NSIDRC Journal Article Alert — March 6, 2009

Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.

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. Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yücesan K, Sauerland C, Mitchell EA; and the GeSID Study Group

Does breastfeeding reduce the risk of sudden infant death syndrome?

Pediatrics. 2009 Mar;123(3):e406-10

PD, University of Münster, Institute of Legal Medicine, Röntgenstrasse 23, D-48149 Münster, Germany. mechtild.vennemann@ukmuenster.de.

BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful. In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not. OBJECTIVE. To examine the association between type of infant feeding and sudden infant death syndrome. METHODS. The German Study of Sudden Infant Death is a case-control study of 333 infants who died of sudden infant death syndrome and 998 age-matched controls. RESULTS. A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding at the age of 1 month also reduced the risk of sudden infant death syndrome, but after adjustment this risk was not significant. Being exclusively breastfed in the last month of life/before the interview reduced the risk, as did being partially breastfed. Breastfeeding survival curves showed that both partial breastfeeding and exclusive breastfeeding were associated with a reduced risk of sudden infant death syndrome. CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant death syndrome by approximately 50% at all ages throughout infancy. We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages.

2. Dergacheva O, Kamendi H, Wang X, Pinol RM, Frank J, Jameson H, Gorini C, Mendelowitz D

The Role of 5-HT3 and Other Excitatory Receptors in Central Cardiorespiratory Responses to Hypoxia: Implications for Sudden Infant Death Syndrome

Pediatr Res. 2009 Feb 25. [Epub ahead of print]

Department of Pharmacology and Physiology, The George Washington University, Washington, DC 20037.

While brainstem serotonergic (5-HT) systems are involved in the protective responses to hypoxia, abnormalities of 5-HT function are strongly implicated in SIDS, and the neurochemical mechanisms by which 5-HT receptors influence brainstem cardiorespiratory responses to hypoxia remains unclear. This study focuses on the role of excitatory neurotransmission, including 5-HT3 signaling, to cardiac vagal neurons (CVNs) that dominate the control of heart rate. Excitatory synaptic inputs to CVNs, located in the nucleus ambiguus (NA), were recorded simultaneously with respiratory activity in in-vitro brainstem slices. During control conditions excitatory inputs to CVNs were blocked by application of NMDA and AMPA/kainate glutamatergic receptor antagonists, while the 5-HT3 and purinergic receptor antagonists ondansetron and pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), respectively, had no effect. However, during hypoxia ondansetron inhibited excitatory neurotransmission to CVNs. In recovery from hypoxia, spontaneous and respiratory-related excitatory events were blocked by glutamatergic and purinergic receptor blockers, respectively, while ondancetron had no effect. These results demonstrate that hypoxia recruits a 5-HT pathway to CVNs that activates 5-HT3 receptors on CVNs to maintain parasympathetic cardiac activity during hypoxia. Exaggeration of this 5-HT neurotransmission could increase the incidence of bradycardia and risk of sudden infant death during hypoxia.

3. Saiki T, Rao H, Landolfo F, Smith AP, Hannam S, Rafferty GF, Greenough A

Sleeping position, oxygenation and lung function in prematurely born infants studied post term

Arch Dis Child Fetal Neonatal Ed. 2009 Mar;94(2):F133-7

MRC-Asthma Centre, Division of Asthma, Allergy and Lung Biology, King's College Hospital, King's College London, Denmark Hill, London, UK.

