April 30, 2006 E-zine

 

The Georgia SIDS Project E-Zine is an on-line educational update offered monthly by the Georgia Sudden Infant Death Information, Referral and Support Project, an affiliate of First Candle/SIDS Alliance. To comment on this issue, request additional information, refer families in need of support, make a donation or be added or removed from the list please contact us at gasids@mindspring.com or call 678-342-3360 or through Powerline at 1-800-822-2539.

This publication is made available through the generous donation of friends and supporters of our program.

We wish to thank the many of you who participated in the 2006 Georgia SIDS Conference �Grief, Grieving and Grief Support Training� On April 27^th. The conference was a huge success. We are especially grateful to the Center for Excellence in Health Disparity at Morehouse School of Medicine for their financial support of this program.

 

Volume 2 - Issue Number 4, April 2006

 

1.       Improving the Investigation of Sudden and Unexplained Infant Deaths: �the new national Sudden Unexplained Infant Death Investigation Reporting Form Teleconference will be held May 16, 2006 2:00 pm - 3:30 pm EDT. Hosted by HHS, MCH, CDC, U. S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention Register for the event at http://www.mchcom.com. Recently, the CDC released a new version of the National Sudden and Unexplained Infant Death Investigation (SUIDI) Reporting Form.  This investigation form is now available for use in states and communities.  This tool can guide and standardize the work and practices of EMS professionals, law enforcement, death scene investigators, medical examiners and coroners, death certifiers and child death review (CDR) team members.  Information obtained by using the tool in infant death investigations can also be used to guide the development of strategies for the prevention of infant deaths. The goals of the Web Cast are:  

To explain the importance of infant death scene investigations in both the determining the manner and cause of sudden unexplained infant deaths.;To outline the components of a comprehensive, high quality infant death scene investigation; To demonstrate why investigators can use the SUIDI tool to improve their investigations of infant deaths; To demonstrate how state and local professionals can utilize the tool to meet their local reporting policies and practices; To provide examples of how local/state child death review teams can advocate for improvements in investigations; To explain the new SUIDI reporting system and its relationship to other death reporting systems. To encourage widespread dissemination of the form through the training resources available through the CDC.

Registration: The web cast requires prior online registration.   Participation in this web cast takes place exclusively through the Internet.  Register for the event at http://www.mchcom.com A technical check of your computer will be conducted automatically during the registration process.  To ensure that your computer meets all technical requirements, please register at least a day in advance of the web cast, and be sure to use the same computer to register that you will use to attend the event. If you experience any technical difficulties while registering, please submit a question to http://www.mchcom.com/help/. �The form is available online at http://www.cdc.gov/SIDS.� The announcement and full overview of the project can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a7.htm?s_cid=mm5508a7_e �

 

2.       Recent national trends in sudden, unexpected infant deaths: �More evidence supporting a change in classification or reporting. Shapiro-Mendoza CK, Tomashek KM, Anderson RN, Wingo J.Am J Epidemiol. 2006 Apr 15; The recent US decline in sudden infant death syndrome (SIDS) rates may be explained by a shift in how these deaths are classified or reported. To examine this hypothesis, the authors compared cause-specific mortality rates for SIDS, other sudden, unexpected infant deaths, and cause unknown/unspecified, and they evaluated trends in the age and month of death for these causes using 1989-2001 US linked birth/death certificate data. Reported deaths in state and national data were compared to assess underreporting or overreporting. SIDS rates declined significantly from 1989-1991 to 1995-1998, while deaths reported as cause unknown/unspecified and other sudden, unexpected infant deaths, such as accidental suffocation and strangulation in bed (ASSB), remained stable. From 1999-2001, the decline in SIDS rates was offset by increasing rates of cause unknown/unspecified and ASSB. Changes in the cause-specific age at death and month of death distributions suggest that cases once reported as SIDS are now being reported as ASSB and cause unknown/unspecified. Most of the decline in SIDS rates since 1999 is likely due to increased reporting of cause unknown/unspecified and ASSB. Standardizing data collection at death scenes and improving the reporting of cause of death on death certificates should improve national vital records data and enhance prevention efforts. The above investigators are very involved in the new infant death scene investigation protocols recently developed by CDC. Improved investigation of infant death will likely yield more data on trends and the actual number of SIDS vs. ASSB deaths.

