Increase In Infant Deaths Research Articles

Fetal Reduction of Triplet Pregnancies to Twins vs Singletons: A Meta-analysis of Survival and Pregnancy Outcome

ABSTRACT Fetal reduction (FR) for higher-order multiples accounted for 103.6 per 100,00 births across the United States in 2015, and the need for this service has expanded over the last 30 years. Despite improvements in neonatal care, triplet pregnancies are more likely to experience adverse outcomes, including infant mortality and morbidity, than twin or singleton pregnancies. In triplet pregnancies, prematurity is associated with an 11-fold increase and low birth weight with a 2.2-fold increase in infant deaths compared with singleton and twin prematurity pregnancies. This contributes to higher all-cause healthcare expenses for triplet pregnancies (US $407,000) versus singleton pregnancies (US $21,500). Fetal reduction has been shown to improve outcomes, including a lower risk of premature birth, in triplet pregnancies reduced to twins compared with triplet pregnancies with no FR. Another study found improved outcomes when triplet pregnancies were reduced to singleton or twin pregnancies versus expectant management. However, it remains unclear whether FR in triplet pregnancies to singleton pregnancy (RTS) improved outcomes compared with a reduction to twin pregnancies (RTT). The aim of this study was to compare perinatal outcomes and survival rates of RTS pregnancies versus RTT pregnancies, and FR in any triplet pregnancies versus expectant management. This was a systematic review and meta-analysis based on a literature search for studies with data comparing selective RTT and RTS pregnancies. Excluded were studies with multiple pregnancies >3 fetuses, monochorionic triplets, and missing data. The primary outcome was the rate of fetal survival of RTT and RTS pregnancies, defined as a live birth >24 weeks of gestation. Secondary outcomes included gestational age (GA) at birth, birth weight, incidence of preterm birth, early pregnancy loss at <24 weeks, and neonatal death, up to 28 days after birth. A total of 10 studies directly comparing RTT pregnancies with RTS pregnancies and another 10 studies comparing FR with no FR were included in the analysis. The studies represented 1903 RTT pregnancies and 489 RTS pregnancies. There was a significantly lower survival rate among RTT pregnancies versus RTS pregnancies (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.40–0.92; 95% prediction interval [PI], 0.36–1.03; P = 0.02; I 2 = 0%). There was a comparable risk of early pregnancy loss (OR, 0.89; 95% CI, 0.58–1.38; 95% PI, 0.54–1.48; P = 0.61; I 2 = 0%) and neonatal death (OR, 0.56; 95% CI, 0.10–3.21; P = 0.55; I 2 = 28%). RTT pregnancies had significantly lower GA (mean difference, −2.20; 95% CI, −2.80 to −1.61; 95% PI, −4.27 to −0.14; P < 0.001; I 2 = 79%) and lower birth rates (OR, 8.76; 95% CI, 5.56–13.80; 95% PI, 4.60–16.67; P < 0.001; I 2 = 0%) than RTS pregnancies. RTT pregnancies also had a greater risk of preterm birth at <34 weeks (OR, 3.04; 95% CI, 1.45–6.36; 95% PI, 0.54–17.18; P = 0.003; I 2 = 22%) and at <32 weeks (OR, 2.14; 95% CI, 1.02–4.49; 95% PI, 0.64–7.13; P = 0.04; I 2 = 0%). No difference in live birth rate was observed between RTT pregnancies and expectant management. In conclusion, triplet pregnancies RTS pregnancies had better outcomes than RTT pregnancies, including higher fetal survival rate, higher GA at birth, lower risk of preterm birth, and higher birth weight. Understanding the potential risks and benefits of FR in triplet pregnancies is essential for obstetricians providing parental counseling.

Optimising the Timing of whooping cough Immunisation in MUMs: a randomised controlled trial investigating the timing of pertussis vaccination in pregnancy (OpTIMUM): a protocol paper

