Birth interval and family effects on postneonatal mortality in Brazil.

In this paper random-effects logistic models are used to analyze the effects of the preceding birth interval on postneonatal mortality in Brazil, controlling for the correlation of survival outcomes between siblings. The results are compared to those obtained by using ordinary logistic regression. Family effects are found to be highly significant in the random-effects model, but the substantive conclusions of the ordinary logistic model are preserved. In particular, birth interval effects remain highly significant.

Dextromethorphan and high-dose benzoate therapy for nonketotic hyperglycinemia in an infant.

To test the hypothesis that nonketotic hyperglycinemia causes overstimulation of the excitatory N-methyl-D-aspartate receptor by allosteric glycine activation, and that reduction of glycine and blocking of the cation channel coupled to the receptor would be beneficial, we administered benzoate and dextromethorphan, a blocker of the N-methyl-D-aspartate channel to an infant with nonketotic hyperglycinemia. Therapy with benzoate, 500 mg/kg per day, was started on day 5, and the dosage was increased to 750 mg/kg per day on day 8, with prompt normalization of the neurologic and electroencephalographic findings. The glycine concentrations in both plasma and cerebrospinal fluid were substantially reduced. Dextromethorphan was added to the regimen on day 12. The electroencephalogram remained normal until the infant was 8 months of age, when diffuse slowing became apparent. Serial brain magnetic resonance imaging showed delayed myelination. At 12 months of age, physical examination findings and growth were normal except for hypotonia. The developmental quotient was approximately 60, and the child was free of seizures. This outcome, although not ideal, is better than that typical for nonketotic hyperglycinemia. Our results suggest that trials with additional patients and other N-methyl-D-aspartate cation channel blockers are warranted.

Birth spacing and infant mortality in Brazil.

The effects of birth spacing on neonatal and post-neonatal mortality in Brazil were found to be very consistent with models based on data from other South American countries. The model for neonatal mortality simplified to three significant variables, whereas the model for post-neonatal mortality included four significant interactions.

PIP: Researchers used 1986 data from the Brazil Demographic and Health Survey to determine the effects of birth spacing on neonatal and post neonatal mortality then compared the results with other countries (World Fertility Survey). 1st births had a higher relative risk (RR) of neonatal death (1.49) than births of order 203 Brazil. A similar pattern existed for Peru, Ecuador, Costa Rica, Colombia, and Guyana. In Brazil, 4-6 birth order had the lowest risk (.62). High order births (7+) for all the countries had an RR almost the same as the baseline 2-3 birth order class. Birth order was significant (p.01). Post neonatal mortality for 1st births in Brazil was more favorable than other countries, but the RR for high order births was less favorable. The RR of neonatal mortality declined with mother's education for Brazil (p.05) as well as it did for Peru, Ecuador, Colombia, and Costa Rica. It did not fall in Guyana, however, where it was elevated (1.19) for mothers with 4-6 years of schooling. The positive effect of maternal education was even stronger for post neonatal mortality in Brazil (.62 for 4.6 years and .27 for 7+ years). The effect was basically the same for all the countries, but mothers with 4-6 years of education in Guyana (1.03) had slightly higher post neonatal mortality. The RR of neonatal mortality for the index child if there were 1 surviving sibling born 0-2 years earlier was only slightly increased (1.25) in Brazil, but if there were 1 dead sibling born 0-2 years earlier, RR stood at 2.4 and was significant. This RR rose further if 2 or more children were born in this interval (3.71). For infants in Brazil who had 2+ siblings born 2-4 years earlier, the RR of neonatal mortality was elevated (1.83). Indeed Brazil had higher neonatal mortality for these children than did the other countries. Birth spacing was highly significant (p.001).