Randomized double-blind comparison of single high-dose ondansetron and multiple standard-dose ondansetron in chemotherapy-naive pediatric oncology patients

This prospective, double-blind, randomized study compares the antiemetic efficacy of an equivalent dose of ondansetron administered as a single high dose or as multiple standard doses in pediatric oncology patients. Thirty-one chemotherapy-naive patients were randomized at diagnosis to receive either single high-dose ondansetron (0.6 mg/kg, maximum dose 32 mg) or multiple standard-dose ondansetron (0.15 mg/kg, maximum dose 8 mg, every 4 hr for four doses). Antiemetic efficacy was assessed by an emesis scale described as follows: 1, no nausea or emesis; 2, nauseous but able to eat; 3, nauseous and unable to eat; and 4, emesis. Sixteen patients received high-dose and 15 received standard-dose ondansetron. Patients receiving moderately or severely emetogenic chemotherapy were evenly distributed between the two treatment groups. Eighty-one percent of patients receiving high-dose and 80% receiving standard-dose ondansetron rated 1 or 2 on the emesis scale (p = 0.93). No patient experienced any clinical or laboratory toxicity. Our study suggests that single high-dose ondansetron is as efficacious as the multiple standard-dose regimen and is well tolerated. Its use will facilitate the administration of ondansetron in pediatric patients receiving chemotherapy.

Maternal Lyme disease and congenital heart disease: A case-control study in an endemic area

OBJECTIVE

The purpose of this study was to determine whether maternal Lyme disease increases the risk of congenital heart defect.

STUDY DESIGN

This retrospective case-control study was carried out at a medical center in a suburban area where Lyme disease is endemic. Case patients comprised 796 children with a diagnosis of congenital cardiac anomaly. Control subjects comprised 704 children without cardiac defects selected from the records of the same pediatric cardiology service. Maternal histories were obtained through a mailed questionnaire survey. Unconditional logistic regression analyses examined the relationship between a history of preconception and prenatal clinical Lyme disease or tick bite and case or control status.

RESULTS

There was no association between congenital heart defect and maternal tick bite (adjusted odds ratio 1.1, 95% confidence interval 0.5-2.5) or maternal Lyme disease within 3 months of conception or during pregnancy (adjusted odds ratio 0.9; 95% confidence interval 0.2-3.6).

CONCLUSION

A woman who has been bitten by a tick or is treated for Lyme disease during or before pregnancy is not at increased risk for giving birth to a child with a congenital heart defect.

Maternal Lyme disease and congenital malformations: a cord blood serosurvey in endemic and control areas

This report describes a cohort study of over 5000 infants and their mothers who participated in a cord blood serosurvey designed to examine the relationship between maternal exposure to Lyme disease and adverse pregnancy outcome. Based on serology and reported clinical history, mothers of infants in an endemic hospital cohort are 5 to 20 times more likely to have been exposed to B. burgdorferi as compared with mothers of infants in a control hospital cohort. The incidence of total congenital malformations was not significantly different in the endemic cohort compared with the control cohort, but the rate of cardiac malformations was significantly higher in the endemic cohort [odds ratio (OR) 2.40; 95% confidence interval (CI) 1.25, 4.59] and the frequencies of certain minor malformations (haemangiomas, polydactyly, and hydrocele), were significantly increased in the control group. Demographic variations could only account for differences in the frequency of polydactyly. Within the endemic cohort, there were no differences in the rate of major or minor malformations or mean birthweight by category of possible maternal exposure to Lyme disease or cord blood serology. The disparity between observations at the population and individual levels requires further investigation. The absence of association at the individual level in the endemic area could be because of the small number of women who were actually exposed either in terms of serology or clinical history. The reason for the findings at the population level is not known but could be because of artifact or population differences.

Lyme disease in childhood: clinical and epidemiologic features of ninety cases

In 1982 and 1983 practicing pediatricians in a Lyme disease-endemic county, reported 90 cases of Lyme disease among children 19 years of age and younger (median age, 9 years). Three-fourths of the children had initial symptom onset in the summer months, with peak incidence in July. Infection occurred twice as often in boys than in girls, and tick bites were recalled by less than half (49%) of the children or parents. Erythema chronicum migrans was present in two-thirds (67%) of the cases with median onset 7 days after a definite tick bite. Arthritis or arthralgia occurred in 59% and neurologic symptoms, especially seventh nerve palsy, occurred in 14%. Asymmetric involvement of a few large joints, especially the knee, was most commonly reported for those with joint involvement. antibiotics were prescribed for 79% of the children, three-fourths of whom were treated with oral penicillin. Initial diagnosis of Lyme disease is usually made on clinical grounds alone because serologic tests are often negative. Serologic tests for antibody to Borrelia burgdorferi were more often positive in cases with neurological or joint involvement, in addition to erythema chronicums migrans (80%), than in cases presenting with erythema chronicums migrans only.

