Prevalence, predictors, and outcomes of major congenital anomalies: A population-based register study

Low Apgar Score and Risk of Neonatal Mortality among Infants with Birth Defects

The Apgar score is a clinical tool to assess newborn health at delivery and has shown utility in predicting neonatal mortality in the general population, but its predictive ability in neonates with birth defects remains unexplored. As such, we aimed to investigate the performance of the 5-minute Apgar score in predicting neonatal mortality among neonates with a spectrum of major birth defects.Data for neonates with birth defects born between 1999 and 2017 were obtained from the Texas Birth Defect Registry. We generated receiver operating characteristic curves and corresponding area under the curve (AUC) values for neonatal mortality (death within the first 28 days of life) by 5-minute Apgar score (<7 vs. ≥7) to measure discrimination capacity. We performed secondary analyses to determine the predictive ability of the Apgar score: (1) among infants with an isolated birth defect and (2) separately in preterm and term neonates.Low Apgar score yielded substantial predictive ability for neonatal mortality, with 25 out of 26 AUC values > 0.70 across a spectrum of defect categories. High predictive ability was consistent among neonates with isolated defects, and preterm and term neonates.The Apgar score is likely useful for predicting neonatal mortality among most neonates with birth defects. Despite small sample sizes limiting some secondary analyses, the findings emphasize the potential continued use of the Apgar score as a rapid clinical assessment tool for newborns with birth defects. Continued research may refine the Apgar score's application in this important population, both in clinical practice and population health research. · Predictive models suggest the 5-minute Apgar score (<7) is predictive of neonatal mortality.. · Consistent results were observed across spectrum of birth defect categories.. · Secondary analyses (e.g., preterm infants) yielded similarly consistent results..

Prenatal diagnosis and postnatal outcomes of congenital kidney and urinary tract anomalies: results from a tertiary center

BACKGROUND

This study aimed to investigate the prenatal features, genetic findings, and perinatal outcomes of fetuses with congenital anomalies of the kidney and urinary tract (CAKUT), with a particular focus on associations with additional structural or chromosomal abnormalities.

METHODS

A retrospective cohort analysis was conducted on 277 fetuses diagnosed with CAKUT between December 2020 and December 2024 at a tertiary center. Data on anomaly subtypes, associated findings, genetic testing, pregnancy outcomes, and postnatal follow-up were evaluated. Logistic regression was used to identify predictors of termination.

RESULTS

Urinary tract dilatation was the most frequent anomaly (28.2%), followed by multicystic dysplastic kidney (11.6%) and bilateral renal agenesis (11.2%). Extrarenal anomalies were present in 33.9% of fetuses, primarily involving the CNS. Genetic testing was performed in 48.4%; chromosomal abnormalities were found in 17.3%, most commonly trisomy 21 (5.8%). Termination was significantly associated with early diagnosis (adjusted OR = 0.82; p < 0.001), oligohydramnios (OR = 4.94; p < 0.001), CNS (OR = 3.74; p = 0.001), and cardiac anomalies (OR = 4.21; p = 0.002). Neonatal death occurred in 29.2% of cases, and mortality was higher in non-isolated anomalies (60% vs. 32.9%, p < 0.001).

CONCLUSIONS

Fetuses with CAKUT, particularly those with early diagnosis or coexisting anomalies, carry a higher risk of adverse outcomes. Prenatal detection, coupled with comprehensive genetic and structural evaluation, is essential for informed counseling and postnatal planning.

Maternal Risk Factors, Patterns, and Outcomes of Antenatal Congenital Anomalies: A Hospital-Based Study