Background: Pertussis is a highly infectious respiratory illness caused by the bacteria Bordetella pertussis. A resurgence of pertussis, even in countries with good vaccine coverage, has led to an increase in infant deaths. In response to this, many countries have introduced pertussis vaccination in pregnancy. This strategy is effective at preventing infant disease, but there remains uncertainty about what gestational timing is best to ensure maximal protection of the infant. These uncertainties are the rationale for this randomised controlled trial and a sub-study investigating pertussis-specific antibody in breastmilk. Protocol: We will recruit 354 pregnant women and will randomise them to receive their pertussis vaccination in one of three gestational age windows: ≤23+6, 24-27+6 and 28-31+6 weeks of gestation. Vaccination will be with Boostrix-IPV® and participants will be asked to complete a symptom diary for seven days following vaccination. Blood sampling will be performed prior to vaccination, two weeks following vaccination and at the time of delivery. A cord blood sample will be collected at delivery and a blood sample collected from the infant 4-10 weeks after completion of the primary immunisations. Individuals participating in the breastmilk sub-study will provide a sample of colostrum within 48 hours of delivery and samples of breastmilk at two weeks and around five-six months. Blood samples will be analysed using enzyme linked immunosorbent assay (ELISA) techniques for pertussis toxin, filamentous haemagglutinin and pertactin. A subset of serum samples will also be analysed using a functional assay. Colostrum and breastmilk samples will be analysed using functional assays. Discussion: Although pertussis vaccination has been shown to be safe and effective in pregnancy there remains debate about the optimal timing for the administration during pregnancy. This study will investigate antibody responses in serum and breastmilk when vaccination is performed in three different time periods. Clinicaltrials.gov registration: NCT03908164 (09/04/2019)

Association between short-term exposure to air pollution and sudden infant death syndrome

The association between air pollution and infant mortality has been inconsistently reported. A few studies have estimated short-term effects of air pollution on infants’ health. This population-based case–control study aimed to examine the potential effects of air pollution on sudden infant death syndrome (SIDS) in the post-neonatal period in Taiwan during 1997–2002. Each case of infant death was matched with 20 randomly selected sex-matched controls who were born on the same day and were still alive. We obtained 24-h measurements of air pollutants and meteorological factors in each case and control with 1- to 14-day lags from 55 air-quality monitoring stations. After controlling for potential confounders, conditional logistic regression analysis was performed to estimate effects of air pollutants on SIDS (n = 398) and respiratory death (n = 121) among neonates. In single- and multi-pollutant models, we found that 100-ppb increment in carbon monoxide (Odds Ratio = 1.04–1.07) and 10-ppb increment in nitrogen dioxide (Odds Ratio = 1.20–1.35) with 1- to 14-day lags were associated with significant increase in SIDS, although a significant relationship between air pollution and respiratory death was not determined in 1- to 14-day lags. Short-term carbon monoxide and nitrogen dioxide exposure were associated with significant increase in SIDS in the post-neonatal period, with latency estimated within days before death.

Differential association of air pollution exposure with neonatal and postneonatal mortality in England and Wales: A cohort study.

BackgroundMany but not all studies suggest an association between air pollution exposure and infant mortality. We sought to investigate whether pollution exposure is differentially associated with all-cause neonatal or postneonatal mortality, or specific causes of infant mortality.Methods and findingsWe separately investigated the associations of exposure to particulate matter with aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), and sulphur dioxide (SO2) with all-cause infant, neonatal, and postneonatal mortality, and with specific causes of infant deaths in 7,984,366 live births between 2001 and 2012 in England and Wales. Overall, 51.3% of the live births were male, and there were 36,485 infant deaths (25,110 neonatal deaths and 11,375 postneonatal deaths). We adjusted for the following major confounders: deprivation, birthweight, maternal age, sex, and multiple birth. Adjusted odds ratios (95% CI; p-value) for infant deaths were significantly increased for NO2, PM10, and SO2 (1.066 [1.027, 1.107; p = 0.001], 1.044 [1.007, 1.082; p = 0.017], and 1.190 [1.146, 1.235; p < 0.001], respectively) when highest and lowest pollutant quintiles were compared; however, neonatal mortality was significantly associated with SO2 (1.207 [1.154, 1.262; p < 0.001]) but not significantly associated with NO2 and PM10 (1.044 [0.998, 1.092; p = 0.059] and 1.008 [0.966, 1.052; p = 0.702], respectively). Postneonatal mortality was significantly associated with all pollutants: NO2, 1.108 (1.038, 1.182; p < 0.001); PM10, 1.117 (1.050, 1.188; p < 0.001); and SO2, 1.147 (1.076, 1.224; p < 0.001). Whilst all were similarly associated with endocrine causes of infant deaths (NO2, 2.167 [1.539, 3.052; p < 0.001]; PM10, 1.433 [1.066, 1.926; p = 0.017]; and SO2, 1.558 [1.147, 2.116; p = 0.005]), they were differentially associated with other specific causes: NO2 and PM10 were associated with an increase in infant deaths from congenital malformations of the nervous (NO2, 1.525 [1.179, 1.974; p = 0.001]; PM10, 1.457 [1.150, 1.846; p = 0.002]) and gastrointestinal systems (NO2, 1.214 [1.006, 1.466; p = 0.043]; PM10, 1.312 [1.096, 1.571; p = 0.003]), and NO2 was also associated with deaths from malformations of the respiratory system (1.306 [1.019, 1.675; p = 0.035]). In contrast, SO2 was associated with an increase in infant deaths from perinatal causes (1.214 [1.156, 1.275; p < 0.001]) and from malformations of the circulatory system (1.172 [1.011, 1.358; p = 0.035]). A limitation of this study was that we were not able to study associations of air pollution exposure and infant mortality during the different trimesters of pregnancy. In addition, we were not able to control for all confounding factors such as maternal smoking.ConclusionsIn this study, we found that NO2, PM10, and SO2 were differentially associated with all-cause mortality and with specific causes of infant, neonatal, and postneonatal mortality.

