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Wright M, Cortina-Borja M, Knowles R, Urquhart DS. Global birth prevalence of Robin sequence in live-born infants: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:230133. [PMID: 38056889 DOI: 10.1183/16000617.0133-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
Robin sequence (RS), a congenital disorder of jaw maldevelopment and glossoptosis, poses a substantial healthcare burden and has long-term health implications if airway obstruction is suboptimally treated. This study describes the global birth prevalence of RS and investigates whether prevalence estimates differ by geographical location, ethnicity or study data source (registry versus non-registry data). The protocol was prospectively registered with PROSPERO.Databases were searched using keywords and subject terms for "Robin sequence", "epidemiology", "incidence" and "birth prevalence". Meta-analysis was performed fitting random effects models with arcsine transformation.From 34 eligible studies (n=2722 RS cases), pooled birth prevalence was 9.5 per 100 000 live births (95% CI 7.1-12.1) with statistical heterogeneity. One third of studies provided a case definition for RS and numerous definitions were used. A total of 22 countries were represented, predominantly from European populations (53% of studies). There was a trend towards higher birth prevalence in European populations and lower prevalence from registry-based studies. Only two studies reported ethnicity.This study indicates that RS occurs globally. To investigate geographical differences in prevalence, additional studies from non-European populations and reporting of ethnicity are needed. Heterogeneity of estimates may be due to variable diagnostic criteria and ascertainment methods. Recently published consensus diagnostic criteria may reduce heterogeneity among future studies.
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Affiliation(s)
- Marie Wright
- Division of Respiratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Knowles
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Dude AM, Badreldin N, Schieler A, Yee LM. Periconception glycemic control and congenital anomalies in women with pregestational diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e001966. [PMID: 33888543 PMCID: PMC8070859 DOI: 10.1136/bmjdrc-2020-001966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION To assess the relationship between periconception glycemic control and congenital anomalies in a contemporary, diverse population of women with pregestational diabetes. RESEARCH DESIGN AND METHODS This is a retrospective cohort study of all pregnant women with pregestational diabetes at a single institution (2003-2017) in the USA. The primary outcome was frequency of major or minor congenital anomalies. Glycemic control was assessed by periconception glycosylated hemoglobin (HbA1c). The association of periconception HbA1c with pregnancy outcomes was assessed using bivariable and multivariable analyses. RESULTS Our sample included 351 women, of which 63.8% had type 2 diabetes. Our study cohort is racially and ethnically diverse, with approximately equal numbers of women identifying as white non-Hispanic, black non-Hispanic and Hispanic, with 3.4% identifying as Asian. Of these 351 women, 52 (14.8%) had a fetus with a congenital anomaly, of whom the majority (n=43) had a major anomaly. Over half (51.1%) of all major anomalies were cardiovascular. Compared with the group with the best glycemic control (HbA1c ≤7.4%), which had an anomaly frequency of 10.2%, the frequency of congenital anomalies increased significantly with each category of worsening glycemic control (HbA1c 7.5%-9.4%: 20.6%, adjusted OR (aOR) 2.35, 95% confidence interval (CI) 1.08 to 5.13; HbA1c 9.5% to 11.4%: 25.8%, aOR 2.86, 95% CI 1.08 to 7.59; HbA1c ≥11.5%: 37.5%, aOR 7.66, 95% CI 2.27 to 25.9). CONCLUSION In a diverse cohort of women with pregestational diabetes, higher periconception HbA1c, especially HbA1c >9.5, was significantly associated with major congenital fetal anomalies. Our study sample is reflective of the current population of pregnant women with diabetes, including women with type 2 diabetes and from racial and ethnic minorities.
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Affiliation(s)
- Annie M Dude
- Department of Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Nevert Badreldin
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amanda Schieler
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M Yee
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Paolini SL, Pilato M, Rajasekaran V, Waters JFR, Bagic A, Urban A. Outcomes in three cases after brivaracetam treatment during pregnancy. Acta Neurol Scand 2020; 141:438-441. [PMID: 31943124 DOI: 10.1111/ane.13222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Use of certain antiseizure drugs (ASDs) during pregnancy increases the risk of major congenital malformations, while less is known about newer ASDs. Based on the safety of levetiracetam, brivaracetam may be similarly safe in pregnancy; however, no cases have been published to date. AIMS OF THE STUDY We retrospectively identified three women with epilepsy treated with brivaracetam during pregnancy and described the maternal and neonatal outcomes. METHODS We reviewed the patients' medical records as well as the linked medical records of their infants to identify complications during pregnancy and delivery, neonatal complications, and evidence of major/minor congenital malformations. RESULTS Our series included one woman with idiopathic generalized epilepsy and two women with focal epilepsy (brivaracetam doses ranging from 50 to 200 mg daily). One patient with focal epilepsy experienced breakthrough seizures, and lamotrigine was added to brivaracetam. The other women had no neurologic complications during pregnancy. All three women had full-term deliveries without significant complications. Three healthy infants were born with Apgar scores of 9 and 9 and no major congenital malformations. Three minor congenital malformations were observed in two infants. CONCLUSIONS While the absence of major congenital malformations in these cases is encouraging, further data are needed to determine the safety of brivaracetam in pregnancy.