 

3.       Special Journal Issue Features Articles on Women, Gender, and Health Care Disparities. The March-April issue of the Journal of Women's Health features seven articles on women, gender, and health care disparities coauthored by AHRQ's Director of Women's Health and Gender-Based Research, Rosaly Correa-de-Araujo, M.D. The articles include: A copy is available by sending an e-mail to ahrqpubs@ahrq.hhs.gov. Limited copies are available.

 

4.       Sudden Infant Death Syndrome May Be from Disturbances of Serotonin Levels. A.Tryba, F. Pe�a, Jan-Marino Ramirez . A root cause of sudden infant death syndrome (SIDS) may be disturbances of serotonin levels in key pacemaker cells in the brain. In babies, the normal response to hypoxia is to gasp, which wakes the baby and resets the breathing mechanism, according to Jan-Marino Ramirez, Ph.D., a professor of biology and anatomy at the University of Chicago. That reflex, which kicks in when a baby isn't getting enough oxygen for any reason, is governed by a set of pacemaker neurons in the respiratory neural network, Dr. Ramirez and colleagues had previously shown. In the March 8 issue of the Journal of Neuroscience, they build on the former work by showing that if those pace- maker cells don't have enough serotonin or can't use what's there, the gasping reflex is stifled. In a series of experiments using brain tissue from mice, the researchers blocked serotonin receptors in so-called cadmium-insensitive pacemaker cells. When those cells were placed in a hypoxic condition, the blockade prevented them from emitting the electrical signals characteristic of gasping. The blockade reduced so-called "fictive gasping" - gasping in vitro -from about 20 gasps to two or three. The researchers performed the experiment with two different serotonin receptor blockers, piperidine and ketanserin. That "indicates that if there's a problem with serotonin, the gasping is gone," Dr. Ramirez said. "And when these children don't gasp, they don't wake up." The abstract can be found at http://www.jneurosci.org/cgi/content/abstract/26/10/2623 �

 

5.       The relationship between bedding and face-down death in infancy: Mathematical analysis of a respiratory simulation system using an infant mannequin to assess gas diffusibility in bedding. Sakai J, Funayama M, Kanetake J.Forensic Sci Int. 2006 Apr 16; Rebreathing is a model for the relationship between a prone sleeping position and sudden infant death syndrome. This study used a mechanical simulation model to establish the relationship between types of bedding and rebreathing potential for an infant placed prone (face down) at different postnatal ages. The infant mannequin was connected to a respirator set to deliver physiologically appropriate combinations of tidal volume (V(T)) and respiratory rates (RR) across a range of postnatal ages (0-18 months). Before measurements were made, CO(2) flow was regulated to 5+/-0.1% of end-tidal PCO(2) (EtCO(2)). After the model was placed in a prone position, any increase in the fractional concentration of inspired CO(2) (FiCO(2)) was measured. FiCO(2) increased immediately and rapidly, and reached a maximum value within a few minutes. The maximum FiCO(2) ranged from under 2% to over 10%, depending on the bedding. FiCO(2) was also affected by V(T) and RR. This model is not applicable to actual infants because of the large tissue stores of CO(2) in infants; however, it is useful for evaluation of gas diffusibility of bedding and will simplify the investigation of sleeping environments when a baby is found dead with its face covered by soft bedding. In general, the higher the FiCO(2), the greater the rebreathing potential.

 

6.       The Effects of Cost-Shifting in the State Children's Heath Insurance Program. Johnson TJ, Rimsza M, Johnson WG.
Am J Public Health. 2006 April. Many states are increasing the State Children's Health Insurance Program (SCHIP) cost-sharing requirements to induce reductions in enrollment. We examined the effect of increasing SCHIP premiums on both health care use and cost to the public. Study Methods: The net cost to the public of increased cost sharing for SCHIP-insured children in a border community was estimated with multivariate methods. The majority (88%) of children were of Mexican origin. Results: We estimated that a $10 increase in monthly premiums would induce 10% of SCHIP children to disenroll, resulting in a 6% increase in public expenditures. Conclusions: Families that disenroll from SCHIP and become uninsured typically turn to emergency departments for primary care, which increases total health care expenditures through the use of more expensive services.

