Investigation of a temporal cluster of left sided congenital heart disease.

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Abstract
During Oct. and Nov. 1977, 8 newborns with critical congenital heart disease, 6 of these with left sided lesions, were admitted to a New Jersey [USA] newborn unit serving 2 predominantly rural counties with 9700 annual live births. The 6 left heart lesions (3 cases of hypoplastic left heart, 2 of interrupted aortic arch, and 1 aortic coarctation) represented 30% of all neonatal left sided lesions seen at the unit in the 3 yr period 1976-1978. The scan statistic for temporal clustering was significant (P < 0.05). A case-control study was performed in which an average of 4 controls were matched to each case. A questionnaire was administered to the mothers of cases and controls concerning occupation, periconceptional and prenatal nutrition, radiation and chemical exposure, use of alcohol and tobacco, medications, immunizations, infections and other exposures. No statistically significant differences between cases and controls were found on any of these items. Although no etiology for this cluster of congenital heart anomalies could be found, it is of interest that 3 temporal clusters of fetuses or newborns with chromosomal trisomies were reported in the medical literature whose conceptions were roughly contemporaneous with those of the infants in the series. These occurred in Rhode Island/Massachusetts, Maryland, and New York City. A speculative possibility is that these 4 point epidemics represented exposure to a common teratogenic agent, perhaps influenza B, in the winter of 1976/1977 in the northeastern USA.