Background/Objective: Congenital anomalies (CAs) are structural or functional abnormalities contributing to global neonatal morbidity and mortality. Data on antenatally diagnosed CAs in southern Jordan are limited. The present study reports their prevalence and patterns at the Maternal-Fetal Medicine Clinic of a governmental hospital and examines associated maternal, pregnancy, and delivery outcomes. Methods: This retrospective, hospital-based study involved all pregnant women who presented to the clinic between January 2022 to December 2023 and were diagnosed with congenital fetal anomalies. Data about maternal characteristics, classification of fetal anomalies, and pregnancy outcomes were retrieved from medical files. Statistical analyses comprised chi-square tests, Fisher's exact tests, independent t-tests, and multiple binary logistic regressions. Results: Among the 750 pregnant women, 74 (9.9%) were diagnosed with CAs. Urinary system anomalies were the most common (54.1%), followed by central nervous system (CNS) anomalies (37.8%). Major anomalies constituted 59.5%, whereas 40.5% were minor anomalies. Gestational age at diagnosis and birthweight were significantly associated with major anomalies (p < 0.05). All stillbirths (10.8%) and pregnancy losses before 24 weeks of gestation (9.5%) occurred in cases with major anomalies (p < 0.05). Though preterm delivery rates were higher with major anomalies, this association was not statistically significant. Conclusions: Major CAs (59.5%) in this southern Jordan cohort were strongly linked to stillbirths and early pregnancy loss, highlighting the need for early diagnosis and improved prenatal care. Targeted interventions, including anomaly scans and risk factor (RF) screening, may reduce the 9.9% prevalence observed.

Prevalence of Congenital Anomalies and Predictive Factors in Pregnant Women in Bahrain: A Retrospective Analysis

Background and Objectives: In Bahrain, congenital anomalies (CAs) account for 8.1% of the total deaths in children under 5, indicating a need to understand the patterns, predictors, and prevalence to improve antenatal standards of care and reduce the burden of disease. This study aimed to determine the prevalence and characteristics of CAs in Bahrain and investigate their association with measured neonatal and maternal risk factors. Method: In this five-year retrospective study, data from 31,615 neonates were analyzed, of which 354 had confirmed CAs. Stillbirths, abortions, and CAs discovered later in life were excluded from the study. Results: The prevalence of CAs was determined to be 1.1% (incidence of 11.2 per 1000 births), with 40.1% of the CAs affecting multiple systems. A statistically significant association was found between CAs and nationality, method of conception, gender, method of delivery, diabetes mellitus status, hypertension, and gestational age at birth. However, the association between CAs and multiple gestations was deemed statistically insignificant. Conclusions: As the first study exploring the associations between CAs and potential risk factors and outcomes in Bahrain, it provided a foundation for further exploration of the topic and insight into factors healthcare providers would target during preconception and antenatal care.

Epidemiology of congenital anomalies in the Gulf Cooperation Council countries: a scoping review

OBJECTIVES

Congenital anomalies (CAs) are significant contributors to perinatal mortality and morbidity. The epidemiology of CAs in the Gulf Cooperation Council (GCC) countries remains insufficiently explored. This scoping review aims to provide a comprehensive overview of the existing literature on the epidemiology of perinatally diagnosed CAs in the GCC countries.

DESIGN

Scoping review.

DATA SOURCES

We searched MEDLINE, Embase, Scopus and Web of Science for articles published between 1 January 2000 and 1 February 2024.

ELIGIBILITY CRITERIA

This review included (a) original observational studies such as cross-sectional, cohort or nested case-control studies, which were sourced from general populations, hospital records or registries; (b) published in English between 2000 and 2024; (c) conducted in any of the six GCC countries; and (d) reporting the prevalence or incidence of CAs.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data using Covidence software.

RESULTS

In total, 51 studies reporting the epidemiology of CAs in the GCC countries were eligible and thus summarised. Saudi Arabia dominated with nearly two-thirds of the studies, while Bahrain contributed the least. All studies were hospital based and primarily retrospective. The most researched CAs were cleft lip and cleft palate as well as nervous and circulatory system anomalies, whereas the least researched CAs were chromosomal abnormalities, digestive anomalies and urinary system anomalies. The review reported discrepancies in CA rates across the region, ranging from 2.5 to 68.7 per 1000 live births for multiple anomalies. Few studies explored the association between CAs and risk factors; the main factors reported were advanced maternal age, maternal diabetes and consanguinity.

CONCLUSIONS

This review summarises the heightened prevalence of CAs in the GCC countries, discrepancies in estimates and gaps in research on specific anomalies. Future research is warranted to explore the association between CAs and various risk factors, thereby enabling the development of targeted preventive strategies.

Public Awareness and Perceptions of Congenital Disabilities in Saudi Arabia: A Cross-Sectional Study

Objective

This cross-sectional study aimed to assess the public awareness, knowledge, and perception of congenital disabilities in Saudi Arabia, with a focus on identifying demographic factors that influence these perceptions.