OBJECTIVE: To determine the effect of sleeping position on the lung function of prematurely born infants when post term, whether any effect was similar to that before discharge from the neonatal unit, and if it differed according to bronchopulmonary (BPD) status. DESIGN: Prospective study. SETTING: Tertiary neonatal unit. PATIENTS: Twenty infants, median gestational age 30 weeks (range 25-32); 10 had BPD. INTERVENTIONS: Before neonatal unit discharge (median age 36 weeks postmenstrual age (PMA)) and when post term, infants were studied prone and supine, each position maintained for 3 h. MAIN OUTCOME MEASURES: Oxygen saturation was monitored continuously and, at the end of each 3 h period, functional residual capacity (FRC) and compliance (CRS) and resistance (RRS) of the respiratory system were measured. RESULTS: At a median of 36 weeks PMA and 6 weeks later (post term), respectively, oxygen saturation (98% vs 96%, p = 0.001; 98% vs 97%, p = 0.011), FRC (26 vs 24 ml/kg, p<0.0001; 35 vs 31 ml/kg, p = 0.001) and CRS (3.0 vs 2.4 ml/cm H(2)O, p = 0.034; 3.7 vs 2.5 ml/cm H(2)O, p = 0.015) were higher in the prone than the supine position. In the prone position, both BPD and non-BPD infants had significantly greater FRCs on both occasions and oxygen saturation at 36 weeks PMA, but oxygen saturation was significantly better post term only in non-BPD infants. Twelve infants had superior oxygen saturation and 17 superior FRCs in the prone compared with the supine position at both 36 weeks PMA and post term. CONCLUSIONS: These results suggest that lung function impairment does not explain why prematurely born infants are at increased risk of sudden infant death syndrome in the prone compared with the supine position.

Miscarriage/Stillbirth/Prenatal Issues

1. Eskild A, Vatten LJ, Nesheim BI, Vangen S

The estimated risk of miscarriage should be corrected for induced abortion rates

Acta Obstet Gynecol Scand. 2009 Feb 27:1-6. [Epub ahead of print]

Department of Obstetrics and Gynaecology, Akershus University Hospital and Medical Faculty, University of Oslo, Lørenskog, Norway.

Objective. We wanted to study to what extent induced abortion rates influence the age-dependent estimates of miscarriage risk. Design. Register-based study. Setting. Linkage between hospital records and the Norwegian Population Registry. Population. Included were all women 15-49 years of age in Oslo, Norway, who were pregnant during the three-year study period, 27,932 women. Methods. We estimated proportions with miscarriage according to maternal age with and without inclusion of women with induced abortion in the denominator. Main outcome measure. Proportions with miscarriage in each age group and odds ratios of miscarriage, with age group 25-29 years as the reference. Results. When only women with pregnancies intended to term were included in the denominator, 9.4% of the women were estimated to have miscarriage as the only reproductive event during the three-year period and 6.8% had both miscarriage and delivery. The corresponding figures when also women with induced abortions were included in the denominator, were 7.0 and 5.0%. When taking induced abortion into account, the reduction in estimated proportion with miscarriage during the study period was greatest in the age groups with the highest induced abortion rates, women 15-19 years old (from 22.8 to 6.4%) and women 45-49 years old (from 57.9 to 41.0%). Conclusions. Estimates of age-dependent risk of miscarriage may be strongly influenced by induced abortion rates.

2. Lam SK, Lee AM

More stress, more stillbirth--more than a simple relationship

BJOG. 2009 Mar;116(4):599-600; author reply 600

BJOG. 2008 Jun;115(7):882-5

3. Sugiura-Ogasawara M, Ozaki Y, Kitaori T, Kumagai K, Suzuki S

Midline uterine defect size is correlated with miscarriage of euploid embryos in recurrent cases

Fertil Steril. 2009 Feb 26. [Epub ahead of print]

Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.

OBJECTIVE: To compare subsequent pregnancy outcomes after two or more miscarriages in patients with and without congenital uterine anomalies. DESIGN: Case-control study. SETTING: Nagoya City University Hospital. PATIENT(S): A total of 42 patients with a bicornuate or septate uterus and 1528 with normal uteri. INTERVENTION(S): No surgery. MAIN OUTCOME MEASURE(S): The cumulative success rate for birth, abnormal chromosome karyotype rate in aborted concepti, and the predictive values of the height of the defect/length of the remaining uterine cavity ratio (D/C ratio). RESULT(S): Of the total of 1676 patients, 54 (3.2%) had congenital uterine anomalies; 25 (59.5%) of the 42 patients with a bicornuate or septate uterus had a successful first pregnancy after examination, while this was the case for 1096 (71.7%) of the 1528 with normal uteri. There was no difference in the cumulative live-birth rate (78.0% and 85.5%) within the follow-up period. However, the rates for an abnormal chromosome karyotype in aborted concepti in cases with and without uterine anomalies were 15.4% (two of 13) and 57.5% (134 of 233), respectively, with the latter being significantly higher. The D/C ratio in the miscarriage group was also significantly greater than that for the live-birth group. CONCLUSION(S): Congenital uterine anomalies have a negative impact on reproductive outcome in couples with recurrent miscarriage and are associated with further miscarriage with a normal embryonic karyotype. The D/C ratio was found to have a predictive value for further miscarriages in recurrent cases.

