Prevalence and Pattern of Congenital Anomalies in a Tertiary Hospital in Central Vietnam

De novo variants of dominant monogenic disorders in Vietnam detected by a noninvasive prenatal test: a case series

Background: Noninvasive prenatal tests for monogenic diseases (NIPT-SGG) have recently been reported as helpful in early-stage antenatal screening. Our study describes the clinical and genetic features of cases identified by NIPT-SGG. Materials & methods: In a cohort pregnancy with abnormal sonograms, affected cases were confirmed by invasive diagnostic tests concurrently, with NIPT-SGG targeting 25 common dominant single-gene diseases. Results: A total of 13 single-gene fetuses were confirmed, including Noonan and Costello syndromes, thanatophoric dysplasia, achondroplasia, osteogenesis imperfecta and Apert syndrome. Two novel variants seen were tuberous sclerosis complex (TSC2 c.4154G>A) and Alagille syndrome (JAG1 c.3452del). Conclusion: NIPT-SGG and standard tests agree on the results for 13 fetuses with monogenic disorders. This panel method of screening can benefit high-risk Vietnamese pregnancies, but further research is encouraged to expand on the causative gene panel.

Nurturing the Next Generation: Health Challenges in Infants and Children Across Asia and Africa

Over the past 20 years, there has been a global improvement in the health of the world's population. For instance, the number of illnesses among children under five years old has been reduced by half in the last 40 years. Unfortunately, in the past decade, these positive trends have reversed in many parts of sub-Saharan Africa and some areas of South Asia. Asia and Africa carry the highest disease burden worldwide. The lack of adequately trained healthcare professionals in the public sector, as well as inequalities based on social, financial, and geographical factors, contribute to high mortality rates in Asian and African countries. Infants and children in lower-middle-income countries are particularly vulnerable to these healthcare system inequities. While the global under-five mortality rate has decreased by half in the last two decades, this progress is not observed in African and Asian countries, where the situation may even be worse in some cases. Mortality indicators, although crucial for assessing health status and making global comparisons, fail to fully capture the disease burden and healthcare utilization. Morbidity indicators, which provide insights into the prevalence of diseases, are underutilized due to limited data availability, ineffective reporting, and gaps in data storage and analysis. This article explores the morbidity data from two Asian and two African countries in an attempt to understand the most common health challenges faced by infants and children in these regions.

Higher maternal age is associated with higher occurrence of cleft lip/palate in neonates under intensive care

Aim: To assess the prevalence of cleft lip and/or cleft palate (CL/P) and associated variables in neonates admitted to neonatal intensive care units (ICU). Methods: Medical charts for neonates born and admitted to the ICU between 2012 and 2018 were reviewed. Obstetric and neonatal variables were collected by a trained researcher. In the case group, all neonates with CL/P were included. The control group was formed by matching sex, prematurity and month of birth using random number generation. Neonates with congenital malformations were excluded from the control group. Adjusted logistic regression was used (p<0.05). Results: The prevalence of CL/P was 0.43% (n=15). Five cases were excluded, as pairing was not possible. Twenty neonates were included in the control group. In the final multivariate model, CL/P was only associated with increased maternal age. For each year of increase in maternal age, neonates had a 35.2% higher chance of presenting CL/P (95% confidence interval: 1.021–1.792). Conclusions: Higher maternal age was associated with higher occurrence of CL/P in neonates admitted to the ICU. No other neonatal or maternal independent variables were associated with CL/P. Due to missing data, interpretation of study results must be approached with caution.

Incidence of Intrapartum-Related Events at the Largest Obstetric Hospital in Hanoi, Vietnam: A Retrospective Study

Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related events, we aimed to assess the neonatal demographic characteristics, clinical management, and outcomes among neonates born at the largest obstetric hospital in Hanoi, Vietnam. This was a retrospective cross-sectional study that included all the inborn neonates in November 2019, which was selected as a representative month. A total of 4554 neonates were born during the study period. Of these, 1.0% (n = 44) were stillbirths, 0.15% (n = 7) died in hospital, 0.61% (n = 28) received positive pressure ventilation at birth, and 0.15% (n = 7) were diagnosed with hypoxic ischemic encephalopathy. A total of 581 (13%) neonates were admitted to the neonatal unit, among which the most common diagnoses were prematurity (37%, n = 217) and infection (15%, n = 89). Except for the intrapartum-related events, our findings are consistent with the previously documented data on neonatal morbidity. The intrapartum-related events, however, were surprisingly low in number even in comparison to high-income countries. Research on the current clinical practice at Phu San Hanoi Hospital may bring further clarity to identify the success factors.

Elevated congenital heart disease birth prevalence rates found in Central Vietnam and dioxin TCDD residuals from the use of 2, 4, 5-T herbicides (Agent Orange) in the Da Nang region

Congenital heart disease (CHD) birth prevalence rate in Da Nang City and two adjacent provinces in Central Vietnam reported by Giang et al. in 2019 was 20.09/1000 births, much higher than any CHD birth rates previously reported. In this current study, three physicians trained in pediatric cardiology reanalyzed and reclassified the Giang et al 2019 cardiac anomalies data, eliminating singular small PDAs and separating cardiac defects into 27 contemporary CHD subgroups. These CHD subgroups were then statistically compared with Liu et al. 2019 Global CHD birth prevalence study of Asian Low-Middle Income Countries (LMIC) CHD subgroup rate of 9.34/1000 births (95% CI 8.07-10.70). Despite applying newer diagnostic criteria and refining the cardiac anomalies data, the Da Nang region continued to show significantly (p<0.0001) elevated total CHD birth prevalence rates at 14.71/1000 births (95% CI 12.74-16.69) compared to the Asian LMIC CHD birth prevalence rate 9.34/1000 births. This finding raises the question of whether environmental persistence of the contaminant dioxin TCDD from 2,4,5-T herbicides (Agent Orange) used during the Vietnam War (1961-1971) in the Da Nang region might be a factor associated with elevated CHD birth prevalence, as it is not present in other LMIC surrounding Vietnam. We recommend testing of soils and sediments in rural and agricultural areas in Central Vietnam that received high volume applications of contaminated herbicides to assess the relationship of the higher CHD birth prevalence rate and the presence of residual dioxin TCDD. Enhanced fetal cardiac echocardiograpy in the region to screen for CHD would enable early interventions and could improve outcomes for infants and children.