The authors studied retrospectively the epidemiologic characteristics of necrotizing enterocolitis occurring among Georgia infants born during 1977 and 1978; 148 cases of necrotizing enterocolitis were identified. The highest incidence rate for necrotizing enterocolitis occurred among infants weighing 751-1000 g at birth and declined with increasing birth weight to less than 0.2 cases per 1000 live births among infants weighing more than 2500 g at birth. The overall incidence rate for blacks was significantly greater than that for whites (1.6 vs. 0.5 cases per 1000 live births, p = 0.01). The overall case fatality ratio was 38.5%; there were no differences in these ratios between blacks and whites. Necrotizing enterocolitis accounted for 15% of all deaths after the first week of life for infants weighting 1500 g or less at birth. If Georgia incidence rates and fatality ratios are applied to 1978 US births, it is estimated that 2210 cases of necrotizing enterocolitis with over 900 associated deaths would have occurred.

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L i t t l e epidemiologic a t t e n t i o n has been given t o i n f a n t s 82500 gms. admitted t o NICU's. To determine t h e i r morbidity and mort a l i t y , we reviewed a l l admissions f o r 17 months and they represented 44% (236/545) of t h e admissions and 37% of a l l deaths. The diagnoses were: Pulmonary disease (PD) o t h e r than meconium a s p i r a t i o n syndrome (MAS) (32%) ; asphyxia ( A s ) ( 2 2 % ) ; congenit a l anomalies & h e a r t disease (CA/CHD) (21%) ; s u r g i c a l (11%) ; s e p s i s (5%) ; o t h e r s ( 9 % ) . MAS occurred i n 44% (22/50) of A s inf a n t s . Mortality r a t e was 17% (40/236). Of t h e deaths, 70% were due t o CA/CHD, 23% t o A s and 7% t o s e p s i s . Of t h e 9 A s deaths, a l l were742 wks.and 8 had MAS. Of 21 cases with pers i s t e n t f e t a l c i r c u l a t i o n (PFC), 17 had As, 16 were >42 wks and 7 (33%) died. I n i n f a n t s with PFC, A s and MAS who were >42 wks, m o r t a l i t y was 55%. Thirty four i n f a n t s (14%) were >42 wks, 9 (27%) died. S i x t y seven (28%) were637 wks, only 3 died (4%) & they had CA/CND. PD o t h e r than MAS occurred i n 54/67 (80%). None of t h e 5 3 7 wks.who had PD and were born by e l e c t i v e c-section o r induction had p r e n a t a l lung maturity s t u d i e s .Morbidity and m o r t a l i t y remains high i n t h i s group of i n f a n t s . Prevention of postmaturity and b e t t e r intrapartum management should s i g n i f i c a n t l y decrease t h e number of deaths. Accurate assessment of lung maturity and g e s t a t i o n a l age, i n order t o avoid i a t r o g e n i c prematurity, w i l l decrease t h e number of infants&2500 9ms requiring neonatal i n t e n s i v e c a r e . T h i r t y white and 30 black c h i l d r e n , ages 2 months t o 7 y e a r s , form t h e study group. I n each group, t h e age, number of other s i b l i n g s , duration of fever a f t e r s t a r t i n g therapy, i n i t i a l white c e l l count, and morphological and chemical findings of t h e cerebrospinal f l u i d were recorded. Immunoglobulins were measured i n each group by r a d i a l immunodiffusion. Anticapsular antibody was measured by radioimmunoassay i n both groups. HLA antigens were determined i n all p a t i e n t s from lymphocytes i s o l a t e d from t h e p e r i p h e r a l blood by f i c o l l isopaque centrifugation.The black children responded t o t h e i n f e c t i o n l e s s vigorously. They had more prolonged fever ( P <.01), a lower CSF pleocytosis ( p c.05). and l e s s IgG production ( p <.05). They produced l e s s anticapsular antibody -234.4 ngmlml geometric mean t i t r e v s .312.3 ngmlml f o r t h e white children. The black children had increased frequency of HLA B7 ( p <.001), and t h e white children an increased frequency of B12 ( p <.05). These HLA antigenic d i fferences could not be accounted f o r by r a c i a l t r a i t s . Immune response regulated by Ir genes i n c l o s e proximity of t h e B locus i s t h u s weaker i n black children and may explain t h e incr...

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