3. Jin Y, Wang X, Xiao Y, Lv C, Ding C, Lin Q

The role of TSP-1 on decidual macrophages involved in the susceptibility to unexplained recurrent spontaneous abortion

Am J Reprod Immunol. 2009 Mar;61(3):253-60.

Department of Obstetrics and Gynecology, Ren Ji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.

PROBLEM: To investigate the role of TSP-1 on decidual macrophages (DMPhi) in unexplained recurrent spontaneous abortion (RSA). METHOD OF STUDY: A total of 20 women undergoing artificial abortion in the first trimester and 10 patients with RSA were selected. (i) The expression of TSP-1 mRNA in deciduas was detected by real-time polymerase chain reaction; (ii) Flow cytometry was used to detect the percentage of positive TSP-1, CD36, CD47 markers on macrophages. (iii) Cytokine expression was measured by enzyme-linked immunosorbent spot-forming (ELISPOT) cell assay. RESULTS: (i) The expression of TSP-1 mRNA on DMPhi in RSA was significantly decreased (P < 0.05). (ii) The increased expression of CD36 (P < 0.01) and the decreased expression of TSP1 (P < 0.01) were found on DMPhi of RSA. No different CD47 expression level on DMPhi was observed between two groups. (iii)The expression of IL-10 in DMPhi of RSA patients was decreased significantly compared with that of controls (P < 0.05). When adding TSP1 into culture medium, there was no change in IFN-gamma expression, but increased IL-10 (P < 0.05) expression in DMPhi of RSA patients was observed. The expression of IL-10 was decreased significantly in DMPhi from controls when adding anti-TSP-1 antibody to culture medium (P < 0.05). CONCLUSION: TSP-1 on DMPhi could influence IL-10 expression as Th2 cytokines. The abnormal expression of TSP-1 could make some women undergo pregnancy loss.