Investigating the pertussis resurgence in England and Wales, and options for future control.

BackgroundIn 2012 England and Wales experienced a resurgence of pertussis and an increase in infant deaths. This occurred 8 years after acellular pertussis (aP) vaccine replaced whole cell (wP) primary vaccine despite continued high coverage for the primary series and pre-school aP booster. We developed a mathematical model to describe pertussis transmission dynamics in England and Wales since the 1950s and used it to investigate the cause of the resurgence and the potential impact of additional vaccination strategies.MethodsAn age-structured, compartmental, deterministic model of the pertussis transmission dynamics was fitted to 60 continuous years of age-stratified pertussis notification data in England and Wales. The model incorporated vaccine-induced and natural immunity and differentiated between vaccine-induced protection against clinical disease and infection.ResultsThe degree of protection of wP vaccine against infection was estimated to be higher than that of aP vaccine. Furthermore, the duration of protection for natural and wP-induced immunity was likely to be at least 15 years, but for aP vaccine it could be as low as 5 years. Model results indicated that the likely cause of the resurgence was the replacement of wP by less efficacious aP vaccine and that an elevated level of pertussis would continue. The collapse in wP vaccine coverage in the 1970s and resultant outbreaks in the late 1970s and early 1980s could not explain the resurgence. Addition of an adolescent or toddler booster was predicted to have little impact on the disease in infants.ConclusionsOur findings support the recent recommendation by the World Health Organisation that countries currently using wP vaccine for primary immunisation should not change to aP vaccine unless additional strategies to control infant disease such as maternal immunisation can be assured. Improved pertussis vaccines that provide better protection against infection are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0665-8) contains supplementary material, which is available to authorized users.

Oxytocin receptor antagonists for inhibiting preterm labour.

Oxytocin receptor antagonists for inhibiting preterm labour.

Infant mortality trends in the State of Rio Grande do Sul, Brazil, 1994-2004: a multilevel analysis of individual and community risk factors

The aim of this study was to analyze the trend in infant mortality rates in the State of Rio Grande do Sul, Brazil, from 1994 to 2004, in a longitudinal ecological study, by means of panel data analysis and multilevel linear regression (two levels: microregion and time) to estimate factors associated with infant mortality. The infant mortality rate decreased from 19.2‰ (1994) to 13.7‰ (2004) live births, and the principal causes of death in the last five years were perinatal conditions (54.1%). Approximately 47% of the variation in mortality occurred in the microregions, and a 10% increase in coverage by the Family Health Program was associated with a 1‰ reduction in infant mortality. A 10% increase in the poverty rate was associated with a 2.1‰ increase in infant deaths. Infant mortality was positively associated with the proportion of low birthweight newborns and the number of hospital beds per thousand inhabitants and negatively associated with the cesarean rate and number of hospitals per 100 thousand inhabitants. The findings suggest that individual and community variables display significant effects on the reduction of infant mortality rates.

Air pollution and sudden infant death syndrome.

Sudden infant death syndrome (SIDS) affects approximately 1 in 1000 live births and is the most common cause of infant death after the perinatal period. To determine the influence of air pollution on the incidence of SIDS. Time-series analyses were performed to compare the daily mortality rates for SIDS and the daily air pollution concentrations in each of 12 Canadian cities during the period of 1984-1999. Serial autocorrelation was controlled for by city, and then the city-specific estimates were pooled. Increased daily rates of SIDS were associated with increases, on the previous day, in the levels of sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide but not ozone or fine particles measured every sixth day. Effects persisted despite adjustments for season alone or the combination of daily mean temperature, relative humidity, and changes in barometric pressure for NO2 and SO2 but not carbon monoxide. Increases in both SO2 and NO2, equivalent to their interquartile ranges, were associated with a 17.72% increase in SIDS incidence. Ambient SO2 and NO2 may be important risk factors for SIDS.

Nonmalarial infant deaths and DDT use for malaria control.