Methods

A structured questionnaire was distributed to 1007 participants across various regions of Saudi Arabia. The questionnaire covered demographic information, knowledge of congenital disabilities, awareness of genetic and pharmacological risk factors, and engagement in preventive practices. Statistical analysis included descriptive statistics, correlation coefficients, and general linear modeling to understand the impact of demographic variables on awareness and preventive behaviors.

Results

The study showed moderate public awareness and knowledge about congenital disabilities, with 49.6% of respondents acknowledging awareness and only 8.3% demonstrating excellent understanding. Perceived risks associated with genetic and environmental factors were recognized by over half of the participants. The awareness did not consistently translate into engagement in preventive practices, which remained suboptimal across the population. Demographic factors such as age and having children significantly influenced both risk perception and engagement in preventive behaviors.

Conclusion

Despite moderate levels of awareness, there remains a significant gap in comprehensive knowledge and active engagement in preventive practices against congenital disabilities in Saudi Arabia. The findings suggest the need for targeted educational programs and public health initiatives to enhance understanding and proactive management of risk factors associated with congenital disabilities. These efforts should particularly focus on younger populations and those without children, where risk perception and engagement were lower.

Integrating Prenatal Exome Sequencing and Ultrasonographic Fetal Phenotyping for Assessment of Congenital Malformations: High Molecular Diagnostic Yield and Novel Phenotypic Expansions in a Consanguineous Cohort

To evaluate the diagnostic yield of prenatal exome sequencing (pES) in fetuses with structural anomalies detected by prenatal ultrasound in a consanguineous population. This was a prospective study of 244 anomalous fetuses from unrelated consanguineous Egyptian families. Detailed phenotyping was performed throughout pregnancy and postnatally, and pES data analysis was conducted. Genetic variants were prioritized based on the correlation of their corresponding human phenotype ontology terms with the ultrasound findings. Analyses were carried out to determine the diagnostic efficiency of pES and its correlation to the organ systems involved. The largest clinical category of fetuses referred for pES was those manifesting multisystem anomalies (104/244, 42.6%). pES provided a definitive diagnosis explaining the fetal anomalies in 47.1% (115/244) of the cases, with the identification of 122 pathogenic or likely pathogenic variants completely fitting with the phenotype. Variants of uncertain significance associated with the fetal phenotypes were detected in 84 fetuses (34%), while 18.44% (45/244) had negative results. Positive consanguinity is associated with a high diagnostic yield of ES. The novel variants and new fetal manifestations, described in our cohort, further expand the mutational and phenotypic spectrum of a wide variety of genetic disorders presenting with congenital malformations.

Live birth prevalence of major congenital anomalies in the United Arab Emirates

Major congenital anomalies (MCAs) significantly contribute to perinatal mortality and morbidity. Globally, the United Arab Emirates has the sixth-highest prevalence rate of congenital anomalies. The lack of clear baseline prevalence data for MCAs impedes the development of interventions to alleviate this burden. This study aimed to estimate the live birth prevalence of perinatally diagnosed MCAs in a sample of the Emirati population. The analysis was based on a cohort of all singleton live births in the Mutaba'ah study. Minor anomalies were excluded and the live birth prevalence of MCAs was estimated as the number of affected births per 1000 live births. Among 4034 singleton live births, 284 neonates were diagnosed with at least one MCAs, corresponding to a live birth prevalence of 70.4/1000 live births (95% confidence interval: 62.7-78.7). Of the 284 neonates, 86% presented with single-system anomalies, while 14% displayed multi-system involvement. The circulatory system was predominately affected (21.3/1000), followed by the urinary, genital, and musculoskeletal systems. Within the circulatory system, anomalies of cardiac septa (88.6%) and great arteries (70.2%) were the most prevalent. The findings indicate a relatively high live birth prevalence of MCAs. Further studies are needed to identify risk factors and explore screening and prevention strategies.

Exploring Differentially Methylated Genes among Preterm Birth and Full-Term Birth

INTRODUCTION

Preterm birth (PTB) is a major contributor to neonatal morbidity and mortality. DNA methylation plays a critical role in fetal development and may serve as an epigenetic biomarker for PTB. However, few epigenetic studies have investigated PTB-specific DNA methylation changes. This study aimed to identify epigenetic differences between PTB and term birth (TB) infants.

METHODS

A total of 218 cord blood samples from three independent PTB studies were analyzed to identify epigenetic differences between PTB and TB infants. Differential methylation analysis was conducted while adjusting for key covariates, including gestational age, sex, and disease status. Differentially methylated regions (DMRs) (genes and promoters) and differentially methylated sites (DMSs) (CpG sites) were assessed for significant methylation differences between the two groups.

