Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change servers in April
Editor's Choice | This Week in BMJ | Press releases
BMJ No 7126 Volume 316
Papers - Abstracts Saturday 17 January 1998
Case-control study of childhood leukaemia and cancer in Scotland:
findings for neonatal intramuscular vitamin K
Case-control studies of relation between childhood cancer and
neonatal vitamin K administration
Ecological studies of relation between hospital policies on
neonatal vitamin K administration and subsequent occurrence of
childhood cancer
Neonatal vitamin K administration and childhood cancer in the
north of England: retrospective case-control study
Relation between sexual abuse in childhood and adult depression:
case-control study
Case-control study of childhood leukaemia and cancer in Scotland: findings for neonatal intramuscular vitamin K
Patricia A McKinney, Edmund Juszczak, Elizabeth Findlay, Katrina Smith
See Editorial by von Kries, p 161 and Papers (abstracts only) p 178, p 184, p 189
Abstract
Objective: To test the hypothesis of an association between neonatal intramuscular vitamin K and childhood leukaemia and other cancers.
Design: Population based case-control study with data abstracted from hospital records.
Setting: Scotland.
Subjects: Children aged 0-14 years resident in Scotland from 1991-4 and diagnosed with leukaemia (150), lymphomas (46), central nervous system tumours (79), a range of other solid tumours (142), and a subset of acute lymphoblastic leukaemia (129). Controls were 777 children matched for age and sex, providing 417 matched sets (360 triplets and 57 pairs) for analysis.
Main outcome measure: Odds ratios for the risk of childhood leukaemia and cancer and intramuscular vitamin K versus a combined group of oral doses, none, and no record. Results are given for information recorded in medical notes and data supplemented by hospital policy.
Results: Odds ratios based on medical record abstractions showed no significant positive association for leukaemias (odds ratio 1.30; 95% confidence interval 0.83 to 2.03), acute lymphoblastic leukaemia (1.21; 0.74 to 1.97), lymphomas (1.06; 0.46 to 2.42), central nervous system tumours (0.74; 0.40 to 1.34), and other solid tumours (0.59; 0.37 to 0.96). There was no association with acute lymphoblastic leukaemia in children aged 1 to 6 years. Imputation of exposure from hospital policy gave similar results. Adjustment for deprivation and type of delivery moved risk estimates closer to unity for all major diagnostic groups.
Conclusions: The observation of an increased risk of childhood leukaemia and cancer associated with intramuscular vitamin K is not confirmed by this independent population based study.
Information and Statistics Division,
Common Services Agency for the National Health Service in Scotland,
Trinity Park House,
Edinburgh EH5 3SQ
Patricia A McKinney, principal researcher
Edmund Juszczak, senior statistician
Elizabeth Findlay, research nurse
Katrina Smith, senior administrator
Correspondence to: Dr McKinney
email: p.a.mckinney@leeds.ac.uk
Case-control studies of relation between childhood cancer and neonatal vitamin K administration
S Jane Passmore, Gerald Draper, Pat Brownbill, Mary Kroll
See Editorial by von Kries, p 161, and Papers (abstracts only) p 173, 184, 189
Abstract
Objective: To investigate the possible link between neonatal administration of intramuscular vitamin K and childhood cancer.
Design: Matched case-control study.
Setting: Selected large maternity units in England and Wales.
Subjects: Children with cancer born 1968-85, diagnosed 1969-86; controls matched for sex, month of birth, and hospital of birth.
Main exposure measures: Neonatal administration of vitamin K, length of gestation, birth weight, type of delivery, admission to special care baby unit.
Results: After exclusion of cases with missing notes or unknown hospital vitamin K policy, 597 cases and matched controls were studied. Written records on the use of vitamin K were available for only about 40% of these, and to avoid possible bias from selective recording it was assumed that the stated hospital policy was followed. The association between cancer generally and intramuscular vitamin K was of borderline significance (odds ratio 1.44, P=0.05); the association was strongest for leukaemia. There was, however, also an effect of abnormal delivery, which could explain some of the findings.
Conclusions: The lack of consistency between the various studies so far published, including this one, and the low relative risks found in most of them suggest that the risk, if any, attributable to the use of vitamin K cannot be large, but the possibility that there is some risk cannot be excluded. A comparison of the predicted consequences of various policies shows that even a 10% increase would imply that prophylaxis using the commonly recommended 1 mg intramuscular dose should be restricted to babies at particularly high risk of vitamin K deficiency bleeding; alternatively a lower dose might be given to a larger proportion of those at risk.
Childhood Cancer Research Group,
Oxford OX2 6HJ
S Jane Passmore, research officer
Gerald Draper, director
Pat Brownbill,
research programmer
Mary Kroll,
statistician
Correspondence to: Dr Draper
email: gjd@ccrg.ox.ac.uk
Ecological studies of relation between hospital policies on neonatal vitamin K administration and subsequent occurrence of childhood cancer
S Jane Passmore, Gerald Draper, Pat Brownbill, Mary Kroll
See Editorial by von Kries, p 161, and Papers (abstracts only) p 173, 178, 189
Abstract
Objective: To investigate the possible link between neonatal administration of intramuscular vitamin K and childhood cancer.