Although dichlorodiphenyl trichloroethane (DDT) is being banned worldwide, countries in sub-Saharan Africa have sought exemptions for malaria control. Few studies show illness in children from the use of DDT, and the possibility of risks to them from DDT use has been minimized. However, plausible if inconclusive studies associate DDT with more preterm births and shorter duration of lactation, which raise the possibility that DDT does indeed have such toxicity. Assuming that these associations are causal, we estimated the increase in infant deaths that might result from DDT spraying. The estimated increases are of the same order of magnitude as the decreases from effective malaria control. Unintended consequences of DDT use need to be part of the discussion of modern vector control policy.

Responses to Deforestation in a Group of Mantled Howlers (Alouatta palliata) in Costa Rica

To evaluate the effects of partial deforestation of the home range of a group of free-ranging howlers on Hacienda La Pacifica, Costa Rica, we compared activity patterns, social interactions, daily travel lengths, group sizes and migration patterns before, during, and after habitat destruction. Immediate responses were a decrease in social interactions and increase in start to travel. Long-term responses included an increase in feeding time and longer daily path length. The long-term responses were associated with the adjustment to a new home range which was longer and narrower, with the patchiest resources at the furthest end points. Group size decreased due to a significant decrease in adult males and females and a significant increase in infant deaths between the predeforestation period and the deforestation/postdeforestation periods. Significant increase in adult female deaths/emigration continues, though emigration of immatures remains unchanged. Reduced group size could be due to reduced resources or disturbed migration routes throughout the farm due to the construction of a major canal system.

Why is sudden infant death syndrome more common at weekends?

OBJECTIVESTo determine whether the prevalence of known risk factors and the magnitude of their association with sudden infant death syndrome (SIDS) differed between weekends and weekdays.METHODA large nationwide case-control study,...

Sudden Infant Death Syndrome: a possible primary cause

The hypothesis that poisoning by phosphines, arsines and stibines might be the primary cause of sudden infant death syndrome (SIDS) was investigated. Most mattress materials contain phosphorus or antimony compounds as fire retardant additives. Mattress materials in areas affected by the warmth and perspiration of the sleeping infant were found to be naturally infected by the fungus Scopulariopsis brevicaulis which is thought to be capable of generating phosphines, arsines and stibines from materials containing phosphorus, arsenic or antimony compounds. These gases may cause anticholinesterase poisoning and cardiac failure in infants, but contributory factors include the prone sleeping position and overwrapping. In England and Wales, the progressive increase in SIDS between 1951 and 1988 seems to be related to increasing use of phosphorus and antimony compounds as fire retardents in cot mattresses.

Sudden Infant Death Syndrome: Will Establishing Risk Factors Spuriously Reduce Incidence?

<h3>To the Editor.</h3> —Guntheroth and Spiers¹have reviewed recent studies of sleep position and sudden infant death syndrome (SIDS) in the Netherlands, Great Britain, Australia, and New Zealand, which, following publicity about avoidance of the prone sleep position, report a reduction of SIDS by 20% to 67% without a simultaneous increase in infant deaths due to other causes. Although these reports are encouraging, we are concerned about (1) the effect that such reports may have on the practice of diagnosing and certifying SIDS as the cause of death, and (2) the effects that changes in these practices may have on mortality statistics. As public and professional knowledge of these reports on the possible protective effect of the supine or other nonprone sleeping positions becomes more widespread, medical examiners, coroners, and other certifiers of infant deaths may use sleep position as a diagnostic criterion and certify SIDS as a cause

Seasonal relationship of sudden infant death syndrome and environmental pollutants.

Evidence that chronic hypoxia precedes death from sudden infant death syndrome (SIDS) is mounting. Prolonged exposure to moderate levels of pollutants could be a contributing factor to hypoxia. Levels of carbon monoxide (CO), sulphur dioxide (SO2), nitrogen dioxide (NO2) and hydrocarbons (HC) are highest in the winter when incidence of SIDS is increased. SIDS cases in Los Angeles County were correlated with daily mean levels of these pollutants, temperature, barometric pressure and monthly lead levels with the aid of time series analyses. Peaks in CO, SO2, NO2, HC and lead preceded the seasonal increase in SIDS by seven weeks. Theoretical considerations, such as the hypoxia-inducing effects of CO, support the hypothesis that this temporal relation has functional significance. Three additional findings provided evidence for this hypothesis: 1) SIDS infants born during months of low pollution lived longer than those born during months of high pollution. 2) SIDS infants born in a district with low pollution lived longer than those born in a district with high pollution. 3) The bimonthly rate of SIDS was directly proportional to the level of CO pollution to which the infants had been exposed between conception and two months of age. The role of pollution levels as a predisposing factor in risk for SIDS cannot be summarily dismissed.