We departed from usual groupings of E-codes and devised groupings that would be reflective of age-related developmental characteristics. Differences in rates by narrow age groups for young children can be related to developmental achievements, w can be related to developmental achievements, which place the child at risk for specific causes of injury. We found marked variability in both rates and leading causes of injury by 3-month interval age groupings that were masked by year of age analyses. Children aged 15 to 17 months had the highest overall injury rate before age 15 years. This coincides with developmental achievements such as independent mobility, exploratory behavior, and hand-to-mouth activity. The child is able to access hazards but has not yet developed cognitive hazard awareness and avoidance skills. A remarkable finding was the high rate of battering injury among infants 0 to 5 months, suggesting the need to address potential child maltreatment in the perinatal period. Poisoning was the second major leading cause of injury; more than two thirds were medication. Cultural factors may influence views of medications, storage practices, use of poison control system telephone advice, and risk of toddler poisoning. The pedestrian injury rate doubled between 12 and 14 months and 15 and 17 months and exceeded motor vehicle occupant injury rates for each 3-month interval from 15 to 47 months. Pedestrian injury has not received sufficient attention in general and certainly not in injury prevention counseling for children younger than 4 years. Anticipatory guidance for pedestrian injury should be incorporated before 1 year of age. Effective strategies must be based on the epidemiology of childhood injury. Pediatricians and other pediatric health care providers are in a unique position to render injury prevention services to their patients. Integrating injury prevention messages in the context of developmental assessments of the child is 1 strategy. These data can also be used for complementary childhood injury prevention strategies such as early intervention programs for high-risk families for child abuse and neglect, media and advocacy campaigns, public policies, and environmental and product design.

ABSTRACT. Objective. The purpose of this study was to analyze causes of injury hospitalization/death by individual year of age and by specific causes of injury and to examine how well aggregate age groups represented individual year-of-age rates.Methods. Hospital discharge data and death certificate data for California residents age 0 to 19 years with a principal external cause of injury code (E-code) of E800 to E869, E880 to E929, or E950 to E999, calendar year 1997, were analyzed. Annual rates of injury hospitalization/ death by year of age were calculated using combined hospital discharges and deaths as the numerator for major causes and important subcategories. For comparison, rates of injury hospitalization/death were calculated for conventional vital statistics age groups: <1 year, 1 to 4 years; 5 to 9 years, 10 to 14 years, and 15 to 19 years.Results. In 1997 in California, 35 277 children and adolescents 0 to 19 years were hospitalized and 1934 died as a result of injury, a ratio of 17 hospitalizations to 1 death. The distribution was bimodal with rates highest among 18-year-olds (732/100 000) and 1-year-olds (495/ 100 000). Except for children who were 5 to 9 years of age, the group rates for all injuries were not reflective of the individual year-of-age rates. In specific categories of injuries, variation in rates by year of age were masked by age group rates for unintentional poisoning among 1-to 4-year-olds, self-inflicted poisoning for 10-to 19-yearolds, falls from playground equipment among 5-to 9-year-olds, falls from furniture among 1-to 4-year-olds, and motor vehicle occupant injury rates among 10-to 19-year-olds. The peak rate of falls from playground equipment among 6-year-olds (34/100 000) was more than twice the rate for 9-year-olds (15/1000,000). Motor vehicle occupant injury rates doubled between 10 and 14 years of age and quadrupled between 14 and 18 years of age.Conclusions. Analyses using conventional age groups did not identify the age of highest risk for many causes of childhood injury. Changes in the rates often transected the traditional age groups and were not apparent with conventional age group analysis. These data can inform on the age at which to begin a specific injury intervention and on how to allocate resources. These data allow pediatricians and other health professionals to be anticipatory in providing injury prevention counseling. The greatest impact can be achieved by making the counseling topic most age appropriate in anticipation of the Epidemiologic studies predominantly use the vital statistics age groupings for children: Ͻ1 year, 1 to 4 years, 5 to 9 years, 10 to 14 years, and 15 to 19 years of age. In 1989, on the basis of a National Institute of Health and Human Development conference, standard definitions for childhood injury research were developed on the basis of factors such as development and life events. It was determined that broad age aggregations for children mask wide variation within categories as a result of rapid changes in development and risk. 3 Th...

