Comparison of growth of black and white infants during their first two years of life

Growth data were analyzed on 406 infants (211 black, 195 white) during their first two years of life. Only term children weighing more than 2500 g were included in the study. Prenatal and postnatal care were provided at the same university affiliated health maintenance organization. Mean birth weight of black female newborns was 150 g less than white female newborns with a statistical significance of P = .028. Mean birth weight of black male newborns was 40 g less than white male newborns. The difference was not statistically significant. Black male infants were significantly heavier at 12, 18, and 24 months and significantly taller at 24 months than their white counterparts.     

Increased hospitalizations for asthma among children in the Washington, D.C. area during 1961-1981

Hospital admissions for childhood asthma to three university affiliated hospitals in the Washington D.C. area (Children's Hospital National Medical Center, CHNMC, Prince George's General Hospital, PGGH, and Holy Cross Hospital, HCH) for the period 1961-1981 increased at least three to 18 fold. The over-all population of children less than or equal to 14 years of age increased, at most, only 1.5 fold by 1970, and thereafter decreased gradually until the end of the study. This increase in pediatric asthma hospitalizations has occurred despite significant improvements in the ambulatory management of the asthmatic child. In particular, the amount of specific anti-asthmatic medication prescribed for these patients has grown markedly. The increased hospitalization is most likely due to an increase in the occurrence of severe asthma in children, particularly black children.     

Campylobacter jejuni antibodies in Nigerian children.

Titers of complement-fixing (CF) antibody to Campylobacter jejuni were demonstrated in 87 (36.7%) of 237 infants 6 to 15 months old in Jos, Nigeria. Of the total number of children examined, 81 had acute diarrhea and 27 of them (33.3%) were found to have CF antibodies in their serum. The remaining 156 children were asymptomatic, and 60 (38.4%) of them had CF antibodies. In the diarrheal group, 27 of 75 children 6 to 8 months old were CF antibody positive. There was no significant difference in the incidence of CF C. jejuni antibodies in the diarrheal and nondiarrheal infants (P greater than 0.05). Also, infants 9 to 15 months old had a higher incidence of CF antibodies (46.5%) than those 6 to 8 months of age (25%). The data suggest that the infants whose sera were CF antibody positive had had an exposure to C. jejuni. All 33 infants 6 to 8 months of age who had no diarrhea were CF antibody negative.     

Cystic fibrosis in blacks in Washington, DC: fifteen years' experience

Controversies exist regarding the clinical presentation and characteristics of cystic fibrosis (CF) in American blacks. Between 1971 and 1986, 188 patients with CF (165 whites, 20 blacks, and 3 others) seen at Children's Hospital National Medical Center, Washington, DC, were evaluated for age at diagnosis, duration of symptoms prior to diagnosis, clinical presentations, initial sputum culture results, and weight and height at diagnosis. Comparisons between black and white patients revealed no statistically significant differences in average age at diagnosis, average duration of symptoms prior to diagnosis, average sweat electrolyte concentrations, or sputum culture results. A breakdown of presenting symptoms by race showed some points of disparity. About twice as many black patients as white patients (40% v 22%) presented with only pulmonary symptoms, whereas slightly more whites presented with only gastrointestinal symptoms (46% v 35%). Those patients presenting with a combination of symptomatology were equally distributed by race (25% black, 21% white). At diagnosis, age-adjusted weight percentiles were significantly lower for black patients than for white patients (chi 2 = 9.60, P less than or equal to 0.05). Although the authors agree that CF is relatively rare among blacks, a high index of suspicion is essential for early diagnosis.     