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Affiliation(s)
- Stephanie L. Paolini
- Department of Neurology University of Pittsburgh Medical Center Pittsburgh PA USA
- Department of Neurology University of South Carolina School of Medicine Columbia SC USA
| | - Madison Pilato
- Department of Neurology University of Pittsburgh Medical Center Pittsburgh PA USA
| | | | - Janet F. R. Waters
- Department of Neurology University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Anto Bagic
- Department of Neurology University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Alexandra Urban
- Department of Neurology University of Pittsburgh Medical Center Pittsburgh PA USA
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Toufaily MH, Westgate MN, Nasri H, Holmes LB. Malformations among 289,365 Births Attributed to Mutations with Autosomal Dominant and Recessive and X-Linked Inheritance. Birth Defects Res 2018; 110:92-97. [PMID: 29377642 DOI: 10.1002/bdr2.1101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The number of malformations attributed to mutations with autosomal or X-linked patterns of inheritance has increased steadily since the cataloging began in the 1960s. These diagnoses have been based primarily on the pattern of phenotypic features among close relatives. A malformations surveillance program conducted in consecutive pregnancies can identify both known and "new" hereditary disorders. METHODS The Active Malformations Surveillance Program was carried out among 289,365 births over 41 years (1972-2012) at Brigham and Women's Hospital in Boston. The findings recorded by examining pediatricians and all consultants were reviewed by study clinicians to establish the most likely diagnoses. The findings in laboratory testing in the newborn period were reviewed, as well. RESULTS One hundred ninety-six (0.06%) infants among 289,365 births had a malformation or malformation syndrome that was attributed to Mendelian inheritance. A total of 133 (68%) of the hereditary malformations were attributed to autosomal dominant inheritance, with 94 (71%) attributed to apparent spontaneous mutations. Forty-six (23%) were attributed to mutations with autosomal recessive inheritance, 17 associated with consanguinity. Seventeen (9%) were attributed to X-linked inheritance. Fifteen novel familial phenotypes were identified. The family histories showed that most (53 to 71%) of the affected infants were born, as a surprise, to healthy, unaffected parents. CONCLUSION It is important for clinicians to discuss with surprised healthy parents how they can have an infant with an hereditary condition. Future studies, using DNA samples from consecutive populations of infants with malformations and whole genome sequencing, will identify many more mutations in loci associated with mendelizing phenotypes. Birth Defects Research 110:92-97, 2018.© 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- M Hassan Toufaily
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston
| | - Marie-Noel Westgate
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston
| | - Hanah Nasri
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston
| | - Lewis B Holmes
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Holmes LB, Nasri H, Westgate MN, Toufaily MH, Lin AE. The Active Malformations Surveillance Program, Boston in 1972-2012: Methodology and demographic characteristics. Birth Defects Res 2018; 110:148-156. [DOI: 10.1002/bdr2.1156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Lewis B. Holmes
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - Hanah Nasri
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - Marie-Noel Westgate
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - M. Hassan Toufaily
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - Angela E. Lin
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
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Thomas EG, Higgins C, Westgate MN, Lin AE, Anderka M, Holmes LB. Malformations Surveillance: Comparison between Findings at Birth and Age 1 Year. Birth Defects Res 2017; 110:142-147. [PMID: 28796462 DOI: 10.1002/bdr2.1096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/07/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Malformations surveillance programs among newborn infants are used to determine the prevalence of congenital anomalies. A comparison in the same group of infants between the malformations detected at birth and those detected at 1 year of age will identify errors in the surveillance process and, also, the abnormalities more likely not to be detected at birth, but later in the first year of life. METHODS The malformations identified at birth by Brigham and Women's Hospital (BWH) in the years 2000 and 2005 have been compared with the abnormalities detected in the same infants up to age 1 year by the Massachusetts Birth Defects Monitoring Program. RESULTS The Massachusetts Birth Defects Monitoring Program identified 557 malformed infants in 2000 and 415 in 2005. Of these, 34 (3.5%) of the malformed infants were missed at birth by BWH Surveillance Program. An additional 22 (2.3%) malformed infants had delayed detection, as they were identified later in the first year. The reasons were the fact that: (1) the Surveillance staff reviewed the physicians' recorded findings only on the first day of life; (2) failure of the examining pediatrician to record the presence of a malformation in her/his notes. The most common abnormalities with delayed detection were mild heart defects, such as atrial septal defects. CONCLUSION These findings emphasize the importance in a newborn malformations surveillance program of continued follow up in the first days of life, especially in small, premature infants. Birth Defects Research 110:142-147, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Emma G Thomas
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Cathleen Higgins
- The Birth Defects Monitoring Program, Massachusetts Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts
| | - Marie-Noel Westgate
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Angela E Lin
