Space-time hot spots of critically ill small for gestational age newborns and industrial air pollutants in major metropolitan areas of Canada.

We assessed the association of spatiotemporal hot spots of critically ill small for gestational age (ciSGA) newborns and industrial air emissions. Using neonatal admission data from the Canadian Neonatal Network between 2006 and 2010 (n = 32,836 infants), we aggregated maternal residential postal codes from nineteen census metropolitan areas (CMA) into space-time cubes and applied emerging hot spot analyses. Using National Pollutant Release Inventory data (n = 161 chemicals) and Environment Canada weather station data (n = 19 sites), we estimated monthly wind-dispersion of air emissions and calculated hot spots. We associated the patterns using logistic regression, with covariates for low socioeconomic status, NO pollution, and number of infants. A total of 5465 infants were identified as ciSGA and the larger CMAs had more and larger hot spots (i.e. accumulation of events in space and time). Seventy-eight industrial chemical hot spots were associated with ciSGA hot spots. The highest number of positive associations were for 28 different pollutants, which differed by CMA. Twenty-one were known or suspected developmental toxicants, such as particulate matter, carbon monoxide, heavy metals, and volatile organic compounds. Associations with hot spots of industrial chemical emissions were geographically specific and may help explain the space-time trends of ciSGA.