Resource Center Journal Article Alert — September
19, 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 NSIDRC 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
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more details.
Sudden Infant Death
1. Goldwater PN
Sterile site infection at autopsy in sudden unexpected deaths
in infancy
Arch Dis Child. 2008 Sep 15. [Epub ahead of print]
Women's & Children's Hospital, Australia.
OBJECTIVE: To examine and compare bacteriological findings
at autopsy of cases of sudden unexpected infant death and those
of deaths of other cause. DESIGN: autopsy report review of
130 SIDS cases (2004 definition), 32 cases of sudden unexpected
death in infancy (SUDI) due to infection and 33 cases of non-infectious
sudden deaths. SETTING: Qualitative assessment of normally
sterile site (NSS) (heart blood, spleen or cerebrospinal fluid)
bacteriology in SIDS and age-matched comparison deaths that
occurred in the late 1980s and early 1990s. MAIN OUTCOME MEASURES:
comparative sterile site bacteriological findings. RESULTS:
Sterile site infection was uncommon in cases of sudden accidental
death (e.g. motor vehicle accident or drowning, etc.) however,
the finding of true pathogens such as Staphylococcus aureus
in sterile sites in SIDS and deaths associated with infection
was relatively common. 10.76% of SIDS had S. aureus in a sterile
site, compared with 18.75% of cases of infection-related deaths.
S. aureus was not found in sudden accidental deaths. The incidence
of coliform bacteria in NSS in SIDS was not significantly different
from that seen in deaths of other cause. NSS bacteriology yielded
no growth in 45.4% of sudden accidental death, 43% of SIDS
and 28.1% of infectious causes of death. CONCLUSIONS: The finding
of S. aureus in NSS in a large proportion of cases of SIDS
would indicate that a proportion of these babies died of staphylococcal
disease. Although the differences in NSS isolation of Staphylococcuus
aureus in the three infant groups did not quite achieve significance,
nevertheless, on the basis of these findings and the characteristic
virulence of S. aureus, it is recommended that sudden unexpected
deaths from which Staphylococcus aureus is isolated from NSS
be considered for reclassifiication. The incidence of coliform
bacteria in NSS in SIDS is not significantly different from
that in deaths of other cause (both accidental and infectious).
From these findings it is recommended that the opinion of a
consultant microbiologist be sought to interpret microbiological
findings prior to finalising autopsy reports on SUDI.
2. Bruckner TA
Economic antecedents of prone infant sleep placement among
black mothers
Ann Epidemiol. 2008 Sep;18(9):678-81
Department of Epidemiology, School of Public Health, University
of California at Berkeley, CA 94720-7360, USA.
PURPOSE: Black infants die from sudden infant death syndrome
at twice the incidence observed among non-Hispanic white infants.
Explanations for this disparity include a two-fold greater
prevalence of prone (i.e., stomach) infant sleep placement
among black caregivers. I test the hypothesis that the contraction
of state economies may contribute to this disparity by increasing
the risk of prone infant sleep placement among black mothers.
METHODS: I retrieved data from the Bureau of Labor Statistics
employment series and 33,518 black mothers in 26 states participating
in the 1996-2002 Pregnancy Risk Assessment Monitoring System.
I use weighted multivariable analyses to control for individual
characteristics and state and time trends. RESULTS: Black mothers
exhibit an elevated risk of reporting prone placement one month
following statewide declines in employment (adjusted odds ratio
for a one percent decline = 1.11, 95% CI 1.01 to 1.22). This
risk remains elevated after control for individual variables.
In contrast, I find no association between the economy and
prone placement among white mothers. CONCLUSIONS: Statewide
economic decline may reduce adherence to the recommended non-prone
infant sleep position among black, but not white, mothers.
Additional research among black caregivers should determine
which mechanisms connect economic downturns to prone infant
sleep placement.
Other Infant Death
1. Fitzhugh VA, Shaikh JR, Heller DS
Adnexal torsion leading to death of an infant
J Pediatr Adolesc Gynecol. 2008 Oct;21(5):295-7
Department of Pathology and Laboratory Medicine, University
of Medicine and Dentistry- New Jersey Medical School, Newark
NJ, USA.
BACKGROUND: Torsion of the uterine adnexa is an uncommon occurrence
in infants, but when it does occur, the consequences may be
catastrophic. CASE: A 4-month-old female presented with sudden
cardiac and respiratory arrest. There were no prior signs of
illness. The infant was resuscitated and survived for one day
after the event. Autopsy revealed a left ovarian cyst with
torsion. Necrosis of the transverse colon was also seen. Other
organs revealed signs of shock. The cause of death was felt
to be related to the torsion. SUMMARY AND CONCLUSION: Torsion
of the uterine adnexa is rare in infants. In the few reported
cases, antecedent symptoms were present. Clinicians should
be aware of this possibility and include it in the differential
diagnosis of death in infancy.