 

7.       The CDC has released national recommendations encouraging women to take steps toward good health before becoming pregnant. The recommendations on preconception health and health care identify more than a dozen risk factors and conditions that require interventions before pregnancy to be effective. The recommendations on preconception health and health care identify more than a dozen risk factors and conditions that require interventions before pregnancy to be effective. Among developed nations, the United States is ranked 26th in infant mortality. If implemented, the recommendations can help improve the health of babies and moms. Among the topics addressed are folic acid supplementation; detecting and treating existing health conditions; reviewing medications; stopping smoking and eliminating alcohol; family planning counseling to avoid unplanned pregnancies; and counseling on behaviors related to weight, nutrition, exercise and oral health. These recommendations were published last week in the Morbidity and Mortality Weekly Report (MMWR) and may be accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm

 

8.       Anticipatory guidance topics: are more better? Barkin SL, et al �Anticipatory guidance is a cornerstone of primary care pediatrics. Despite the fact that retention of information is essential for later action, data are lacking on what parents recall immediately after the visit and 1 month later and how the total number of topics discussed affects this outcome. Parents and practitioners completed post visit surveys of anticipatory guidance topics discussed during health-maintenance visits for children ages 2-11. Post visit and 1 month later, parental recall was compared with provider report of topics discussed. We examined the relationship between parental recall and the total number of topics discussed. 861 families with children ages 2-11 years participated. Providers reported discussing the topics of nutrition, car restraints, dental care, and reading aloud most often (72%- 93%). Concordance between parent and provider was high for all topics (72%-90%). Immediately post visit, parents reported 6.33 as the mean number of topics discussed while providers reported 6.9 as the mean. However, parental recall decreased significantly with more topics (> or =9) discussed. The same trend existed 1 month later. Parental recall dwindles with increasing numbers of topics discussed. Rethinking well-child care to limit the total number of topics discussed is warranted. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16302840&query_hl=24&itool=pubmed_docsum

 

9.       New site for Project IMPACT, a partner in the SIDS risk reduction efforts national has been opened. Look for great information at www.sidsprojectimpact.com

 

10.    The role of molecular autopsy in unexplained sudden cardiac death. Tester DJ, Ackerman MJ. Curr Opin Cardiol. 2006 May;21

Purpose of Review: Sudden cardiac death (SCD) is one of the most common causes of death, with many attributable to cardiac/coronary abnormalities evident at autopsy. A significant number of SCDs, however, particularly in young people, remain unexplained following a medico-legal investigation, including autopsy, and are referred to as autopsy-negative sudden unexplained death (SUD). Due to molecular advances, however, a cardiac channel molecular autopsy may potentially provide a pathogenic basis for SUD and establish cause and manner of death. Recently 5 population-based investigations of sudden death in young people elucidated the frequency �and causes for these tragic events. The most inclusive study concluded that nearly 30% of SCDs in young people are autopsy-negative (i.e. SUD) and most likely secondary to cardiac channelopathies. Recently, a molecular autopsy series of SUD identified pathogenic mutations in long QT syndrome and catecholaminergic polymorphic ventricular tachycardia-associated genes in over one-third of cases. Similar post-mortem cardiac channel genetic testing in a large population-based cohort of sudden infant death syndrome has elucidated mutations in 5-10% of cases. With autopsy-negative SUD accounting for a significant number of sudden deaths in young people, a new role for the medical examiner is emerging. An accurate diagnosis, derived from a molecular autopsy, will guide the appropriate initiation of pre-emptive strategies to prevent future tragedies among those left behind.

 

11.    Relation between grief and subsequent pregnancy status 13 months after perinatal bereavement. Barr P. J Perinat Med. 2006;34(3) The present longitudinal study sought to explore the relationship between parental grief following perinatal bereavement and subsequent pregnancy, according to the particular facets of grief and pregnancy state being considered.The study participants were 63 couples who had been bereaved by stillbirth (n=31) or neonatal death (n=32). The relationship of self-reported grief (Perinatal Grief Scale-33 Active Grief, Difficulty Coping and Despair) 1 month and 13 months after the loss to subsequent pregnancy status (Pregnant, n=20, Live Baby, n=10, Trying, n=11, Not Trying, n=22) at 13 months was investigated with repeated measures analysis of variance. There were statistically significant main effects for Active Grief and Difficulty Coping in women and men and Despair in women, but not in men. There was a statistically significant Active Grief by pregnancy status interaction in women (F(3, 59)=2.89, P=0.04), but not in men. Simple main effects analysis indicated a statistically significant decrease in Active Grief in women who were pregnant), women who were not pregnant and not trying to conceive and women who had had a live baby �There was no statistically significant decrease in Active Grief in women who were not pregnant but trying to conceive �The Difficulty Coping in women and men and Despair in women by pregnancy status interactions were not statistically significant. None of the between-subjects main effects for pregnancy status was statistically significant in women or men. Conclusion: The relation between grief and subsequent pregnancy differed with the sex of the parent and the particular facets of grief and pregnancy state being considered. Subsequent pregnancy was related to Active Grief in women, but not to Difficulty Coping or Despair that are known to be predictors of chronic grief.

