BACKGROUND: In February, 1999, a local US health department identified a cluster of pertussis cases among neonates born at a community hospital and recommended oral erythromycin for post-exposure prophylaxis for about 200 neonates born at that hospital between Feb 1 and Feb 24, 1999. We investigated a cluster of seven cases of infantile hypertrophic pyloric stenosis (IHPS) that occurred the following month among the neonates who had received erythromycin. METHODS: We obtained a masked, independent review of the IHPS ultrasonography diagnoses, calculated the monthly IHPS incidence, and compared index and historical (1998-99) IHPS cases with respect to several characteristics including erythromycin exposure. We used a retrospective cohort of infants born in January and February, 1999, to investigate further erythromycin exposure and development of IHPS. FINDINGS: An independent review confirmed the ultrasonographic diagnoses of all seven index IHPS cases. All index cases versus none of the historical IHPS cases had been given erythromycin for pertussis prophylaxis. The IHPS rate for infants born in the hospital in February, 1999, was 32.3 per 1000 liveborn infants, representing nearly a seven-fold increase over 1997-98 (relative risk 6.8 [95% CI 3.0-15.7]). Among infants born in January and February, 1999, erythromycin was associated with IHPS (absolute risk 4.5%, relative risk infinity [1.7-infinity]). INTERPRETATION: Neonates receiving oral erythromycin may have an increased risk of IHPS. The risks and benefits of erythromycin for neonatal pertussis prophylaxis should be re-evaluated, and caution should be used in defining risk groups for prophylaxis.

Administration, Oral↗

PubMedDate not supplied

Airport noise and teratogenesis.

It has been suggested that exposures to high-noise levels near major airports may cause increased incidence of birth defects in the offspring of parents residing near these airports. Using data gathered in Metropolitan Atlanta during 1970 to 1972, we compared the rates of seventeen categories of defects in high- and low-noise census tracts. No significant differences were observed. However, when we subdivided the category of central nervous system defects into several subcategories of specific defects, we noted a significantly increased incidence of spina bifida without hydrocephalus in the high-noise areas. Because the small number of cases associated with this finding we did a matched case-control study using all cases of central nervous system defects born during the years 1968 to 1976. No significantly increased risk for residents in the high-noise areas was noted in this study. It is our opinion that noise or other factors associated with residence near airports are unlikely to be important environmental teratogens.

Aircraft↗

PubMedDate not supplied

Possible teratogenic effects of intrauterine exposure to chlorpyrifos (Dursban)

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Chlorpyrifos↗

PubMedDate not supplied

Maternal factors in dizygotic twinning: evidence from interracial crosses.

In the USA, Blacks have been shown to have a higher incidence of DZ twinning than Whites. We studied maternal and paternal race determinants of the rates of like-sex and unlike-sex twinning using US live-birth certificate data for 1973-78. After adjustment was made for father's race, Black mothers had a higher rate of unlike-sex twinning than White mothers (odds ratio, OR = 1.74, P less than 10(-8]. This maternal race effect persisted after further adjustments were made for maternal age, parity, education, and marital status and did not apply to the rates of like-sex twinning (OR = 1.06). On the other hand, after adjustment was made for mother's race, Black fathers did not have higher rates of unlike-sex (OR = 0.93) or like-sex (OR = 1.11) twinning than White fathers. The study shows that the high rate of DZ twinning in Blacks is associated with maternal race and not paternal race. The data further support the importance of maternal determinants of dizygotic twinning in humans.

Black People↗

PubMedDate not supplied

Risk factors for trisomy 21: maternal cigarette smoking and oral contraceptive use in a population-based case-control study.

PURPOSE: We examined maternal smoking and oral contraceptive use as possible risk factors in the genesis of cases of trisomy 21 of maternal origin. This is the first epidemiological study to categorize cases of trisomy 21 by parent of origin and timing of the meiotic error before assessing possible risk factors. METHODS: We used chromosome 21-specific DNA markers to assign origin to each case. Structured interviews were employed to determine maternal smoking and oral contraceptive use around conception. RESULTS: The odds ratio (OR) for maternal smoking was significantly increased among younger mothers (OR = 2.98; 95% CI = 1.01-8.87), but only in a particular subset of meiotically-derived cases. The combined use of cigarettes and oral contraceptives increased the risk further (OR = 7.62; 95% CI = 1.63-35.6); however, oral contraceptive use alone was not a significant risk factor. CONCLUSION: Our results indicate that categorizing cases of trisomy 21 by parent and timing of the meiotic error allows more precision in identifying risk factors and may shed light on mechanisms of meiotic nondisjunction.

Adult↗

PubMedDate not supplied

Statistical tests for the OHI-S and PI: a commentary.

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Female↗