RESULTS

In PTB infants, several genes, including RNASE3, HGF, CLEC5A, LIPN, NXF1, and CCDC12 showed significant hypermethylation (p < 0.05), while the MUC20 and IFNL4 genes showed significant hypomethylation (p < 0.05). The eForge analysis revealed that hypermethylated (p < 0.05) CpG sites were significantly enriched in different fetal tissues such as the small and large intestines, adrenal gland, fetal heart, lungs, and kidney, whereas hypomethylated CpGs showed no significant enrichment. Gene ontology analysis indicated that differentially methylated genes were primarily involved in immune response regulation. Notably, S100A9 and S100A8 genes, which play crucial roles in neonatal immune function and sepsis risk, were hypermethylated (p < 0.05) in PTB infants.

CONCLUSION

This study identified PTB-associated DNA methylation changes in immune-related genes, suggesting their potential epigenetic biomarkers for PTB. These findings enhance our understanding of PTB pathogenesis and may contribute to the development of novel diagnostic and therapeutic strategies.

Amniotic fluid-derived stem cells: potential factories of natural and mimetic strategies for congenital malformations

BACKGROUND

Mesenchymal stem cells (MSCs) derived from gestational tissues offer a promising avenue for prenatal intervention in congenital malformations although their application is hampered by concerns related to cellular plasticity and the need for invasive, high-risk surgical procedures. Here, we present naturally occurring exosomes (EXOs) isolated from amniotic fluid-derived MSCs (AF-MSCs) and their mimetic analogs (MIMs) as viable, reproducible, and stable alternatives. These nanovesicles present a minimally invasive therapeutic option, addressing the limitations of MSC-based treatments while retaining therapeutic efficacy.

METHODS

MIMs were generated from AF-MSCs by combining sequential filtration steps through filter membranes with different porosity and size exclusion chromatography columns. A physicochemical, structural, and molecular comparison was conducted with exosomes (EXOs) released from the same batch of cells. Additionally, their distribution patterns in female mice were evaluated following in vivo administration, along with an assessment of their safety profile throughout gestation in a mouse strain predisposed to neural tube defects (NTDs). The possibility to exploit both formulations as mRNA-therapeutics was explored by evaluating cell uptake in two different cell types(fibroblasts, and macrophages) and mRNA functionality overtime in an in vitro experimental setting as well as in an ex vivo, whole embryo culture using pregnant C57BL6 dams.

RESULTS

Molecular and physiochemical characterization showed no differences between EXOs and MIMs, with MIMs determining a threefold greater yield. Biodistribution patterns following intraperitoneal administration were comparable between the two particle types, with the uterus being among targeted organs. No toxic effects were observed in the dams during gestation, nor were there any malformations or significant differences in the number of viable versus dead fetuses detected. MIMs delivered a more intense and prolonged expression of mRNA encoding for green fluorescent protein in macrophages and fibroblasts. An ex-vivo whole embryo culture demonstrated that MIMs mainly accumulate at the level of the yolk sac, while EXOs reach the embryo.

CONCLUSIONS

The present data confirms the potential application of EXOs and MIMs as suitable tools for prevention and treatment of NTDs and proposes MIMs as prospective vehicles to prevent congenital malformations caused by in utero exposure to drugs.

Maternal and neonatal risks and outcomes after bariatric surgery: a comparative population based study across BMI categories in Qatar

The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18-2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06-2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33-15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153-2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09-2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23-2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women.

Precision medicine activities and opportunities for shaping maternal and neonatal health in Qatar

Precision Medicine (PM) is a transformative clinical medicine strategy that aims to revolutionize healthcare by leveraging biological information and biomarkers. In the context of maternal and neonatal health, PM enables personalized care from preconception through the postnatal period. Qatar has emerged as a key player in PM research, with dedicated programs driving advancements and translating cutting-edge research into clinical applications. This article delves into neonatal and maternal health in Qatar, emphasizing PM programs and initiatives that have been implemented. It also features noteworthy clinical cases that demonstrate the effectiveness of precision interventions. Furthermore, the article highlights the role of pharmacogenomics in addressing various maternal health conditions. The review further explores potential advancements in the application of PM in maternal and neonatal healthcare in Qatar.