Ethnic variation in the size of infant at birth

The impact of ethnicity and other maternal factors (BMI, parity, glucose tolerance, gestational age) on the size of the infant at birth was investigated in a relatively low socioeconomic status, multi-ethnic population at San Francisco General Hospital. A sample of 2,069 infants born to mothers of black, non-Hispanic white, Hispanic, and Chinese descent and whose mothers had received prenatal care at San Francisco General Hospital were studied. Maternal size, pregnancy history, and blood glucose were determined prenatally at 26–28 weeks gestation. Anthropometry was performed on the infant within 72 hours of birth. Black and Chinese infants were the lightest in weight, while Hispanic infants were the heaviest. When correction was made for maternal factors black infants were shown to be significantly (P < .05) lighter in birth weight than non-Hispanic white, Chinese, or Hispanic infants. Black infants were also significantly shorter in birth length and smaller in chest circumference. Chinese infants had significantly (P < .05) greater adiposity, as indicated by the sum of skinfold measurements, than both black and Hispanic infants. These findings are relevant to current practices in neonatal growth categories which are determined solely by birth weight and do not account for variations in body composition. Comparisons with a relatively higher socioeconomic status sample from Kaiser-Permanente Hospital (Oakland) shows a similar prevalence of low birth weight among blacks. These results support other results that ethnicity is a major independent influence on the weight of the newborn.     

Serotypes of Streptococcus pneumoniae causing invasive childhood infections in Bangladesh, 1992 to 1995.

One hundred sixty-five invasive Streptococcus pneumoniae strains were isolated from children under five at Dhaka Shishu (Children's) Hospital during the period 1992 to 1995. Ninety-four strains were from cerebrospinal fluid, and 71 were from blood. More than 91% of the strains were isolated from patients aged 24 months or less. Predominant serotypes were, in descending order 7F, 12F, 14, 15B, 18, 5, and 22A. These comprised 70% of all isolates. The marked differences in serotype distribution in different countries indicate the need for a sentinel surveillance study for the countries of South Asia, particularly Bangladesh, China, India, and Pakistan.     

Books received

A comparative study of clinical, hematologic, and cytogenetic findings was made in 40 black and 35 white children with Fanconi anemia. The black children were Bantu-speaking Negroid stock of diverse tribal origin. The white children were predominantly Afrikaans stock of Dutch/German/French Huguenot origin. All of the patients had IFAR scores of 2 to 4+ and over 80% in each group had increased spontaneous and/or mutagen-induced chromosomal breakage (CB-positive). There were no significant clinical differences between black and white patients or between CB-pos and CB-neg patients, with the exception of white children in whom significantly more CB-pos patients had thumb and radial anomalies than the CB-neg patients. The age-at-onset of hematologic manifestations was the same for all groups, but more black than white CB-pos patients were severely anemic at the time of diagnosis. Response to androgen and steroid therapy occurred in only 33% of black children compared with 86–90% of white children; 81% of black patients died during the 18 year study period compared with 30% of white children, but the age at death was similar. More sophisticated studies are required to determine whether these differences are genetically determined or related to cultural, educational, and socio-economic differences between the two ethnic groups. © 1994 Wiley-Liss, Inc.     

A prospective study of cow milk allergy in Danish infants during the first 3 years of life