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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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. Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yücesan K, Sauerland C, Mitchell EA; and the GeSID Study Group Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics. 2009 Mar;123(3):e406-10 PD, University of Münster, Institute of Legal Medicine, Röntgenstrasse 23, D-48149 Münster, Germany. mechtild.vennemann@ukmuenster.de. BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful. In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not. OBJECTIVE. To examine the association between type of infant feeding and sudden infant death syndrome. METHODS. The German Study of Sudden Infant Death is a case-control study of 333 infants who died of sudden infant death syndrome and 998 age-matched controls. RESULTS. A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding at the age of 1 month also reduced the risk of sudden infant death syndrome, but after adjustment this risk was not significant. Being exclusively breastfed in the last month of life/before the interview reduced the risk, as did being partially breastfed. Breastfeeding survival curves showed that both partial breastfeeding and exclusive breastfeeding were associated with a reduced risk of sudden infant death syndrome. CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant death syndrome by approximately 50% at all ages throughout infancy. We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages. 2. Dergacheva O, Kamendi H, Wang X, Pinol RM, Frank J, Jameson H, Gorini C, Mendelowitz D The Role of 5-HT3 and Other Excitatory Receptors in Central Cardiorespiratory Responses to Hypoxia: Implications for Sudden Infant Death Syndrome Pediatr Res. 2009 Feb 25. [Epub ahead of print] Department of Pharmacology and Physiology, The George Washington University, Washington, DC 20037. While brainstem serotonergic (5-HT) systems are involved in the protective responses to hypoxia, abnormalities of 5-HT function are strongly implicated in SIDS, and the neurochemical mechanisms by which 5-HT receptors influence brainstem cardiorespiratory responses to hypoxia remains unclear. This study focuses on the role of excitatory neurotransmission, including 5-HT3 signaling, to cardiac vagal neurons (CVNs) that dominate the control of heart rate. Excitatory synaptic inputs to CVNs, located in the nucleus ambiguus (NA), were recorded simultaneously with respiratory activity in in-vitro brainstem slices. During control conditions excitatory inputs to CVNs were blocked by application of NMDA and AMPA/kainate glutamatergic receptor antagonists, while the 5-HT3 and purinergic receptor antagonists ondansetron and pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), respectively, had no effect. However, during hypoxia ondansetron inhibited excitatory neurotransmission to CVNs. In recovery from hypoxia, spontaneous and respiratory-related excitatory events were blocked by glutamatergic and purinergic receptor blockers, respectively, while ondancetron had no effect. These results demonstrate that hypoxia recruits a 5-HT pathway to CVNs that activates 5-HT3 receptors on CVNs to maintain parasympathetic cardiac activity during hypoxia. Exaggeration of this 5-HT neurotransmission could increase the incidence of bradycardia and risk of sudden infant death during hypoxia. 3. Saiki T, Rao H, Landolfo F, Smith AP, Hannam S, Rafferty GF, Greenough A Sleeping position, oxygenation and lung function in prematurely born infants studied post term Arch Dis Child Fetal Neonatal Ed. 2009 Mar;94(2):F133-7 MRC-Asthma Centre, Division of Asthma, Allergy and Lung Biology, King's College Hospital, King's College London, Denmark Hill, London, UK. OBJECTIVE: To determine the effect of sleeping position on the lung function of prematurely born infants when post term, whether any effect was similar to that before discharge from the neonatal unit, and if it differed according to bronchopulmonary (BPD) status. DESIGN: Prospective study. SETTING: Tertiary neonatal unit. PATIENTS: Twenty infants, median gestational age 30 weeks (range 25-32); 10 had BPD. INTERVENTIONS: Before neonatal unit discharge (median age 36 weeks postmenstrual age (PMA)) and when post term, infants were studied prone and supine, each position maintained for 3 h. MAIN OUTCOME MEASURES: Oxygen saturation was monitored continuously and, at the end of each 3 h period, functional residual capacity (FRC) and compliance (CRS) and resistance (RRS) of the respiratory system were measured. RESULTS: At a median of 36 weeks PMA and 6 weeks later (post term), respectively, oxygen saturation (98% vs 96%, p = 0.001; 98% vs 97%, p = 0.011), FRC (26 vs 24 ml/kg, p<0.0001; 35 vs 31 ml/kg, p = 0.001) and CRS (3.0 vs 2.4 ml/cm H(2)O, p = 0.034; 3.7 vs 2.5 ml/cm H(2)O, p = 0.015) were higher in the prone than the supine position. In the prone position, both BPD and non-BPD infants had significantly greater FRCs on both occasions and oxygen saturation at 36 weeks PMA, but oxygen saturation was significantly better post term only in non-BPD infants. Twelve infants had superior oxygen saturation and 17 superior FRCs in the prone compared with the supine position at both 36 weeks PMA and post term. CONCLUSIONS: These results suggest that lung function impairment does not explain why prematurely born infants are at increased risk of sudden infant death syndrome in the prone compared with the supine position. Miscarriage/Stillbirth/Prenatal Issues 1. Eskild A, Vatten LJ, Nesheim BI, Vangen S The estimated risk of miscarriage should be corrected for induced abortion rates Acta Obstet Gynecol Scand. 