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts.,The Birth Defects Monitoring Program, Massachusetts Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Marlene Anderka
- The Birth Defects Monitoring Program, Massachusetts Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts
| | - Lewis B Holmes
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Holmes LB, Westgate MN. Inclusion and exclusion criteria for malformations in newborn infants exposed to potential teratogens. ACTA ACUST UNITED AC 2011; 91:807-12. [PMID: 21800414 DOI: 10.1002/bdra.20842] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/23/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The surveillance of newborn infants exposed to potential teratogens often relies on the findings in routine physicians' examinations to identify malformations. Exposed newborn infants can have a wide variety of physical features, including malformations, birth marks, positional deformities, and minor anomalies. The routine physician's findings are not standardized. Some physicians record a wide variety of physical features and others do not. The purpose of this study was to develop criteria and definitions for identifying malformations and for identifying the more common and less severe physical features that would be excluded as not being malformations. METHODS The physical features recorded by the examining pediatricians were obtained from a review of the medical records of a consecutive sample of 1000 liveborn and stillborn infants and elective terminations for fetal anomalies. RESULTS A malformation, defined as a structural abnormality with surgical, medical or cosmetic importance, was present in 18 (2.8%) of the infants; 222 other recorded features were identified and excluded: malformations attributed to dominant or recessive genes (4) or chromosome abnormalities (6), minor anomalies and normal variations (65), birth marks (110), positional deformities (6), prematurity-related features (5), physiologic findings (4) and findings identified by prenatal ultrasound (but not by the examining pediatrician) (20), functional abnormalities (1) and findings in newborn screening (1). CONCLUSIONS Investigators should establish, in advance, the exclusion criteria to be used in programs, such as malformation surveillance programs or pregnancy registries, whose findings are based on a review of the routine examinations in medical records. It is essential that the same criteria be used in evaluating the drug-exposed and the unexposed comparison group.
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Affiliation(s)
- Lewis B Holmes
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02114, USA.
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Manyando C, Mkandawire R, Puma L, Sinkala M, Mpabalwani E, Njunju E, Gomes M, Ribeiro I, Walter V, Virtanen M, Schlienger R, Cousin M, Chipimo M, Sullivan FM. Safety of artemether-lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia. Malar J 2010; 9:249. [PMID: 20809964 PMCID: PMC2944339 DOI: 10.1186/1475-2875-9-249] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 09/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Safety data regarding exposure to artemisinin-based combination therapy in pregnancy are limited. This prospective cohort study conducted in Zambia evaluated the safety of artemether-lumefantrine (AL) in pregnant women with malaria. METHODS Pregnant women attending antenatal clinics were assigned to groups based on the drug used to treat their most recent malaria episode (AL vs. sulphadoxine-pyrimethamine, SP). Safety was assessed using standard and pregnancy-specific parameters. Post-delivery follow-up was six weeks for mothers and 12 months for live births. Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth). RESULTS Data from 1,001 pregnant women (AL n = 495; SP n = 506) and 933 newborns (AL n = 466; SP n = 467) showed: perinatal mortality (AL 4.2%; SP 5.0%), comprised of early neonatal mortality (each group 2.3%), stillbirths (AL 1.9%; SP 2.7%); preterm deliveries (AL 14.1%; SP 17.4% of foetuses); and gestational age-adjusted low birth weight (AL 9.0%; SP 7.7%). Infant birth defect incidence was 1.8% AL and 1.6% SP, excluding umbilical hernia. Abortions prior to antenatal care could not be determined: abortion occurred in 4.5% of women treated with AL during their first trimester; none were reported in the 133 women exposed to SP and/or quinine during their first trimester. Overall development (including neurological assessment) was similar in both groups. CONCLUSIONS These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment. However, more data are required on AL use during the first trimester.
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Affiliation(s)
| | | | | | | | - Evans Mpabalwani
- Department of Pediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Eric Njunju
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Melba Gomes
- World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | - Frank M Sullivan
- Former Senior Lecturer, Department of Pharmacology and Toxicology, United Medical Schools of Guy's and St Thomas' Hospitals, University of London, London, UK
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Pluchinotta FR, Memo L. Nursery care of the newborn with malformation syndrome. Early Hum Dev 2009; 85:S63-5. [PMID: 19783387 DOI: 10.1016/j.earlhumdev.2009.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital malformations are not so rare, and represent a relevant challenge to health care providers. We delineate a methodology for the clinical approach to the malformed newborn, that takes into account the needs of the patient as single person and as part of a familiar and social context. We consider first the medical problem that the neonatologists face in the nursery and neonatal intensive care unit regarding clinical assistance, diagnosis, parent counselling and hospital discharge. Then we focus on the periodic follow-up, and the role of the primary care physician and the specialist in the assistance of this patients.