2. Uthman OA, Uthman MB, Yahaya I
A population-based study of effect of multiple birth on infant
mortality in Nigeria
BMC Pregnancy Childbirth. 2008 Sep 10;8(1):41. [Epub ahead
of print]
ABSTRACT: BACKGROUND: Multi-foetal pregnancies and multiple
births including twins and higher order multiples births such
as triplets and quadruplets are high-risk pregnancy and birth.
These high-risk groups contribute to the higher rate of childhood
mortality especially during early period of life. METHODS:
We examined the relationship between multiple births and infant
mortality using univariable and multivariable survival regression
procedure with Weibull hazard function, controlling for child's
sex, birth order, prenatal care, delivery assistance; mother's
age at child birth, nutritional status, education level; household
living conditions and several other risk factors. RESULTS:
Children born multiple births were more than twice as likely
to die during infancy as infants born singleton (hazard ratio
= 2.19; 95% confidence interval: 1.50, 3.19) holding other
factors constant. Maternal education and household asset index
were associated with lower risk of infant mortality. CONCLUSIONS:
Multiple births are strongly negatively associated with infant
survival in Nigeria independent of other risk factors. Mother's
education played a protective role against infant death. This
evidence suggests that improving maternal education may be
key to improving child survival in Nigeria. A well-educated
mother has a better chance of satisfying important factors
that can improve infant survival: the quality of infant feeding,
general care, household sanitation, and adequate use of preventive
and curative health services.
Bereavement
1. Mander R
Good grief: Staff responses to childbearing loss
Nurse Educ Today. 2008 Sep 11. [Epub ahead of print]
School of Health in Social Science, University of Edinburgh,
Teviot Place, Edinburgh EH8 9AG, Scotland, UK.
The emotional implications for staff of loss in childbearing
have been inadequately addressed. In this paper I focus on
maternity situations, but it is necessary to draw on other
areas' findings. I address crying by the care provider and
its association with staff grief. The conclusion emerges that
education is likely to help staff to provide quality care in
these most sensitive of sensitive situations.
Miscarriage/Stillbirth/Prenatal Issues
1. Irvin EA, Williams D, Hamler SE, Smith MA
Immunological and pathological changes in the placenta during
infection with Listeria monocytogenes in pregnant guinea
pigs
Reprod Toxicol. 2008 Aug 28. [Epub ahead of print]
Interdisciplinary Toxicology Program, Department of Environmental
Health Science, University of Georgia, Athens, GA, United States;
Center for Food Safety, College of Agricultural and Environmental
Sciences, University of Georgia, Griffin, GA, United States.
Exposure to Listeria monocytogenes during pregnancy can result
in spontaneous abortion and stillbirths; however, the mechanisms
are unknown. Our objective was to determine the effects of
infection on specific inflammatory and anti-inflammatory cytokine
mRNA expression and apoptosis in the placenta after infection
with L. monocytogenes. Pregnant guinea pigs were treated on
gestation day (gd) 35 with 10(8) colony forming units L. monocytogenes
and sacrificed on gd 37, 41, 44, or 55. At gd 41, IFN-gamma
and IL-2 mRNA expression was significantly decreased in placentas
from treated dams (0.0012-fold and 0.131-fold, respectively).
At gd 55, TNF-alpha mRNA expression was significantly decreased
(0.19-fold), while IFN-gamma mRNA expression was significantly
increased (32-fold), and apoptosis was detected in 100% of
placentas from treated dams. In conclusion, inflammatory cytokine
mRNA expression is altered and apoptosis is increased in the
placenta after treatment with L. monocytogenes, and these changes
may contribute to fetal death.
2. Abbasi S, Jamal A, Eslamian L, Marsousi V
Role of clinical and ultrasound findings in the diagnosis of
retained products of conception
Ultrasound Obstet Gynecol. 2008 Sep 12. [Epub ahead of print]
Perinatology Division, Shariati Hospital, Tehran University
of Medical Sciences, Tehran, Iran.
OBJECTIVE: To assess the role of clinical and ultrasound findings
as predictors of retained products of conception (RPOC) in
women with a suspicion of incomplete miscarriage. METHODS:
This was a retrospective study of 91 patients admitted for
suspected RPOC after spontaneous first-trimester miscarriage
who were evacuated surgically, and for whom histopathological
reports were available. All the women underwent transvaginal
sonography after their miscarriage. The decision to evacuate
the uterus was based on vaginal bleeding, lower abdominal pain
and/or sonographic findings of hyperechoic material or endometrial
thickness more than 8 mm. Maternal age, gestational age, clinical
signs and symptoms and sonographic findings were recorded.