2009 Feb 27:1-6. [Epub ahead of print] Department of Obstetrics and Gynaecology, Akershus University Hospital and Medical Faculty, University of Oslo, Lørenskog, Norway. Objective. We wanted to study to what extent induced abortion rates influence the age-dependent estimates of miscarriage risk. Design. Register-based study. Setting. Linkage between hospital records and the Norwegian Population Registry. Population. Included were all women 15-49 years of age in Oslo, Norway, who were pregnant during the three-year study period, 27,932 women. Methods. We estimated proportions with miscarriage according to maternal age with and without inclusion of women with induced abortion in the denominator. Main outcome measure. Proportions with miscarriage in each age group and odds ratios of miscarriage, with age group 25-29 years as the reference. Results. When only women with pregnancies intended to term were included in the denominator, 9.4% of the women were estimated to have miscarriage as the only reproductive event during the three-year period and 6.8% had both miscarriage and delivery. The corresponding figures when also women with induced abortions were included in the denominator, were 7.0 and 5.0%. When taking induced abortion into account, the reduction in estimated proportion with miscarriage during the study period was greatest in the age groups with the highest induced abortion rates, women 15-19 years old (from 22.8 to 6.4%) and women 45-49 years old (from 57.9 to 41.0%). Conclusions. Estimates of age-dependent risk of miscarriage may be strongly influenced by induced abortion rates. 2. Lam SK, Lee AM More stress, more stillbirth--more than a simple relationship BJOG. 2009 Mar;116(4):599-600; author reply 600 BJOG. 2008 Jun;115(7):882-5 3. Sugiura-Ogasawara M, Ozaki Y, Kitaori T, Kumagai K, Suzuki S Midline uterine defect size is correlated with miscarriage of euploid embryos in recurrent cases Fertil Steril. 2009 Feb 26. [Epub ahead of print] Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan. OBJECTIVE: To compare subsequent pregnancy outcomes after two or more miscarriages in patients with and without congenital uterine anomalies. DESIGN: Case-control study. SETTING: Nagoya City University Hospital. PATIENT(S): A total of 42 patients with a bicornuate or septate uterus and 1528 with normal uteri. INTERVENTION(S): No surgery. MAIN OUTCOME MEASURE(S): The cumulative success rate for birth, abnormal chromosome karyotype rate in aborted concepti, and the predictive values of the height of the defect/length of the remaining uterine cavity ratio (D/C ratio). RESULT(S): Of the total of 1676 patients, 54 (3.2%) had congenital uterine anomalies; 25 (59.5%) of the 42 patients with a bicornuate or septate uterus had a successful first pregnancy after examination, while this was the case for 1096 (71.7%) of the 1528 with normal uteri. There was no difference in the cumulative live-birth rate (78.0% and 85.5%) within the follow-up period. However, the rates for an abnormal chromosome karyotype in aborted concepti in cases with and without uterine anomalies were 15.4% (two of 13) and 57.5% (134 of 233), respectively, with the latter being significantly higher. The D/C ratio in the miscarriage group was also significantly greater than that for the live-birth group. CONCLUSION(S): Congenital uterine anomalies have a negative impact on reproductive outcome in couples with recurrent miscarriage and are associated with further miscarriage with a normal embryonic karyotype. The D/C ratio was found to have a predictive value for further miscarriages in recurrent cases. 3. Jin Y, Wang X, Xiao Y, Lv C, Ding C, Lin Q The role of TSP-1 on decidual macrophages involved in the susceptibility to unexplained recurrent spontaneous abortion Am J Reprod Immunol. 2009 Mar;61(3):253-60. Department of Obstetrics and Gynecology, Ren Ji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China. PROBLEM: To investigate the role of TSP-1 on decidual macrophages (DMPhi) in unexplained recurrent spontaneous abortion (RSA). METHOD OF STUDY: A total of 20 women undergoing artificial abortion in the first trimester and 10 patients with RSA were selected. (i) The expression of TSP-1 mRNA in deciduas was detected by real-time polymerase chain reaction; (ii) Flow cytometry was used to detect the percentage of positive TSP-1, CD36, CD47 markers on macrophages. (iii) Cytokine expression was measured by enzyme-linked immunosorbent spot-forming (ELISPOT) cell assay. RESULTS: (i) The expression of TSP-1 mRNA on DMPhi in RSA was significantly decreased (P < 0.05). (ii) The increased expression of CD36 (P < 0.01) and the decreased expression of TSP1 (P < 0.01) were found on DMPhi of RSA. No different CD47 expression level on DMPhi was observed between two groups. (iii)The expression of IL-10 in DMPhi of RSA patients was decreased significantly compared with that of controls (P < 0.05). When adding TSP1 into culture medium, there was no change in IFN-gamma expression, but increased IL-10 (P < 0.05) expression in DMPhi of RSA patients was observed. The expression of IL-10 was decreased significantly in DMPhi from controls when adding anti-TSP-1 antibody to culture medium (P < 0.05). CONCLUSION: TSP-1 on DMPhi could influence IL-10 expression as Th2 cytokines. The abnormal expression of TSP-1 could make some women undergo pregnancy loss. 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 — March 6, 2009

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