A cohort of 1749 newborns from the municipality of Odense born during 1985 at the University Hospital were followed prospectively for the development of IgE-mediated and non-IgE-mediated cow milk allergy (CMA) during their first year. The diagnosis of CMA was based on the results of strict elimination/milk challenge procedures in a hospital setting, and continued clinical sensitivity to cow milk (CM) was assessed by rechallenging every 6-12 months until the age of 3 years. Further, in infants with CMA, the clinical course of adverse reactions to other foods and the development of allergy to inhalant allergens by 3 years were investigated. Of 117 (6.7%) with symptoms suggestive of CMA, the diagnosis of CMA was proven in 39 infants (2.2%). 64% showed cutaneous symptoms, 59% gastrointestinal symptoms, and 33% had respiratory symptoms. 92% had two or more symptoms and 72% symptoms from greater than or equal to 2 organ systems. Based on a positive skin prick test (greater than or equal to 2+) and/or AL-RAST class greater than or equal to 2 to CM 16 infants at the time of diagnosis, and at reinvestigation at 1 year, a further five infants giving a total of 21, were classified as having IgE-mediated CMA, 19 infants showed "immediate reactions" to CM (within 1 h after intake of 2.3 g milk protein) and 20 infants were "late reactors". No significant correlation between IgE-mediated CMA and "immediate reactions" to CM was demonstrated. The overall prognosis of CMA was good with a total recovery of 22/39 (56%) at 1 year, 30/39 (77%) at 2 years, and 34/39 (87%) at 3 years. Adverse reactions to other foods, particularly egg, citrus, tomato, developed in a total of 21/39 (54%) with the maximum point prevalence of 15/39 (38%) at 18 months, and 9/39 (23%) were still intolerant to other foods at 36 months. Inhalant allergy before 3 years developed in 11/39 (28%), particularly against dog and cat to which the infants had been exposed. Infants with CMA and early IgE sensitization to CM had an increased risk of persisting CMA (24%), development of persistent adverse reactions to other foods (38%), particularly egg white (29%), and finally, inhalant allergy (48%) before 3 years of age.     

Characteristics of Chlamydia trachomatis infection in hospitalized infants with lower respiratory tract infection.

BACKGROUND AND PURPOSE: To study the epidemiology, presentation and laboratory findings of Chlamydia trachomatis pneumonia in hospitalized infants younger than 6 months. METHODS: Between January 2001 and December 2005, infants younger than 6 months admitted to the children's medical center of Taipei Veterans General Hospital with the diagnosis of acute bronchiolitis, bronchopneumonia or pneumonia were prospectively studied. Chest radiograph findings were reviewed in all patients. Basic laboratory examinations performed included white blood cell count and eosinophil count. C. trachomatis was detected via enzyme-linked immunosorbent assay antigen test and the titers of immunoglobulin G and immunoglobulin M by indirect immunoperoxidase assay. RESULTS: A total of 60 infants, 32 males and 28 females, were included. C. trachomatis infection was detected in 30% of patients (18/60). The median age was 2.5 months (range, birth to 6 months). Fever was not detected in 72% of patients (13/18). Only 22% (4/18) of these patients had the characteristic staccato cough. The mean duration of symptoms before admission was 8 days (range, 1 day to 2 months). Rhinorrhea was a prodromal symptom in 67% (12/18) of patients, with a mean pre-onset duration of 7 days (range, 1 to 14 days). Eighty three percent (15/18) of the patients had tachypnea, with a mean duration of 3.2 days (range, 1 to 7 days). Conjunctivitis was noted before admission in 6 patients (33%). Only peripheral eosinophils showed statistically significant difference between Chlamydia-positive and -negative disease (p=0.046), and may be clinically useful in cases of suspected C. trachomatis infection. Mixed infection with other pathogens including adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, cytomegalovirus and Streptococcus pneumoniae was found in 27% (5/18) of patients. CONCLUSIONS: C. trachomatis is not infrequent and plays an important role in infants younger than 6 months old hospitalized due to lower respiratory tract infection.     

Mortality among infants of black as compared with white college-educated parents.

BACKGROUND. In the United States, black infants are twice as likely to die as white infants; this difference reflects both black infants' higher rates of low birth weight and the higher mortality among black infants of normal birth weight. We studied mortality in infants born to college-educated parents in order to investigate this gap while controlling for sociodemographic variables. METHODS. We used the National Linked Birth and Infant Death Files for 1983 through 1985 to calculate infant mortality rates for children born to college-educated parents. The study population consisted of 865, 128 white infants and 42,230 black infants. A separate effect of birth weight was assessed by examining mortality rates before and after the exclusion of infants weighing less than 2500 g at birth (low-birth-weight infants). RESULTS. In this population, the infant mortality rate was 10.2 per 1000 live births for black infants and 5.4 per 1000 live births for white infants; the adjusted odds ratio for death among black infants was 1.82 (95 percent confidence interval, 1.64 to 2.01). The rate of low birth weight was more than twice as high among blacks (7 percent) as among whites (3 percent), although the mortality rate in this group was not higher among blacks than among whites. Black infants were three times as likely as white infants to die of causes attributable to perinatal events, including prematurity. They were no more likely to die of the sudden infant death syndrome. After the exclusion of low-birth-weight infants, the mortality rates for black and white infants were equal. CONCLUSIONS. In contrast to black infants in the general population, black infants born to college-educated parents have higher mortality rates than similar white infants only because of their higher rates of low birth weight. Black and white infants of normal birth weight have equivalent mortality rates.     