 

12.    NICHD has developed a SIDS risk reduction brochure for grandparents. The brochure, described below, is available, in quantity free of charge at http://www.nichd.nih.gov.  The brochure PDF will be available on the GA SIDS Project website after 5/3/06.

 

13.    The SIDS/ID Project of the National Center for Cultural Competence is pleased to announce a new feature on our website. We know that dealing with interpretation and translation are challenges that we all face as the linguistic diversity of our country is growing. This feature is a list of frequently asked questions about the whats, whys and hows of providing language access for the individuals and families you serve. It contains useful links to an array of resources. While it was developed for our SIDS/ID Project, the information is applicable across health and mental health programs. NCCC hopes that this will be a useful support to the field. You can find this new feature at: http://gucchd.georgetown.edu/nccc/languageaccess.html

 

14.    Is Small for Gestational Age a Marker of Future Fetal Survival In Utero? Salihu HM, Sharma PP, Aliyu MH, Kristensen S, Grimes-Dennis J, Kirby RS, Smulian J.Obstet Gynecol. 2006 Apr; The study sought to assess whether small for gestational age is a risk factor for stillbirth of a subsequent sibling. The Missouri maternally linked cohort data set, containing data on births from 1978 through 1997, was used. We identified the study group (women who delivered a SGA infant in the first pregnancy) and a comparison group (women who delivered a non-SGA infant in their first pregnancy) and compared the outcome (stillbirth) in the second pregnancy between both groups. They analyzed information on the first and second pregnancies of 402,015 women (43,549 in the study arm and 358,466 in the comparison arm). Of the 1,883 cases of stillbirth in the second pregnancy, 314 cases occurred in mothers with a history of SGA (stillbirth rate 7.2/1,000) and 1,569 in the comparison group (stillbirth rate 4.4/1,000), The adjusted risk of stillbirth was 60% higher in women with a prior SGA The risk for stillbirth in the second pregnancy increased with decreasing gestational age at birth of the SGA infant in the first pregnancy Conclusion: Small for gestational age is a marker for subsequent stillbirth, and the risk rises with decreasing gestational age of the SGA birth. This information is potentially useful for counseling parents of SGA infants.

 

15.    Neural tube defects and maternal residential proximity to agricultural pesticide applications. Rull RP, Ritz B, Shaw GM.
Am J Epidemiol. 2006 Apr 15; Residential proximity to applications of agricultural pesticides may be an important source of exposure to agents that have been classified as developmental toxins. Data on two case-control study populations of infants with neural tube defects (NTDs) and nonmalformed controls delivered in California between 1987 and 1991 were pooled to investigate whether maternal residential proximity to applications of specific pesticides or physicochemical groups of pesticides during early gestation increases the risk of these malformations. Maternal residential proximity within 1,000 m of pesticide applications was ascertained by linking mothers' addresses with agricultural pesticide use reports and crop maps. Odds ratios were computed by using conventional single- and multiple-pesticide and hierarchical multiple-pesticide logistic regression. In single-pesticide models, several pesticides were associated with NTDs after adjustment for study population, maternal ethnicity, educational level, cigarette smoking, and vitamin use. In a hierarchical multiple-pesticide model, effect estimates for only benomyl and methomyl suggested a possible association. Elevated risks of NTDs and anencephaly or spina bifida subtypes were also associated with exposures to chemicals classified as amide, benzimidazole, methyl carbamate, or organophosphorus pesticides and with increasing numbers of pesticides. These results suggest that ambient exposure to certain categories of agricultural pesticides may increase the risk of NTDs.

 

 

 

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