title: Environmental risk factors associated with pediatric idiopathic pulmonary hemorrhage and hemosiderosis in a Cleveland community.
abstract: BACKGROUND
  Unexplained pulmonary hemorrhage and hemosiderosis are rarely seen in infancy. A geographic cluster of 10 infants with this illness was identified in a large pediatric referral hospital in Cleveland, Ohio, during the period of January 1993 through December 1994. One infant died of severe respiratory failure.
  
  
  METHODS
  A case-control study was conducted. Three control infants were matched by age with each case infant. All study infants' guardians were interviewed. Questions were asked about child care practices and home conditions for the period before case infants' illnesses. All infants' records were reviewed, their homes were visited, and a structural and environmental survey was conducted.
  
  
  RESULTS
  All 10 case infants were black, and 9 were male, whereas 50.0% of control infants were male, and 83.3% were black. The case infants' mean age was 10.2 weeks (range, 6 weeks to 6 months). Matched analysis demonstrated that case infants' homes were more likely to have had water damage preceding the pulmonary hemorrhage event (odds ratio, 16.25; 95% confidence interval, 2.55 to infinity). Case infants were also more likely to have had close relatives with pulmonary hemorrhage (odds ratio, 33.14; 95% confidence interval, 5.10 to infinity). In addition, 50.0% of case infants experienced recurrent pulmonary hemorrhaging after returning to their homes.
  
  
  CONCLUSIONS
  The results of this investigation of a cluster of infants with massive, acute pulmonary hemorrhage and hemosiderosis suggest that the affected infants may have been exposed to contaminants in their homes. Epidemiologic clues, such as water damage in the case infants' homes, suggest that environmental risk factors may contribute to pulmonary hemorrhage.
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia, USA.
authors.forename: E
authors.initials: E
authors.lastname: Montaña
authors.forename: R A
authors.initials: RA
authors.lastname: Etzel
authors.forename: T
authors.initials: T
authors.lastname: Allan
authors.forename: T E
authors.initials: TE
authors.lastname: Horgan
authors.forename: D G
authors.initials: DG
authors.lastname: Dearborn
mesh_terms: D000208:Acute Disease; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D016022:Case-Control Studies; D016000:Cluster Analysis; D004785:Environmental Pollutants / Q000009:adverse effects / Q000032:analysis; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006486:Hemosiderosis / Q000209:etiology*; D006798:Housing; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D009820:Ohio; D010575:Pesticides / Q000032:analysis / Q000652:urine; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014867:Water
chemical_list: D004785:Environmental Pollutants; D010575:Pesticides; D014028:Tobacco Smoke Pollution; D014867:Water