Clinical and sonographic findings were compared with the histopathological
reports and the sensitivity and specificity of vaginal bleeding,
abdominal pain and sonographic appearance of the endometrium
for detecting the products of conception were assessed. RESULTS:
Histopathological analysis confirmed the presence of chorionic
villi in 55 women (60%) and decidua in 36 (40%). Vaginal bleeding
was more frequent in women with RPOC (P < 0.001), whilst
lower abdominal pain was a more frequent symptom in those with
decidua (P = 0.019). The ultrasound finding of hyperechoic
material had a sensitivity of 78%, specificity of 100% and
positive and negative predictive values of 100% and 75%, respectively,
in predicting RPOC. Vaginal bleeding as a predictor of RPOC
had a sensitivity of 93%, specificity of 50%, and positive
and negative predictive values of 74% and 82%, respectively.
The combination of hyperechoic material and/or vaginal bleeding
increased the sensitivity to 98% and negative predictive value
to 95%. There was no significant difference in endometrial
thickness between the two groups. CONCLUSION: The ultrasound
finding of hyperechoic material is the best predictor for diagnosing
RPOC. In the absence of hyperechoic material and vaginal bleeding,
RPOC are extremely unlikely. Copyright (c) 2008 ISUOG. Published
by John Wiley & Sons, Ltd.
3. Raghupathy R
Manipulation of cytokine production profiles as a therapeutic
approach for immunologic pregnancy loss
Indian J Biochem Biophys. 2008 Aug;45(4):229-36
Department of Microbiology, Faculty of Medicine, Kuwait University,
P.O. Box 24923, Safat 13110, Kuwait. raj@hsc.edu.kw
Pregnancy is not as successful as one might think; it can
be compromised by several complications such as recurrent spontaneous
miscarriage, pre-term delivery, pre-eclampsia etc. Much attention
has been paid to the possibility of the maternal immune system
mediating deleterious effects on pregnancy. Research conducted
during the last two decades has shed much light on cell-mediated
immunologic effectors that might underlie these pregnancy complications.
Of particular interest are the effects that pro-inflammatory
and anti-inflammatory cytokines have on the foetus and placenta,
and thus on the success and failure of pregnancy. This review
presents evidences that certain cytokine profiles are associated
with recurrent miscarriage and pre-term delivery and discusses
possible pathways of effector function of cytokines in pregnancy
loss and the redirection of cytokine profiles from one that
is antagonistic to pregnancy towards one that is conducive
to the success of pregnancy. Among the promising agents for
the modulation of the Th1/Th2 balance are progestogens like
progesterone and dydrogesterone; this review also discusses
recent evidence that progestogens are capable of modulating
cytokine production patterns in pregnancy loss.
4. Coyle M, Sulger E, Fletcher C, Rouse D
A successful 39-week pregnancy on hemodialysis: a case report
Nephrol Nurs J. 2008 Jul-Aug;35(4):348-55, 402; quiz 356
The Renal Care Center, United Medical Associates, United Health
Services Hospitals, Binghamton, NY, USA.
Pregnancy in women on hemodialysis is very uncommon, and rates
of spontaneous abortion, hypertension, pre-eclampsia, polyhydramnios,
pre-term labor, and premature birth are high. This article
documents a successful 39-week pregnancy in a woman who conceived
at Stage 5 in chronic kidney disease and who started hemodialysis
at 7 weeks gestation. The dialysis prescription included 3-hour
treatments 5 times weekly. Blood urea nitrogen levels and fluid
removal by ultrafiltration were managed according to the recommendations
in the available literature. Erythropoietin and IV iron were
utilized liberally for her worsening anemia. She was closely
monitored by a multidisciplinary team at the dialysis center
and by the perinatologist in her health care system. Pre-term
labor and premature birth were avoided; however, she developed
hypertension, pre-eclampsia, and polyhydramnios. She delivered
a healthy female by scheduled cesarean section. There is limited
data on management of this minority population, and much can
be learned regarding mineral metabolism, safety and use of
medications, control of hypoalbuminemia, and care practices
to reduce the incidence of maternal complications and premature
birth.
5. Alijotas-Reig J, Casellas-Caro M, Ferrer-Oliveras R, Llurba-Olive
E, Hermosilla E, Vilardell-Tarres M, Cabero-Roura L
Are anti-Beta-glycoprotein-I antibodies markers for recurrent
pregnancy loss in lupus anticoagulant/anticardiolipin seronegative
women?
Am J Reprod Immunol. 2008 Sep;60(3):229-37
Systemic Autoimmune Disease Unit, Department of Internal Medicine
I, Hospital Universitari Vall d'Hebron; and Department of Medicine,
Universitat Autonoma; and Institute Universitari Dexeus Universitat
Autonoma, Barcelona, Spain.