Range of normal neutrophil counts in healthy zimbabwean infants: implications for monitoring antiretroviral drug toxicity

Mother-to-child HIV prevention trials in sub-Saharan Africa use the US National Institutes of Health Division of AIDS (DAIDS) grading scale to monitor hematologic toxicity. A recent study of nevirapine prophylaxis given for 6 months in breast-feeding Zimbabwean infants reported several cases of relative neutropenia in clinically well infants, raising concerns of drug toxicity. However, the DAIDS tables are based on normal blood counts for white infants, although there is evidence that black African infants may have lower absolute neutrophil counts (ANCs) than white infants. To establish normal hematologic values in black Zimbabwean infants and to quantify the apparent prevalence of relative neutropenia in this population, we evaluated HIV-uninfected healthy infants born to HIV-uninfected women at birth, 10 days, 6 weeks, 3, and 4 months of life. A physical examination and blood count were performed at each visit, and an HIV test was performed at the final visit. The ANC values were graded using the DAIDS table. A total of 145 healthy term infants satisfied the inclusion criteria. The mean ANC values for Zimbabwean infants were less than half of the corresponding standard values at all 5 time points (P < 0.0001). Using the DAIDS table in use at the time that the blood was collected, 57% of these healthy infants had relative neutropenia of any grade at birth, followed by 29% at day 10, 53% at 6 weeks, 32% at 3 months, and 37% at 4 months of life. Our data indicate that relative neutropenia exists in healthy black Zimbabwean infants. The guidelines for identifying toxicity were changed in December 2004. However, even by the new DAIDS tables, 43%, 23%, 24%, 42%, and 43% of these healthy babies had relative neutropenia at the time of the 5 visits. Future HIV prevention and treatment trials in sub-Saharan Africa should use normal hematologic values derived from African infants to avoid the overestimation of antiretroviral drug toxicity.     

The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan

Black infants are born with low birth weights (less than 2500 g) and very low birth weights (less than 1500 g) at twice the rate of white infants. We investigated the effect of prenatal care delivered in a health maintenance organization on the birth weights of black and white infants at normal risk for low birth weight. Using birth certificates for all children born in 1978 in the California Kaiser-Permanente hospitals, we studied data on more than 31,000 black and white newborns whose mothers' ages and levels of education were comparable. The data show that black mothers used prenatal care less extensively and had a higher incidence of infants with low birth weights (8.4 vs. 3.6 percent) and very low birth weights (2.0 vs. 0.7 percent) than white mothers. The difference in the use of prenatal care, however, accounted for less than 15 percent of the difference in the incidence of low birth weight. The rates of low birth weight, very low birth weight, and preterm birth (less than 260 days' gestation) decreased with increasing levels of prenatal care for both blacks and whites. However, increasing levels of care were associated with a greater reduction among black infants than among white infants in low birth weight, very low birth weight, and low birth weight at term (greater than or equal to 260 days' gestation). When we compared mothers who received adequate care with those who received inadequate care, the relative risk of giving birth to a very-low-birth-weight infant was reduced 3.6-fold (95 percent confidence interval, 2.0 to 6.6) for black mothers and 2.1-fold (confidence interval, 1.3 to 3.4) for white mothers; the relative risk of giving birth to a low-birth-weight infant at term was reduced 3.4-fold (95 percent confidence interval, 2.2 to 5.4) for black mothers and 1.6-fold (confidence interval, 1.1 to 2.3) for white mothers. We conclude that even in a population of women at low risk for giving birth to low-birth-weight infants, prenatal care is more beneficial for blacks than for whites.     