Design: Ecological studies comparing incidence of cancer in groups of children classified by the vitamin K policy in operation at their hospital of birth.
Setting: Selected large maternity units in England, Scotland, and Wales.
Subjects: Children born in these units in varying periods between 1966 and 1991.
Main outcome measures: Cancer occurring among these children before age 15 years identified by using the National Registry of Childhood Tumours. Ratios of observed to expected numbers of these conditions calculated for hospitals where the policy was to give all babies intramuscular vitamin K (non-selective) and where the policy was to use this treatment only for a selected minority of babies at increased risk of vitamin K deficiency bleeding (selective).
Results: These ratios were calculated for children born in 94 hospitals with varying vitamin K policies. A raised risk was occasionally associated with vitamin K, but the overall results were not significant, and there was no evidence to support the previously suggested doubling of the risk of childhood cancer.
Conclusions: On the basis of the results reported here it is unlikely that there is a greatly increased risk of childhood cancer attributable to intramuscular vitamin K given to newborns, if indeed there is any.
Childhood Cancer Research Group,
Oxford, OX2 6HJ
S Jane Passmore, research officer
Gerald Draper, director
Pat Brownbill,
research programmer
Mary Kroll,
statistician
Correspondence to: Dr Draper
email: gjd@ccrg.ox.ac.uk
Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study
L Parker, M Cole, A W Craft, E N Hey
See Editorial by von Kries, p 161, and Papers (abstracts only) p 173, 178, 183
Abstract
Objective: To explore the possible association between intramuscular vitamin K given to neonates and the subsequent development of childhood cancer.
Design: Retrospective case-control study on the basis
Setting: The former Northern Health region of England.
Subjects: 685 children who were born and lived in the region and who developed cancer before their 15th birthday, and 3,442 controls also born between 1960 and 1991 and matched only for date and hospital of birth. The notes of a further 701 index cases were untraceable.
Main exposure measure: Administration of intramuscular vitamin K versus no exposure to vitamin K.
Results: There was no association between the administration of vitamin K and the development of all childhood cancers (unadjusted odds ratio 0.89; 95% confidence interval 0.69 to 1.15) or for all acute lymphoblastic leukaemia (1.20; 0.75 to 1.92), but there was a raised odds ratio for acute lymphoblastic leukaemia developing 1-6 years after birth (1.79; 1.02 to 3.15). No such association was seen in a separate cohort-based study not dependent on case note retrieval in which the rates of acute lymphoblastic leukaemia in children born in hospital units where all babies received vitamin K were compared with those born in units where less than a third received prophylaxis.
Conclusions: It is not possible, on the basis of currently published evidence, to refute the suggestion that neonatal intramuscular vitamin K administration increases the risk of early childhood leukaemia. Any association may have been masked in earlier studies that did not use controls matched for time and locality by other unidentified factors affecting the spatiotemporal variations in incidence of leukaemia.
Sir James Spence
Institute of Child Health,
University of Newcastle upon Tyne,
Royal
Victoria Infirmary,
Newcastle upon Tyne NE1 4LP
L Parker, senior lecturer in epidemiology
M Cole, research associate
A W
Craft, professor of child health
E N
Hey, retired paediatrician
Correspondence to: Dr Parker
email: Louise.Parker@ncl.ac.uk
Relation between sexual abuse in childhood and adult depression: case-control study
Marese Cheasty, Anthony W Clare, Claire Collins
Abstract
Objective: To examine the association between sexual abuse in childhood and adult depression in women.
Design: Two stage, case detection and case identification design, using the 30-item general health questionnaire and the Beck depression inventory for screening and the affective items relating to current functioning on the schizophrenia and affective disorders schedule to identify depressed cases. Details of sexual abuse in childhood were elicited retrospectively by semistructured interview, and social problems by the social problems questionnaire.
Setting: Three general practices, in middle class suburban, deprived inner city, and rural areas.
Subjects: 1189 women were screened and 237 subsequently interviewed; 132 were depressed.
Results: 49 (37%) of the depressed interviewees and 24 (23%) of the non-depressed interviewees reported experience of sexual abuse when they were aged under 16 years. A positive association existed between the more severe abuse and depression - all those who had experienced penetration were depressed as adults. A relation was also found between sexual abuse in childhood and sexual problems, housing problems, and problems with their children at school.
Conclusion: A positive association between child sexual abuse and depression was confirmed, but this was confined to more severe abuse (penetration or attempted penetration).
St Patrick's Hospital,
James's Street,
Dublin 8,
Republic of Ireland
Marese
Cheasty, senior registrar in
psychiatry
Anthony W Clare, medical
director of hospital
Claire
Collins, data analyst
Correspondence to: Dr Cheasty
email: dpn@iol.ie
Home | Current contents | Past issues | Classified ads | Career Focus | Feedback
Collections | About this site | About the BMJ | BMA | Medline