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Abstract
Improvements in nutrition, sanitation, housing, and medical care have been associated with reductions in infectious diseases of infancy, such as diarrhea, and, concomitantly, with a decline in infant mortality. Although deaths from congenital abnormalities have also decreased, the rate of their decline has not kept pace with the overall rate. Thus in the United States they have become the most frequent cause of infant death (58). For abnormalities detected in the newborn period, which comprise 3% of all births, about 8 per cent are due to single gene disorders, 6 to 12% to chromosome abnormalities, and less than 5% to viral infections of the mother (39,69). Little is known about underlying causes in the remainder; polygenic factors, environmental agents, and, probably the most common, genetic-environmental interactions, account for them. Congenital abnormalities also contribute substantially to childhood hospitalizations in several developed countries (17). One chromosome disorder, Down's syndrome, accounts for about 16 to 30% of all severe mental retardation, with other genetic and chromosome disorders contributing another 15 to 20% (58). Although the incidence of congenital abnormalities differs to some extent geographically (39), it seems likely that as any country develops, the proportion of infant mortality and childhood disability due to congenital abnormalities will increase.
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Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units. J Perinatol 2008; 28:297-302. [PMID: 18046336 DOI: 10.1038/sj.jp.7211904] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Current scoring systems, which adjust prediction for severity of illness, do not account for higher observed mortality in neonatal intensive care units (NICUs) of children's hospitals than that of perinatal centers. We hypothesized that three potential predictors, (a) admission from another NICU, (b) presence of congenital anomalies and (c) need for surgery, would modify expected mortality and/or length of stay for infants admitted to NICUs in children's hospitals. STUDY DESIGN We reviewed consecutive admissions to two NICUs in children's hospitals in Canada. We performed regression analyses to evaluate these potential predictors and severity-of-illness indices for the outcomes of mortality and length of stay. RESULT Of 625 neonatal admissions, transfer from another NICU, congenital anomalies requiring admission and surgery were identified in 371 (59%). Using logistic regression, mortality was predicted based on admission from another NICU (odds ratio (OR) 1.92; 95% confidence interval (CI) 1.04, 3.57), congenital anomalies (OR 7.28; 95% CI 3.69, 14.36) and a validated severity-of-illness score, the Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE-II; OR 1.07; 95% CI 1.05, 1.09 per point). By contrast, surgical intervention was predictive of survival (OR 0.35; 95% CI 0.18, 0.67). Length of stay >or=21 days was predicted by SNAPPE-II (OR 1.02; 95% CI 1.01, 1.03 per point), congenital anomalies (OR 2.47; 95% CI 1.60, 3.79) and surgery (OR 2.73; 95% CI 1.77, 4.21). CONCLUSION Fair performance comparisons of NICUs with different case-mixes, such as children's hospital and perinatal NICUs, in addition to severity-of-illness indices, should account for admissions from another NICU, congenital anomalies and surgery.
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Shapira SK, Dolan S. Genetic risks to the mother and the infant: assessment, counseling, and management. Matern Child Health J 2007; 10:S143-6. [PMID: 16786416 PMCID: PMC1592163 DOI: 10.1007/s10995-006-0099-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stuart K Shapira
- NCBDDD, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, Mailstop E-86, Atlanta, Georgia 30333, USA.
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Velisavljev-Filipović G. Arthrogryposis multiplex congenita - a rare congenital stiff joints syndrome. ACTA ACUST UNITED AC 2006; 59:375-9. [PMID: 17140040 DOI: 10.2298/mpns0608375v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction: Arthrogryposis multiplex congenita is not a disease but a term describing multiple congenital contractures. Etiological factors include neurological and primary myogenic diseases. This rare syndrome is present at birth and is characterized by reduced mobility of many joints. The contractures involve two or more joints with ankylosis. The accompanying musculature is hypoplastic, but multiple pterygia are also present. Arthrogryposis multiplex congenita is a heterogeneous group of disorders with the incidence rate of 6.2/100000 liveborn infants. The true incidence cannot be established, because many cases result in spontaneous miscarriages or stillbirth. More than 90% of cases are associated with birth defects. The cause of this syndrome is unknown. Many forms are not hereditary, though there are hereditary forms as well. Case report. This paper presents a case with arthrogryposis multiplex congenita. The pregnancy was not controlled regularly. During the pregnancy, oligohydramnion was detected. Due to contractures, labor ended is cesarean section. The child was born in the 34th week of gestation. Flexion and extension joint contractures were observed. Active and passive mobility of the afflicted joints was reduced. There was a limited motor function in the shoulder, elbow and wrist joints with a slight internal rotation of the shoulder joint and lower arm joints during pronation. The hips were subluxated; the feet were in equinovarus position and the fingers in ulnar deviation with partial syndactyly of the 4th and 5th fingers on the left hand. The infant had abnormal dermatoglyphics. The neck was short, and the 2nd and 3rd cervical vertebrae were fused. There was also a slight left-sided thoracic scoliosis. Trismus was present due to the existing ankylosis of the temporomandibular joint. The karyotype was normal. The serum creatinine phosphokinase was slightly elevated. The electromyographic picture indicate non-specific signs of myopathy. Discussion and conclusion. This is a case report of a "stiff joint syndrome". Due to the fact that data from the family history were unavailable, we could not establish the type of syndrome. However, heredity, growth and development at later age, as well as IQ, might significantly help in definite differentiation of this syndrome. In pregnancy, oligohydramnion should indicate more detailed ultrasonographic examination, as ankylosed joints can be detected in utero. .