Problem Anti-beta(2)-Glicoprotein-1 antibodies (anti-beta(2)GPI-ab)
have been related to recurrent miscarriage (RM) with conflicting
results. The aim was to evaluate the role of anti-beta(2)-GPI-ab
as unique biological marker in RM related to antiphospholipid
(aPL). Method of study A cohort study that included 59 cases,
divided in two groups, was designed: group 1 comprised 43 pregnant
women with 'obstetric' antiphospholipid syndrome (APS) and
group 2 included 16 cases with similar complaints but only
having repeatedly anti-beta(2)-GPI-ab. Previous thrombosis
and/or inherited thrombophilia were excluded. Lupus anticoagulant,
anticardiolipin antibodies (aCA), anti-beta(2)-GPI-ab, and
other autoantibodies were analyzed. Miscarriages, premature
births, pre-eclampsia, live births, placental and systemic
thromboses were studied. Results No differences in previous
obstetric complications were detected (P = 1.00-0.164). After
the treatment, differences in number of obstetric complications
were not seen (P = 1.00). Live births were similar in two groups
(88.4% and 93.7%; P = 1.00). Placental thrombosis was equal
in both groups, 93.3% versus 80% (P = 1.00). Conclusion These
results suggest that anti-beta(2)-GPI-ab may be considered
a biological marker for obstetric APS.
6. Levrant S, Coulam CB, Jeyendran RS
Interleukin 1 receptor antagonist gene polymorphisms are not
risk factors for recurrent pregnancy loss: evaluation of
couples
Am J Reprod Immunol. 2008 Sep;60(3):224-8
Partners in Reproductive Health, Tinley Park, IL, USA.
Problem The interleukin-1 system has been implicated in pregnancy
outcome. Fetal carriage of interleukin-1 receptor antagonist
(IL-1Ra) specific alleles has been associated with adverse
pregnancy outcomes including spontaneous abortion and pre-term
labor. This study was undertaken to compare the frequency of
IL-1RN*2 alleles among both male and female partners of couples
experiencing recurrent pregnancy loss with that of fertile
control couples. Method of study Buccal swabs were obtained
from 42 couples experiencing recurrent pregnancy loss and from
20 fertile control couples. DNA was extracted from the buccal
swabs and analyzed for the presence of IL-1RN variable number
tandem repeat. Results No significant differences were found
when the frequency of IL-1RN*2 polymorphisms were compared
between fertile control couples and couples experiencing recurrent
pregnancy loss. Similar results were also obtained when comparing
women or men respectively from each group. Conclusion IL-1RN*2
allele is not a risk factor for recurrent pregnancy loss.
7. Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Agyei
SO, Kirkwood BR
Diagnostic accuracy of verbal autopsies in ascertaining the
causes of stillbirths and neonatal deaths in rural Ghana
Paediatr Perinat Epidemiol. 2008 Sep;22(5):417-29
Kintampo Health Research Centre, Ghana Health Service, Kintampo,
Brong Ahafo Region, Ghana. karen.edmond@lshtm.ac.uk.
This study evaluated the diagnostic accuracy of a verbal autopsy
(VA) tool in ascertaining the causes of stillbirths and neonatal
deaths in rural Ghana and was nested within a community-based
maternal vitamin A supplementation trial (ObaapaVitA trial).
All stillbirths and neonatal deaths between 1 January 2003
and 30 June 2004 were prospectively included. Community VAs
were carried out within 6 months of death and were classified
with a primary cause of death by three experienced paediatricans.
The reference standard diagnosis was obtained by the study
paediatrician in 4 district hospitals in the study area. There
were 20,317 deliveries, 661 stillbirths and 590 neonatal deaths
with a VA diagnosis in the study population. A total of 311
stillbirths and 191 neonatal deaths had both a VA and a hospital
reference standard diagnosis. The VA performed poorly for stillbirth
diagnoses such as congenital abnormalities and maternal haemorrhage.
Accuracy was higher for intrapartum obstetric complications
and antepartum maternal disease. For neonatal deaths, sensitivity
was >60% for all major causes; specificity was 76% for birth
asphyxia but >85% for prematurity and infection. Overall,
VA diagnostic accuracy was higher than expected in this rural
African setting. Our classification system was based on the
expected public health importance of the individual causes
of death, differing implications for intervention and the ability
to distinguish between the individual causes in low-resource
settings. We believe this system was easier to use than traditional
approaches and resulted in high precision and accuracy. However,
further simplifications are needed to allow use of the World
Health Organisation VA in routine child health programmes.
The diagnostic accuracy of the VA tool should also be assessed
in other regions and in multicentre studies.
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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