Gestational vaginal bleeding and pregnancy outcome

The relation between vaginal bleeding and pregnancy outcome was examined in a prospective study of 3,531 women seeking prenatal care in New York City from 1975 through 1985. Women were interviewed in the second trimester or later and were followed up at delivery. The frequency of vaginal bleeding during pregnancy was 22%. Few maternal characteristics or exposures were predictive of bleeding, and those that were associated with an increased risk of bleeding were only marginally so. Risk factors included advanced maternal age, previous spontaneous or induced abortion, working during pregnancy, and certain gynecologic conditions (fibroids, cervical inflammation, and ovarian cysts). Severity of bleeding was examined in relation to birth weight and length of gestation at delivery. Light bleeding during pregnancy was not associated with decreased birth weight or with shortened gestation at delivery. Heavy bleeding was associated with a decrease in mean birth weight of about 100 g (p less than 0.05) but was not significantly associated with the risk of low birth weight (odds ratio (OR) = 1.7, 95% confidence interval (CI) 0.9-3.3). Heavy bleeding was associated with preterm delivery among private patients (OR = 6.4, 95% Cl 1.7-23.5) but not public patients (OR = 0.3, 95% Cl 0.1-1.4). First trimester bleeding of any severity was marginally associated with congenital malformations in the offspring (OR = 1.7, 95% Cl 1.0-2.9); the effect was the same for major and minor abnormalities. There was no association between first trimester bleeding and placental complications of pregnancy or the delivery of a stillborn infant.

Spermicide use and pregnancy outcome

The relation between periconceptional vaginal spermicide use and sex ratio at birth, birthweight, and the frequency of congenital anomalies was examined in a cohort of 2,712 New York City obstetric patients, 149 of whom (5.5 per cent) became pregnant while using spermicides or had used spermicides before and after conception. Periconceptional spermicide use was not associated with any important variation in the expected sex ratio at birth, nor with major or minor congenital anomalies. Exposure to spermicides in the periconceptional period, defined dichotomously as present or absent, was not associated with decreased birthweight in male or female infants. There was a slight decrease in birthweight among female infants with increasing duration of postconceptional spermicide use; an estimated 7.4 grams decrease with each day of use. The size of the effect and its selectivity by sex suggest a chance finding.

Characteristics of women with recurrent spontaneous abortions and women with favorable reproductive histories

Women with a history of recurrent spontaneous abortions (repeaters) are compared with women who have had live births and no spontaneous abortions (multiparae) and women who have had live births and only one spontaneous abortion (sporadics) to identify characteristics of the women and their abortuses that might predict subsequent fetal loss. A number of risk factors for recurrent spontaneous abortion have been identified: the loss of a chromosomally normal conception, loss after the first trimester of pregnancy, a delay in conceiving prior to the study pregnancy, a diagnosis of cervical incompetence, and a history of very low birthweight deliveries. The odds ratios associated with being a repeater vary from 1.4 to 5.6 depending on the number of characteristics present.

Vaginal spermicides and spontaneous abortion of known karyotype

The relationship between spermicide use and spontaneous abortion was examined in a New York City case-control study carried out during 1974-1982. In a series of matched sample analyses, case groups categorized by karyotype of the abortus were compared to a control group of prenatal patients with respect to spermicide use. Spermicide use was defined in terms of proximity to the date of conception of the study pregnancy and duration of the episode of use most recent to the study pregnancy. There was no association between spermicide use defined either in terms of recency or duration of use and chromosomally normal abortions, which comprise about 60% of all spontaneous abortions. Similarly, there was no association between spermicide use and the various types of chromosomally abnormal abortions, with the exception of trisomic abortion. Spermicide use for more than one year at any time prior to conception was more common in the cases aborting trisomic conceptions than in the control group (odds ratio = 1.9, confidence limits = 1.2, 3.0). There was evidence to suggest that the association varied with maternal age and phase of entrance into the study.