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NSIDRC Journal Article Alert — July 31, 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
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Other Infant Death
1. Talbert DG
Cyclic vomiting syndrome: Contribution to dysphagic infant death
Med Hypotheses. 2009 Jul 23. [Epub ahead of print]
Institute of Reproductive and Developmental Biology, Imperial College School of Medicine, Du Cane Road, London W12 ONN, UK.
Vomiting involves the simultaneous violent contraction of abdominal and diaphragm muscles to produce a high pressure on the stomach. The heart right atrium forms a through path from IVC to SVC, so the high intra-abdominal pressure will drive blood from abdominal contents into the head. Normally internal viscous drags in organs will limit the volume leaving them during a single vomiting event. However, repetitive vomiting such as occurs in cyclic vomiting syndrome (CVS) may drive sufficient blood into head veins to produce extreme venous hypertension. Dysphagic infant death is essentially a head vein hypertension malady, some features of which match those that are postulated for Shaken Baby Syndrome. CVS was described by Gee in 1882 but is still poorly understood. Recently a consensus statement has been released by the North American Society for Pediatric Gastroenterology Hepatology and Nutrition setting out key issues to be addressed. Understanding CVS may therefore have important implications beyond its gastroenterological aspects. A case demonstrating a sequence of features suggesting CVS and the effects of increasing abdominal muscle strength with age is presented. It showed (1) swallowing dysfunction, (2) grunting and apnoea (surfactant poisoning), (3) reflux, (4) diarrhoea, (5) apparently unprovoked prolonged screaming fits (migraine?), (6) petechiae (local capillary rupture), (7) skull growth abnormalities (hydrocephalus) and (8) unconscious "blank staring spells " (from which the infant would auto-resuscitate). Repetitive vomiting may also sensitise the epiglottis thus increasing the risk of laryngospasm, and making attempts at intubation hazardous, possibly leading to hypoxic brain death.
2. Evid Based Ment Health. 2009 Aug;12(3):94
Schizophrenia in either parent increases risk of infant mortality
Miscarriage/Stillbirth/Prenatal Issues
1. Swanson KM, Chen HT, Graham JC, Wojnar DM, Petras A
Resolution of Depression and Grief during the First Year after Miscarriage: A Randomized Controlled Clinical Trial of Couples-Focused Interventions
J Womens Health (Larchmt). 2009 Jul 24. [Epub ahead of print]
1 University of North Carolina, Chapel Hill , North Carolina.
Abstract Aims: The purpose of this randomized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men's resolution of depression and grief during the first year after miscarriage. Methods: Three hundred forty-one couples were randomly assigned to nurse caring (NC) (three counseling sessions), self-caring (SC) (three video and workbook modules), combined caring (CC) (one counseling session plus three SC modules), or control (no treatment). Interventions, based on Swanson's Caring Theory and Meaning of Miscarriage Model, were offered 1, 5, and 11 weeks after enrollment. Outcomes included depression (CES-D) and grief, pure grief (PG) and grief-related emotions (GRE). Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework. Results: Bayesian odds (BO) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women's resolution of depression. BO of 3.2-6.6 favored NC and no treatment over SC and CC for resolving men's depression. BO of 3.1-7.0 favored all three interventions over no treatment for accelerating women's PG resolution, and BO of 18.7-22.6 favored NC and CC over SC or no treatment for resolving men's PG. BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women's resolution of GRE. BO from 3.5 to 17.9 favored NC, CC, and control over SC for resolving men's GRE. Conclusions: NC had the overall broadest positive impact on couples' resolution of grief and depression. In addition, grief resolution (PG and GRE) was accelerated by SC for women and CC for men.
2. Holm Tveit JV, Saastad E, Stray-Pedersen B, Bordahl PE, Flenady V, Fretts R, Froen JF
Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement
BMC Pregnancy Childbirth. 2009 Jul 22;9(1):32. [Epub ahead of print]
ABSTRACT: BACKGROUND: Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals. METHODS: All singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively. RESULTS: Reports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32-0.81), and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.49-0.94). There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced. CONCLUSIONS: Improved management of DFM and uniform information to women is associated with fewer stillbirths.
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