Variance in rotavirus infection rates in different urban population groups in South Africa

Rotavirus infection in black infants contrasts markedly with that of white infants in being much less common and showing no seasonal variation. In this multicentre study in Johannesburg, the aetiology of winter infantile gastroenteritis in black, coloured, and white infants was investigated. Stools were examined by electron microscopy and also by enzyme-immunoassay to detect subparticular antigen which may be missed by electron microscopy in patients presenting late in the course of the illness. Stools were also examined bacteriologically by conventional techniques. Rotavirus was the most common pathogen in all three population groups with bacteria playing a relatively minor role. Striking differences were observed in the rotavirus rates between the three groups. Infection in the whites was five times more common than in the blacks (60% versus 12%) with the coloureds intermediate at 40%. The hypothesis was put forward that the relative protection of the black population may be due to a greater degree of colonization of neonates, thus inducing protection against symptomatic infection at the target age of 6 to 24 months. This may well have important implications in immunoprophylaxis. The reason for the lack of seasonal variation in the black population is still unclear.     

Recurrent wheezing in relation to environmental risk factors in infancy

Clinical course and environmental factors were recorded in a prospective study of 276 unselected infants followed from birth to the age of 18 months. The study was performed with a questionnaire at the age of 6 and 12 months and a physical examination at 18 months. Fifty-nine (21%) of the children had greater than or equal to 2 episodes of wheezing before they were 18 months old. A total of 58 (21%) of the children belonged to the lowest social class V, 182 (66%) were daily exposed to passive tobacco smoking at home and/or in daycare, 164 (59%) were breastfed greater than or equal to 3 months, 192 (70%) were in daycare, 62 (22%) lived in flats and 167 (61%) were in daily contact with furred pets at home and/or in daycare. In social class V a preponderance of children were exposed to passive tobacco smoking, a majority were living in flats and a minority were breastfed greater than or equal to 3 months. Linear logistic regression analysis was used for the purpose of assessing the causal effect of environmental risk factors on the risk of recurrent episodes of wheezing before the age of 18 months. The study demonstrated that male sex and daily exposure to passive tobacco smoking were significant risk factors with estimated odds ratios 1.9 and 2.4, respectively. Maternal tobacco smoking seemed to be associated with the highest risk. There was a tendency--though not significant--indicating that breastfeeding greater than or equal to 3 months had a protective effect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rotavirus isolate WI61 representing a presumptive new human serotype.

A virus (strain WI61) representing a presumptive new human serotype was isolated from an 18-month-old child with gastroenteritis admitted to Children's Hospital of Philadelphia in February 1983. The WI61 virus was clearly distinguished by cross-neutralization tests from human rotaviruses of serotypes 1, 2, 3, and 4, human 69M, and representative bovine (NCDV), porcine (OSU), and chicken (Ch2) rotaviruses. Antisera generated in guinea pigs hyperimmunized to WI61 virus displayed a partial cross-reactivity with rotaviruses of human serotypes 1, 2, 3, and 4. By means of studies with reassortant rotaviruses, it was presumptively determined that the WI61 virus cross-reactive antigenic determinants are localized on the vp3 surface polypeptide coded by gene segment 4. The characteristic RNA genome electropherotype of WI61 virus was observed in 5 of 59 cases of infant gastroenteritis detected in 1983 and 1984 but has not been observed in a subsequently at Children's Hospital. Serotype WI61-specific neutralizing antibodies were observed in a majority of sera of normal adults and infants of less than 4 or greater than 12 months of age collected in the Philadelphia area. Median antibody titers to WI61 equaled or exceeded those to rotaviruses of serotype 1 or 3. Each of seven samples of commercial cow's milk exhibited neutralizing antibodies to WI61 virus at a titer greater than or equal to that to serotype 1 or 3 or bovine (strain NCDV) rotavirus. However, WI61 rotavirus did not induce disease or a specific serum-neutralizing antibody response when fed to a caesarean-derived colostrum-deprived newborn calf. WI61 rotavirus caused diarrhea in newborn mice with a 50% diarrhea-inducing dose of 10(7.0) PFU.     