The effect of folic acid intake on congenital anomalies. A systematic review and meta-analysis

Background

Congenital anomalies pose a significant challenge to global health and result in considerable morbidity and mortality in early childhood. With the decline of other causes of death among children under five, the burden of congenital anomalies is rising, emphasizing the need for improved prenatal care, screening, and nutrition for pregnant women. This systematic review and meta-analysis aim to estimate the pooled effect of folic acid intake on congenital anomalies.

Methods

To identify relevant research published up until December 30/2023, we conducted electronic searches of PubMed/Medline, PubMed Central, Hinary, Google, African Journals Online, Web of Science, Science Direct, and Google Scholar databases using predefined eligibility criteria. We used Excel to extract data and evaluated the studies using the JBI appraisal checklist. We computed the pooled effect size with 95% confidence intervals for maternal folic acid intake on congenital anomalies using STATA version 17 and the DerSimonian and Laird random effects meta-analysis model. We assessed statistical heterogeneity using Cochran's Q-test, I 2 statistic, and visual examination of the funnel plot.

Results

The review included 16 case-control, cohort, and cross-sectional studies. According to the results of this systematic review and meta-analysis, maternal folic acid intake significantly lowers the incidence of congenital anomalies (odds ratio (OR), 0.23; confidence interval (CI), 0.16, 0.32). Among the included studies, both the Cochrane Q-test statistic (χ2 = 118.82, p < 0.001) and I 2 test statistic (I 2 = 87.38%, p < 0.001) revealed statistically significant heterogeneity. Egger's weighted regression (p < 0.001) and funnel plot show evidence of publication bias in this meta-analysis.

Conclusion

The results of the recent meta-analysis and systematic review have demonstrated a significant association between maternal folic acid intake and the risk of congenital anomalies. Specifically, children whose mothers received periconceptional folic acid supplementation had a 77% reduced risk of congenital anomalies. To further investigate the correlation between maternal folic acid supplementation and the occurrence of various congenital anomalies, particularly in developing countries, it is recommended that a comprehensive prospective study be conducted.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42024511508).

Hyperemesis gravidarum and the risk of offspring morbidity: a longitudinal cohort study

PURPOSE

Hyperemesis gravidarum has the potential to affect the long-term health of offspring. We examined whether maternal hyperemesis gravidarum was associated with the risk of hospitalization for childhood morbidity.

METHODS

We conducted a longitudinal cohort study of 1,189,000 children born in Quebec, Canada, between April 2006 and March 2021. The main exposure measure was maternal hyperemesis gravidarum requiring hospitalization in the first or second trimester. The outcome was any pediatric admission between birth and 16 years of age, with follow-up ending in March 2022. We used Cox regression models adjusted for maternal and socioeconomic factors to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal hyperemesis gravidarum and childhood hospitalization.

RESULTS

Among 1,189,000 children, 6904 (0.6%) were exposed to maternal hyperemesis gravidarum. Hospitalization rates at age 16 years were higher for children exposed to hyperemesis gravidarum than unexposed children (47.6 vs 43.9 per 100 children). Relative to no exposure, hyperemesis gravidarum was associated with a 1.21 times greater risk of any hospitalization before 16 years (95% CI 1.17-1.26). Hyperemesis gravidarum was associated with hospitalization for neurologic (HR 1.50, 95% CI 1.32-1.71), developmental (HR 1.51, 95% CI 1.29-1.76), digestive (HR 1.40, 95% CI 1.30-1.52), and allergic disorders (HR 1.39, 95% CI 1.24-1.56). When contrasted with preeclampsia, hyperemesis gravidarum was a stronger risk factor for these outcomes.

CONCLUSIONS

Maternal hyperemesis gravidarum is associated with an increased risk of childhood hospitalization, especially for neurologic, developmental, digestive, and atopic disorders.

WHAT IS KNOWN

• Hyperemesis gravidarum is associated with neurodevelopmental disorders in offspring. • However, the effect of hyperemesis gravidarum on other childhood morbidity is unclear.

WHAT IS NEW

• In this longitudinal cohort study of 1.2 million children, maternal hyperemesis gravidarum was associated with a greater risk of hospitalization before age 16 years. • Exposure to hyperemesis gravidarum was associated with developmental, neurologic, atopic, and digestive morbidity in childhood.