Congenital heart defects (CHDs) are the most common of all birth defects. For many newborns with a CHD, prenatal versus postnatal detection is associated with substantially decreased morbidity and mortality risks. Although technological advances in fetal echocardiography have led to an increased capacity to detect CHDs prenatally, pregnancies without an identified risk factor are not routinely screened. With the aim of identifying pregnancies at increased risk for CHDs, this study examined the relationship between CHDs and typically collected second trimester biomarker data collected on a large population-based sample of singleton pregnancies with one or more second trimester screen positive result for Down syndrome, trisomy 18 (T-18), Smith-Lemli-Opitz syndrome (SLOS), or a neural tube defect (NTD). Where possible, logistic models for cases and controls were built and potential referral models were tested among study subsamples with information on the presence or absence of CHDs reported pre- and perinatally. When considered in combination, screen positive for T-18, screen positive for SLOS, nuchal fold measurement > or = 5 mm, and/or having an adjusted hCG multiple of the median > or = the 95th centile detected 42.7% of all pregnancies with a CHD in the combined subsample (where co-occurrence with chromosomal defects was not considered) and detected 29.7% of all pregnancies with a CHD in the no-chromosomal defect subsample. A nuchal fold measurement > or = 5 mm detected 18.2% of those with a CHD in the Down syndrome subsample and an adjusted hCG multiple of the median (MoM) < or = 5th centile detected 92.9% of those with a CHD in the T-18 subsample.

III.

A number of studies have reported an association between low concentrations of serum folate and preterm birth. Folate supplementation during pregnancy increased the length of pregnancy in some but not all clinical trials. This cohort study investigated whether preconceptional folate supplementation (as ascertained by patient questionnaire in the first trimester of pregnancy) lowers the risk of spontaneous preterm birth. The investigators analyzed data collected from a cohort of 34,480 low-risk singleton pregnancies in women enrolled in a previous prospective cohort study on Down syndrome screening conducted at 15 US centers between 1999 and 2002. Duration of pregnancy was estimated by ultrasound measurement in the first trimester. Spontaneous preterm birth was defined as preterm birth between 20 and 37 weeks with no medical or obstetrical complications that constituted indications for delivery. The effects of the duration of preconceptional folate supplementation of Ն1 year (long-term), Ͻ1 year and the effect of no supplementation on risk of spontaneous preterm birth were compared using time-to-event analysis. Data were subjected to analysis with multivariable logistic regression.Compared to women who did not take a folate supplement, the risk of spontaneous preterm delivery between 20 and 28 weeks was 70% lower in women who took folate supplements for a year or longer before pregnancy (0.27% vs 0.04%); the hazard ratio was 0.22, with a 95% confidence interval of 0.08 to 0.61, P ϭ 0.004. Long-term folate supplementation reduced the risk between 28 and 32 weeks by over 50% (0.38% vs 0.18%) (hazard ratio, 0.45; 95% confidence interval, 0.24-0.83, P ϭ 0.010). Supplementation had no significant effect on the risk of spontaneous preterm birth beyond 32 weeks. Adjustment for maternal variables (age, body mass index, race and ethnicity, educational level, marital status, smoking, parity and history of prior preterm birth) did not affect the association between long-term folate and risk of spontaneous preterm birth but did eliminate the association found in unadjusted analysis between duration of preconceptional folate supplementation less than one year and risk.These findings suggest that preconceptional folate supplementation for a year or longer may substantially reduce the risk of early spontaneous preterm birth. The risk is lower with longer duration of folate supplementation before pregnancy. The beneficial effect of folic acid does not appear to be associated with other complications of OBSTETRICS Volume 64, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY pregnancy such as preeclampsia, small for gestational age infant, placental abruption, or nonspontaneous preterm birth. EDITORIAL COMMENT(From an analytic standpoint, the abstracted report by Bukowski et al is sophisticated and well done. The limitations of this study relate to its design-it is a retrospective cohort study rather than a prospective randomized trial. This design gives direct rise to 2 of its main limitations. The first relates to ascertainment of f...