生酮饮食治疗儿童难治性癫痫的临床研究

目的 对生酮饮食治疗小儿难治性癫癎的疗效及安全性研究。方法 选取自2012年8月~2017年3月天津市儿童医院神经内科74例难治性癫痫患儿,使用生酮饮食方案进行治疗。随访治疗3个月时临床发作频率及不良反应。结果 65例(88.00%)坚持治疗3个月,其中30例(46.20%)癫痫发作减少>50.00%,11例（16.90%）发作完全缓解。治疗期间的不良反应包括低血糖、腹泻、拒食、高血脂、肾结石等,可自行或经对症治疗后缓解。结论 生酮饮食方案治疗小儿难治性癫痫有效且较安全。     

Emergence of racial/ethnic and socioeconomic differences in objectively measured sleep–wake patterns in early infancy: results of the Rise & SHINE study

Study ObjectivesTo characterize objectively assessed sleep–wake patterns in infants at approximately 1 month and 6 months and examine the differences among infants with different racial/ethnic backgrounds and household socioeconomic status (SES).MethodsFull-term healthy singletons wore an ankle-placed actigraph at approximately 1 month and 6 months and parents completed sleep diaries. Associations of racial/ethnic and socioeconomic indices with sleep outcomes were examined using multivariable analyses. Covariates included sex, birth weight for gestational age z-score, age at assessment, maternal education, household income, bed-sharing, and breastfeeding.ResultsThe sample included 306 infants, of whom 51% were female, 42.5% non-Hispanic white, 32.7% Hispanic, 17.3% Asian, and 7.5% black. Between 1 month and 6 months, night sleep duration increased by 65.7 minutes (95% CI: 55.4, 76.0), night awakenings decreased by 2.2 episodes (2.0, 2.4), and daytime sleep duration decreased by 73.3 minutes (66.4, 80.2). Compared to change in night sleep duration over this development period for white infants (82.3 minutes [66.5, 98.0]), night sleep increased less for Hispanic (48.9 minutes [30.8, 66.9]) and black infants (31.6 minutes [−5.9, 69.1]). Night sleep duration also increased less for infants with lower maternal education and household income. Asian infants had more frequent night awakenings. Adjustment for maternal education and household income attenuated all observed day and night sleep duration differences other than in Asians, where persistently reduced nighttime sleep at 6 months was observed.ConclusionsRacial/ethnic differences in sleep emerge in early infancy. Night and 24-hour sleep durations increase less in Hispanic and black infants compared to white infants, with differences largely explained by SES.     

Epidemiologic and clinical features of HIV-infected and HIV-uninfected Ugandan children younger than 18 months