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Affiliation(s)
- Gordana Velisavljev-Filipović
- Klinika za decje bolesti, Centar za neonatologiju, intenzivnu negu i prevremeno rodenu novorodencad, Odeljenje za prevremeno rodenu novorodencad, Institut za zdravstvenu zastitu dece i omladine, Novi Sad.
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Peres LC. Review of Pediatric Autopsies Performed at a University Hospital in Ribeirão Preto, Brazil. Arch Pathol Lab Med 2006; 130:62-8. [PMID: 16390240 DOI: 10.5858/2006-130-62-ropapa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Autopsy continues to provide important data for quality assurance, teaching, scientific purposes, and health planning, especially if performed according to a comprehensive protocol.
Objective.—To describe and analyze data from all perinatal and pediatric autopsies performed at a university hospital in Brazil.
Design.—Review of data from 1716 autopsies performed between April 1993 and April 1999, consisting of age at death, congenital defects, gender, and cause of death.
Results.—Age at death distribution: early neonatal deaths, 31.7%; stillbirth, 25.7%; 1 to 11 months, 19.6%; 1 to 5 years, 10.3%; late neonatal deaths, 6.3%; 11 to 15 years, 4%; 6 to 10 years, 2.5%. Cause of death: perinatal conditions, 51%; congenital malformation(s), 24.4%; infection, 11.9%; neoplasm, 3%; hematologic/immunologic, 2.3%; neurologic, 1.6%; gastrointestinal, 1.5%; cardiovascular, 0.7%; respiratory, 0.6%; genitourinary, 0.3%; other disorders, 0.5%. Gender distribution: male, 54.31%; female, 45.22%; indeterminate, 0.41%; data unavailable, 0.06%. Congenital anomalies were found in 31.5% of the autopsies and were the cause of death in 24.41% of the autopsies.
Conclusions.—High autopsy rates, combined with a comprehensive autopsy protocol, allowed the characterization of perinatal and pediatric deaths. The high proportion of perinatal deaths and stillbirths indicates the need for improvement in the prenatal care program. Congenital anomalies were highly prevalent because few pregnancies are interrupted in Brazil. The low number of cancer cases autopsied was attributed to the fact that most patients die at home, and to the high level of trust between the oncology team and the family, with the erroneous assumption that no relevant information would be provided.
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Affiliation(s)
- Luiz Cesar Peres
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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Abstract
OBJECTIVE The objective of this study was to establish the profile of major congenital malformations at Nizwa Hospital, which is a major hospital in the Al-Dakhliya region of Oman. METHODS All births with birthweight more than 500 g were prospectively studied from January 1993 through December 2002 for a period of 10 years. A congenital anomaly register was maintained in the special care baby unit (SCBU) and details of each case were recorded after parents' interviews, clinical evaluation and relevant radiological and laboratory investigations. The major malformations were classified as multiple or single-system abnormalities as well as genetic or non-genetic disorders. RESULTS Of the 21 988 births during the study period, 541 babies (24.6 per 1000 births) had major malformations. Of the 541 babies, 158 (29.2%) had multiple malformations and 335 (61.9%) had involvement of a single system. In 48 (8.9%) babies a complete evaluation was not possible. Of the cases with multiple abnormalities, 57 had recognized syndromes, of which 28 (49.1%) were autosomal recessive disorders. Seventy (12.9%) cases had chromosomal abnormalities. The most common systems involved in neonates with single-system malformations were the gastrointestinal system (100 cases), the central nervous system (79 cases) and the cardiovascular system (63 cases). Although the consanguinity rate of 53.1% among Omani births almost matched with the regional average of 52.7%, it was 76% among those with major malformations. Also, there was an increased clustering of multiple abnormalities and rare recessive disorders in cases with closely related parents and grandparents. The birth prevalence of major malformations was 14.6 per 1000 in non-Omani births as compared to 25.2 in Omani births (P < 0.05). Genetic factors could be implicated in 343 (63.4%) cases and 130 (37.9%) of these were potentially preventable. CONCLUSION Genetic disorders account for a significant proportion of congenital malformations in Oman.