Amniotic fluid-derived stem cells: potential factories of natural and mimetic strategies for congenital malformations

Background

Mesenchymal stem cells (MSCs) from gestational tissues represent promising strategies for in utero treatment of congenital malformations, but plasticity and required high-risk surgical procedures limit their use. Here we propose natural exosomes (EXOs) isolated from amniotic fluid-MSCs (AF-MSCs), and their mimetic counterparts (MIMs), as valid, stable, and minimally invasive therapeutic alternatives.

Methods

MIMs were generated from AF-MSCs by combining sequential filtration steps through filter membranes with different porosity and size exclusion chromatography columns. Physiochemical and molecular characterization was performed to compare them to EXOs released from the same number of cells. The possibility to exploit both formulations as mRNA-therapeutics was explored by evaluating cell uptake (using two different cell types, fibroblasts, and macrophages) and mRNA functionality overtime in an in vitro experimental setting as well as in an ex vivo, whole embryo culture using pregnant C57BL6 dams.

Results

Molecular and physiochemical characterization showed no differences between EXOs and MIMs, with MIMs determining a 3-fold greater yield. MIMs delivered a more intense and prolonged expression of mRNA encoding for green fluorescent protein (GFP) in macrophages and fibroblasts. An ex-vivo whole embryo culture demonstrated that MIMs mainly accumulate at the level of the yolk sac, while EXOs reach the embryo.

Conclusions

The present data confirms the potential application of EXOs for the prenatal repair of neural tube defects and proposes MIMs as prospective vehicles to prevent congenital malformations caused by in utero exposure to drugs.

Social determinants of gastrointestinal malformation mortality in Brazil: a national study

Introduction

In Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and socioeconomic factors in Brazil.

Methods

GICM admissions (Q39-Q45) between 2012 and 2019 were collected using national databases. Patient demographics, socioeconomic factors, clinical management, outcomes, and the healthcare workforce density were also accounted for. Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed 'NeoSurg'. Socioeconomic variables were combined to create a socioeconomic index termed 'SocEcon'. Simple linear regression was used to investigate if the temporal changes of both indexes were significant. The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient.

Results

Over 8 years, Brazil recorded 12804 GICM admissions. The Southeast led with 6147 cases, followed by the Northeast (2660), South (1727), North (1427), and Midwest (843). The North and Northeast reported the highest mortality, lowest NeoSurg, and SocEcon Index rates. Nevertheless, mortality rates declined across regions from 7.7% (2012) to 3.9% (2019), a 51.7% drop. The North and Midwest experienced the most substantial reductions, at 63% and 75%, respectively. Mortality significantly correlated with the indexes in nearly all regions (p<0.05).

Conclusion

Our study highlights the correlation between social determinants of health and GICM mortality in Brazil, using two novel indexes in the pediatric population. These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.

Autonomous fetal morphology scan: deep learning + clustering merger - the second pair of eyes behind the doctor

The main cause of fetal death, of infant morbidity or mortality during childhood years is attributed to congenital anomalies. They can be detected through a fetal morphology scan. An experienced sonographer (with more than 2000 performed scans) has the detection rate of congenital anomalies around 52%. The rates go down in the case of a junior sonographer, that has the detection rate of 32.5%. One viable solution to improve these performances is to use Artificial Intelligence. The first step in a fetal morphology scan is represented by the differentiation process between the view planes of the fetus, followed by a segmentation of the internal organs in each view plane. This study presents an Artificial Intelligence empowered decision support system that can label anatomical organs using a merger between deep learning and clustering techniques, followed by an organ segmentation with YOLO8. Our framework was tested on a fetal morphology image dataset that regards the fetal abdomen. The experimental results show that the system can correctly label the view plane and the corresponding organs on real-time ultrasound movies.Trial registrationThe study is registered under the name "Pattern recognition and Anomaly Detection in fetal morphology using Deep Learning and Statistical Learning (PARADISE)", project number 101PCE/2022, project code PN-III-P4-PCE-2021-0057. Trial registration: ClinicalTrials.gov, unique identifying number NCT05738954, date of registration 02.11.2023.