METHODS: Groups of HIV-infected and HIV-uninfected infants younger than 18 months (mainly younger than 6 months) were compared to identify clinical features that could differentiate the two groups. The HIV-infected group also was compared with HIV-infected children older than 18 months. Recruitment was as follows for the group younger than 18 months: 708 children admitted with sepsis and clinical features suggestive of HIV infection were screened for HIV1 and HIV2 by HIV enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR) was undertaken on all ELISA-seropositive blood samples (270). HIV infection was confirmed in 136 (19.2%), 438 (61.9%) were HIV-seronegative, 27 (3.8%) were HIV seroreverters, 36 (5.1%) were HIV-seropositive but PCR negative (uninfected), and 71 (10.0%) were indeterminate. One hundred thirty-six HIV-infected children were compared with 501 uninfected children. Confirmed HIV-infected children older than 18 months attending the pediatric HIV clinic were compared with the 136 HIV-infected children younger than 18 months. RESULTS: Under 18 months, the median age of HIV-infected children (n = 136) was 4.0 months (range, 3 d -18 mo ) and the median age of the uninfected children (n = 501) was 1.0 month (range, 3 d -18 mo ). HIV-infected children were more likely to have had injections, chloroquine, and nystatin, and to have attended a health center or hospital (p <.001). In the HIV-infected group, the Z score for weight-for-age was -1.75, length-for-age -0.78, and weight-for-length 1.86, significantly lower scores than those of the uninfected group, which were -0.60, -0.23, and 3.05, respectively (p <.05). The mean head circumference was below the third percentile in 40% of HIV-infected compared with 22% of uninfected children (p <.001). Overall, 56 (8%) children had marasmus, 6 (0.8%) kwashiorkor, and 3 (0.4%) marasmic kwashiorkor. Sixteen percent of the HIV-infected and 7% of uninfected children had marasmus (p <.05). The 1989 revised World Health Organization clinical criteria for diagnosis of AIDS had sensitivity, specificity, and positive predictive values of 28%, 98%, and 93%, respectively. Older than 18 months (n = 109), the median age was 24 months (range, 18-60 mo ). The following were significantly more common in HIV-infected children older than 18 months than in those younger than 18 months: bacille Calmette-Guérin vaccination scar, parotid enlargement, nonspecific generalized dermatitis, and chronic diarrhea ( p <.001). Oral candidiasis was more common in the group younger than 18 months (p <.001). In infants examined in the hospital for infective conditions, oropharyngeal candidiasis, ear discharge, dermatologic disorders, generalized lymphadenopathy, lobar consolidation, hepatosplenomegaly, and failure to thrive, especially marasmus, were important indicators of HIV infection.     

The effect of parental race on fetal and infant mortality in twin gestations

Previous work has found that singleton birth outcomes are better if the father is black and the mother is white than if the father is white and the mother is black. We sought to examine the effects of parental race on fetal and infant mortality in twins. We analyzed the fetal and infant mortality rates in four groups [both parents white (W-W), both parents black (B-B), father black and mother white (FB-MW), and father white and mother black (FW-MB)], using the 1995--1997 U.S. twin registry data (249,221 twins). Compared to W-W, the infant mortality for B-B, FW-MB, and FB-MW (respectively, relative risk [RR] 1.84, 95% confidence interval [CI] 1.73-1.95; RR 1.39, 95% CI 1.03-1.51; and RR 1.49, 95% CI 1.26-1.77) were all significantly different from W-W but not from each other. When fetal mortality was added to infant mortality, the combined mortality was highest for B-B (RR 1.66, 95% CI 1.58-1.75), intermediate for FW-MB (RR 1.18, 95% CI 0.92-1.51) and FB-MW (RR 1.37, 95% CI 1.19-1.58) and lowest for W-W. Thus, twin infants born to black parents have higher risk of fetal and infant mortality compared with twin infants born to white parents and infants of mixed race parents generally have intermediate outcomes.     

Effect of maternal avoidance of eggs, cow''s milk and fish during lactation upon allergic manifestations in infants

Atopic/allergic manifestations and skin-prick tests (SPT) to egg white, cow's milk (CM) and fish were evaluated during the first 18 months of life in two matched groups of infants with a family history of atopy/allergy. In one group (n = 65) the mothers had a diet free from eggs, CM and fish during the first 3 months postpartum, whereas the mothers in the other group (n = 50) consumed an ordinary diet. The diet of the infants was similar in both groups, i.e. CM was not supplied until 6 months of age, and eggs and fish not until 9 months of age. The incidence of atopic dermatitis was significantly lower in the maternal diet group during the first 6 months postpartum (10.8 and 28%, respectively) but not after that age. Other atopic/allergic manifestations did not differ and the number of positive SPT to egg white, CM or fish at 9 months of age was similar in both groups.