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al-Gazali LI, Dawodu AH, Sabarinathan K, Varghese M. The profile of major congenital abnormalities in the United Arab Emirates (UAE) population. J Med Genet 1995; 32:7-13. [PMID: 7897633 PMCID: PMC1050171 DOI: 10.1136/jmg.32.1.7] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to establish the profile of major congenital malformations in the United Arab Emirates (UAE) population which has a high rate of consanguinity. All births with birth weight above 500 g in the three hospitals in the Al Ain Medical District of UAE were prospectively studied from January 1992 to January 1994. About 98% of the births in the district occur in these three hospitals. Detailed family history and clinical and relevant laboratory investigations were recorded in each case. Necropsy was not permitted. The major malformations were classified as multiple or isolated single system abnormalities as well as genetic or non-genetic disorders. Of the 16,419 births which occurred during the two year period, 173 (10.5/1000 births) had major malformations, 90 (52%) had multiple malformations, and 83 (47.97%) had involvement of a single system. Of the infants with multiple malformations, 43 had recognised syndromes, most of which are autosomal recessive disorders with a high frequency of rare syndromes. Twenty eight (31%) had chromosomal abnormalities. The most common systems involved in infants with isolated single system malformations include gastrointestinal (33), central nervous system (17), and cardiovascular (10). While the consanguinity rate was similar (57% v 54%), the frequency of first cousin marriages was much higher (51% v 30%) in the study group compared with the figures for the general population. The consanguinity rate was highest among the syndrome cases, and related parents were more likely to have infants with multiple malformations than an isolated single system abnormality with a relative risk of 1.69 (95% CL 1.27-2.24). Genetic factors could be implicated in 116 (67%) of the 173 cases of major malformations and 49 (28%) were potentially preventable. The study suggests that genetic disorders account for a significant proportion of congenital malformation in the UAE and, thus, a genetic service should be provided as part of the preventive cae programme.
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Affiliation(s)
- L I al-Gazali
- Department of Paediatrics, Faculty of Medicine and Health Sciences, UAE University, Al Ain
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Stoll C, Alembik Y, Dott B, Roth MP. Epidemiology of congenital eye malformations in 131,760 consecutive births. OPHTHALMIC PAEDIATRICS AND GENETICS 1992; 13:179-86. [PMID: 1484696 DOI: 10.3109/13816819209046487] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The epidemiology of eye malformations was studied in the geographical area covered by the authors' registry of congenital malformations. For each of the 78 new cases studied during the period 1979 to 1988, more than 50 factors were compared in probands and in controls. The prevalence rate of congenital eye malformations was 7.5 per 10,000 with microphthalmia 1.8, anophthalmia 0.3, cataract 2.3 and coloboma 0.7 respectively. Sex ratio was 0.82. Prenatal diagnosis was performed in ten cases and three cases were induced abortions. The more common types of associated malformations in the 42 affected cases (53.8%) with at least one anomaly other than an eye malformation were clubfeet, microcephaly, hydrocephaly and facial dysmorphia. At birth infants with eye malformations and other malformations were smaller, weighed less and their head circumference was lower than in controls. Placental weight was also lower than in controls. Pregnancies with eye malformations were more often complicated by threatened abortion, oligoamnios and polyhydramnios. Mothers of children with congenital eye malformations took more often drugs during pregnancy than mothers of controls. Fathers of children with congenital eye malformations were more often exposed to occupational hazards than fathers of controls. There was a significant association between eye malformation and consanguinity of parents. First degree relatives of probands had more than three times the prevalence of non-eye malformations than controls. These results are of relevance to genetic counseling.
