SUA. Previously published articles
dealing with associated malformations found that urogenital
malformations were most commonly associated with SUA. 'Itemizing'
the different non-chromosomal malformations in association
with SUA, we found that hydrocephalus, Potter's sequence, and
atrioventricular septal defect were the most frequent malformations,
while in earlier studies, the association with non-chromosomal
malformations such as vertebral malformations, imperforated
anus, cheilognathopalatoschisis, and renal agenesis occurred
more frequently than usual.
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
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