title: Neonatal medical exposures and characteristics of low birth weight hepatoblastoma cases: a report from the Children's Oncology Group.
abstract: BACKGROUND
  Hepatoblastoma is a malignancy of young children. Low birth weight is associated with significantly increased risk of hepatoblastoma and neonatal medical exposures are hypothesized as contributors. This study represents the largest case-control study of hepatoblastoma to date and aimed to define the role of neonatal exposures in hepatoblastoma risk among low birth weight children.
  
  
  METHODS
  Incident hepatoblastoma cases who were born <2,500 g (N = 60), diagnosed between 2000 and 2008, were identified through the Children's Oncology Group. Controls were recruited through state birth registries (N = 51). Neonatal medical exposures were abstracted from medical records. Subjects from the Vermont Oxford Network were used for further comparisons, as were existing reports on neonatal medical exposures.
  
  
  RESULTS
  Case-control comparisons were hindered by poor matching within birth weight strata. Cases were smaller and received more aggressive neonatal treatment compared to controls, and reflected high correlation levels between birth weight and treatments. Similar difficulty was encountered when comparing cases to Vermont Oxford Network subjects; cases were smaller and required more aggressive neonatal therapy. Furthermore, it appears hepatoblastoma cases were exposed to a greater number of diagnostic X-rays than in case series previously reported in the neonatal literature.
  
  
  CONCLUSIONS
  This study presents the largest case series of hepatoblastoma in <2,500 g birth weight infants with accompanying neonatal medical exposure data. Findings confirm that birth weight is highly correlated with exposure intensity, and neonatal exposures are themselves highly correlated, which hampers the identification of a causal exposure among hepatoblastoma cases. Experimental models or genetic susceptibility testing may be more revealing of etiology.
authors.affiliation: Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Lucie M
authors.initials: LM
authors.lastname: Turcotte
authors.forename: Michael K
authors.initials: MK
authors.lastname: Georgieff
authors.forename: Julie A
authors.initials: JA
authors.lastname: Ross
authors.forename: James H
authors.initials: JH
authors.lastname: Feusner
authors.forename: Gail E
authors.initials: GE
authors.lastname: Tomlinson
authors.forename: Marcio H
authors.initials: MH
authors.lastname: Malogolowkin
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krailo
authors.forename: Nicole
authors.initials: N
authors.lastname: Miller
authors.forename: Rachel
authors.initials: R
authors.lastname: Fonstad
authors.forename: Logan G
authors.initials: LG
authors.lastname: Spector
mesh_terms: D016022:Case-Control Studies; D005865:Gestational Age; D018197:Hepatoblastoma / Q000209:etiology*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000209:etiology*; D010289:Parenteral Nutrition, Total
keywords: NICU; case-control study; exposure; hepatoblastoma; low birth weight