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Affiliation(s)
- C Stoll
- Institut de Puériculture, Centre Hospitalo-Universitaire, Strasbourg, France
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Thein MM, Koh D, Tan KL, Lee HP, Yip YY, Tye CY, Phoon WO. Descriptive profile of birth defects among livebirths in Singapore. TERATOLOGY 1992; 46:277-84. [PMID: 1523586 DOI: 10.1002/tera.1420460312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case-control study of birth defects was carried out in Kandang Kerbau Hospital in Singapore for a three-year period from January 1986 until December 1988. This paper presents the descriptive profile of birth defects among livebirths seen in that hospital. Out of 44,842 livebirths, 678 babies were found to have birth defects, giving a prevalence of 15.13 per 1000 livebirths (95% CI 14.0-16.2). The musculoskeletal system was the most frequently affected system accounting for 161 cases with a prevalence of 3.59 per 1,000 livebirths (95% CI 3.06-4.19), followed by 111 cases with defects of the gastrointestinal system (2.47 per 1,000 livebirths 95% CI 2.04-2.98), 88 cases of chromosomal disorders (prevalence of 1.96 per 1,000 livebirths 95% CI 1.57-2.42), 78 cases with defects of the cardiovascular system (1.74 per 1,000 livebirths 95% CI 1.38-2.17), 73 cases with defects of the urogenital system (1.63 per 1,000 livebirths 95% CI 1.28-2.05), and 52 cases with defects of the central nervous system (1.16 per 1,000 livebirths 95% CI 0.87-1.52). The prevalence of cleft lip, cleft palate in isolation, and cleft lip and palate combined was 1.72 per 1,000 livebirths and the occurrence of Down's syndrome was 1 in 700 livebirths. When reviewed 6 weeks postpartum, the rate of false positives at birth was 4%. In a control group of 709 "normal" cases at birth, the rate of cases not detected at birth but detected at 6 week follow-up, false negatives was 0.84%.
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Affiliation(s)
- M M Thein
- Department of Community, Occupational, and Family Medicine, National University Hospital, National University of Singapore
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Mir NA, Galczek WC, Soni A. Easily identifiable congenital malformations in children: Survey of incidence and pattern in 32,332 live born neonates. Ann Saudi Med 1992; 12:366-71. [PMID: 17586995 DOI: 10.5144/0256-4947.1992.366] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Over a period of two years, 32,332 live-born infants were screened for the presence of identifiable congenital malformations. Congenital anomalies were present in 2.38% of all infants; major and minor malformations were present in 79% and 21% of the cases, respectively. Anomalies in general and chromosomal anomalies in particular were more common in multiparous women of advanced age. Anatomical organs most frequently affected were musculoskeletal and cardiovascular systems; talipes, chromosomal anomalies and congenital cardiac defects being the most common. The incidence of congenital anomalies in infants of diabetic mothers was 13.8% compared with 3% in the non-diabetic population (P=<0.01); multiple anomalies were present in 50% of the cases. Of a total of 770 infants born with malformations, 58 died during the early neonatal period with a mortality rate of 7.5% compared with an overall early neonatal death rate of 11.8/1000 live births.
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Affiliation(s)
- N A Mir
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Arab Medical University of Benghazi, Libya
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22
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Abstract
By means of a mail questionnaire, information on a series of 56 pregnancies i in 48 women diagnosed with leukemia or lymphoma was collected from ten hospitals. Seven patients conceived while receiving treatment for their neoplasms; in 22 patients, the hematologic disease was diagnosed during pregnancy, and the remaining 27 patients became pregnant after completion of the antineoplastic treatment. When a comparison was made of the evolution of these pregnancies to that of pregnancies in a healthy population, no increase in the incidence of complications was observed: 64% of the pregnancies went to term, 9% resulted in spontaneous abortion, and 5% resulted in premature births. The observed incidence of one major malformation in 56 pregnancies did not differ from the frequency of malformations in the offspring of healthy individuals. There were no fetal losses in six pregnancies in which conception occurred during the first year after chemotherapy. In spite of the inherent limitations derived from the design of this type of study and the type of subject analyzed, the data here support the hypothesis that the cytostatic treatment of hematologic malignancies, if deemed necessary, should not be postponed because of pregnancy. Moreover, the authors agree with advice recommending that no antifolic or alkylating agents be used for prolonged periods and that radiotherapy be avoided, especially to those fields involving the pelvic area.
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Affiliation(s)
- J Zuazu
- Hematology Service of Hospital Valle de Hebron, Barcelona, Spain
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Borovik CL, Brunoni D, Sato AE, Barletta H, Dualibi-Casanova L, Hironaka HC, Brunoni LR, Brock R, Carvalho LA, Costa EDC. Chromosome abnormalities in selected newborn infants with malformations in Brazil. AMERICAN JOURNAL OF MEDICAL GENETICS 1989; 34:320-4. [PMID: 2596521 DOI: 10.1002/ajmg.1320340305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Between 1982 and 1985, 109 infants were referred for cytogenetic examination out of a population of 73,192 liveborn infants from eight maternity hospitals surveyed by the ECLAMC/MONITOR program. Thirty-one of the children had a chromosome abnormality different from trisomy 21. Considering the total population surveyed, trisomy 18 was detected in 1:6,099; trisomy 13 was seen in 1:24,397 and unbalanced rearrangements were found in 1:7,319 infants. Those rates were not significantly different from the expected ones, as compared to previous cytogenetic surveys of consecutive births. We concluded that most chromosome abnormalities associated with congenital malformations can be detected at low cost, provided there is a high accuracy of clinical examination and referral criteria, as well as close cooperation between pediatricians and geneticists.