Pattern Recognition and Anomaly Detection in fetal morphology using Deep Learning and Statistical learning (PARADISE): protocol for the development of an intelligent decision support system using fetal morphology ultrasound scan to detect fetal congenital anomaly detection

INTRODUCTION

Congenital anomalies are the most encountered cause of fetal death, infant mortality and morbidity. 7.9 million infants are born with congenital anomalies yearly. Early detection of congenital anomalies facilitates life-saving treatments and stops the progression of disabilities. Congenital anomalies can be diagnosed prenatally through morphology scans. A correct interpretation of the morphology scan allows a detailed discussion with the parents regarding the prognosis. The central feature of this project is the development of a specialised intelligent system that uses two-dimensional ultrasound movies obtained during the standard second trimester morphology scan to identify congenital anomalies in fetuses.

METHODS AND ANALYSIS

The project focuses on three pillars: committee of deep learning and statistical learning algorithms, statistical analysis, and operational research through learning curves. The cross-sectional study is divided into a training phase where the system learns to detect congenital anomalies using fetal morphology ultrasound scan, and then it is tested on previously unseen scans. In the training phase, the intelligent system will learn to answer the following specific objectives: (a) the system will learn to guide the sonographer's probe for better acquisition; (b) the fetal planes will be automatically detected, measured and stored and (c) unusual findings will be signalled. During the testing phase, the system will automatically perform the above tasks on previously unseen videos.Pregnant patients in their second trimester admitted for their routine scan will be consecutively included in a 32-month study (4 May 2022-31 December 2024). The number of patients is 4000, enrolled by 10 doctors/sonographers. We will develop an intelligent system that uses multiple artificial intelligence algorithms that interact between themselves, in bulk or individual. For each anatomical part, there will be an algorithm in charge of detecting it, followed by another algorithm that will detect whether anomalies are present or not. The sonographers will validate the findings at each intermediate step.

ETHICS AND DISSEMINATION

All protocols and the informed consent form comply with the Health Ministry and professional society ethics guidelines. The University of Craiova Ethics Committee has approved this study protocol as well as the Romanian Ministry of Research Innovation and Digitization that funded this research. The study will be implemented and reported in line with the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) statement.

TRIAL REGISTRATION NUMBER

The study is registered under the name 'Pattern recognition and Anomaly Detection in fetal morphology using Deep Learning and Statistical Learning', project number 101PCE/2022, project code PN-III-P4-PCE-2021-0057.

TRIAL REGISTRATION

ClinicalTrials.gov, unique identifying number NCT05738954, date of registration: 2 November 2023.

Epidemiological trends of isolated and non-isolated central nervous system congenital malformations in live births in a middle-income setting

OBJECTIVES

This study aimed to analyze, in the São Paulo state of Brazil, time trends in prevalence, neonatal mortality, and neonatal lethality of central nervous system congenital malformations (CNS-CM) between 2004 and 2015.

METHODS

Population-based study of all live births with gestational age ≥22 weeks and/or birthweight ≥400 g from mothers living in São Paulo State, during 2004-2015. CNS-CM was defined by the presence of International Classification Disease 10th edition codes Q00-Q07 in the death and/or live birth certificates. CNS-CM was classified as isolated (only Q00-Q07 codes), and non-isolated (with congenital anomalies codes nonrelated to CNS-CM). CNS-CM associated neonatal death was defined as death between 0 and 27 days after birth in infants with CNS-CM. CNS-CM prevalence, neonatal mortality, and lethality rates were calculated, and their annual trends were analyzed by Prais-Winsten Model. The annual percent change (APC) with 95% confidence interval (95%CI) was obtained.

RESULTS

7,237,628 live births were included in the study and CNS-CM were reported in 7526 (0.1%). CNS-CM associated neonatal deaths occurred in 2935 (39.0%). Isolated CNS-CM and non-isolated CNS-CM were found respectively in 5475 and 2051 livebirths, with 1525 (28%) and 1410 (69%) neonatal deaths. CNS-CM prevalence and neonatal lethality were stationary, however neonatal mortality decreased (APC -1.66; 95%CI -3.09 to -0.21) during the study. For isolated CNS-CM, prevalence, neonatal mortality, and lethality decreased over the period. For non-isolated CNS-CM, the prevalence increased, neonatal mortality was stationary, and lethality decreased during the period. The median time of CNS-CM associated neonatal deaths was 18 h after birth.

CONCLUSIONS

During a 12-year period in São Paulo State, Brazil, neonatal mortality of infants with CNS-CM in general and with isolated CNS-CM showed a decreasing pattern. Nevertheless CNS-CM mortality remained elevated, mostly in the first day after birth.