ENVIRONMENTAL RISK-FACTORS ASSOCIATED WITH PEDIATRIC IDIOPATHIC PULMONARY HEMORRHAGE AND HEMOSIDEROSIS IN A CLEVELAND COMMUNITY

Background. Unexplained pulmonary hemorrhage and hemosiderosis are rar ely seen in infancy, A geographic cluster of 10 infants with this illn ess was identified in a large pediatric referral hospital in Cleveland , Ohio, during the period of January 1993 through December 1994. One i nfant died of severe respiratory failure. Methods. A case-control stud y was conducted. Three control infants were matched by age with each c ase infant. All study infants' guardians were interviewed. Questions w ere asked about child care practices and home conditions for the perio d before case infants' illnesses. All infants' records were reviewed, their homes were visited, and a structural and environmental survey wa s 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). Ma tched analysis demonstrated that case infants' homes were more likely to have had water damage preceding the pulmonary hemorrhage event (odd s ratio, 16.25; 95% confidence interval, 2.55 to infinity). Case infan ts were also more likely to have had close relatives with pulmonary he morrhage (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. Conclusion. The results o f this investigation of a cluster of infants with massive, acute pulmo nary hemorrhage and hemosiderosis suggest that the affected infants ma y have been exposed to contaminants in their homes. Epidemiologic clue s, such as water damage in the case infants' homes, suggest that envir onmental risk factors may contribute to pulmonary hemorrhage.