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Affiliation(s)
- C L Borovik
- Unidade de Citogenética, Hospital dos Servidores Públicos do Estado de São Paulo, Brazil
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Chaturvedi P, Banerjee KS. Spectrum of congenital malformations in the newborns from rural Maharashtra. Indian J Pediatr 1989; 56:501-7. [PMID: 2633992 DOI: 10.1007/bf02722424] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
We conducted hospital-based surveillance of congenital malformations to determine the rate of apparently spontaneous single mutations leading to recognized phenotypes. Through surveillance of 69,277 infants with gestational ages of at least 20 weeks, we identified 48 infants (0.07 percent) with major malformations, with phenotypes that suggested that the malformations were due to single mutant genes. Family studies suggested that 11 of these infants (10 with autosomal dominant disorders and 1 with an X-linked condition) were affected as the result of a new (spontaneous) genetic mutation. The spontaneous mutation rates per gene were 0.7 x 10(-5) and 1.44 x 10(-5) for the disorders in which one and two infants were affected, respectively. In addition, 5 of the 10 infants with autosomal recessive malformations had negative family histories, but we were unable to infer the presence of spontaneous mutations in these cases. Because the family history was negative in 44.4 percent of the infants with disorders considered due to autosomal or X-linked genes, counseling should include the understanding that genetic disorders often occur unexpectedly among children of healthy parents.
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Affiliation(s)
- K Nelson
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA
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Green DM, Hall B. Pregnancy outcome following treatment during childhood or adolescence for Hodgkin's disease. Pediatr Hematol Oncol 1988; 5:269-77. [PMID: 3152972 DOI: 10.3109/08880018809037366] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To evaluate the outcome of pregnancies occurring after the completion of treatment for Hodgkin's disease in children or adolescents, questionnaires were sent to 93 former patients diagnosed after January 1, 1960, who were currently 18 or more years of age and 5 or more years from the date of diagnosis of Hodgkin's disease. Forty-eight pregnancies were reported by twenty-two of the former patients or their spouses. Fifteen female patients had thirty-three pregnancies, of which three were electively terminated, two aborted spontaneously, four were stillborn, and twenty-four resulted in the birth of full-term infants, one of whom was small for gestational age. The spouses of seven male patients reported 14 pregnancies, of which two aborted spontaneously, three are in gestation, and nine resulted in the birth of full-term infants. Congenital anomalies were diagnosed in 9% (3/33) of the liveborn offspring, a frequency similar to that reported for the general population. The reported anomalies included lacrimal duct blockage, hydrocele, and ventricular septal defect. None of these children has been diagnosed with any type of childhood cancer.
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Affiliation(s)
- D M Green
- Department of Pediatrics, Roswell Park Memorial Institute, Buffalo, New York 14263
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Khrouf N, Spång R, Podgorna T, Miled SB, Moussaoui M, Chibani M. Malformations in 10,000 consecutive births in Tunis. ACTA PAEDIATRICA SCANDINAVICA 1986; 75:534-9. [PMID: 3751547 DOI: 10.1111/j.1651-2227.1986.tb10245.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Malformations were assessed in 10,000 consecutively born infants, dead or alive, at the Wassila Bourgiba Maternity Hospital in Tunis. The medical and social history including the rate of consanguinity was studied in the malformed group as well as in a control group of 229 infants. Three hundred and ninety-six infants were malformed; 248 had major malformations and 148 had minor ones. Thirteen per cent of the stillborn were malformed compared to 3.7% of the liveborn. The rates of most specific malformations were comparable to those in other studies but a relatively high rate of neural tube defects, 2.2/1000, can be noted. There is a significant overrepresentation of consanguinity (65%) in parents of non syndromic multi-malformed infants.
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Stoll C, Roth MP, Dott B, Bigel P. Usefulness of a registry of congenital malformations for genetic counseling and prenatal diagnosis. Clin Genet 1986; 29:204-10. [PMID: 3698330 DOI: 10.1111/j.1399-0004.1986.tb00813.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During three years, 39,924 infants born consecutively in the area covered by our registry of congenital malformations were surveyed; 775 had major congenital malformations. Recurrence risks for the major malformation was estimated and classified as high (greater than 10%, 5.3% of the cases), low (1 to 10%, 85.3% of the cases) or occasional (less than 1%, 9.4% of the malformed). Feasibility of prenatal diagnosis was considered. On the basis of the recurrence risk of 1% or higher and the feasibility of prenatal diagnosis, such a procedure should be considered in future pregnancies in 64.1% of the mothers. Genetic counseling has to be given to couples at risk of having a malformed child. For this purpose, as is shown in our study, the best way is the possibility of using a registry of congenital malformations.
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