Frecuencia de malformaciones congénitas: evaluación y pronóstico de 52.744 nacimientos en tres ciudades colombianas

Tracking the Global Burden of Neural Tube Defects and Assessing Disparities Across World Health Organization Regions: A Scoping Literature Review

BACKGROUND AND OBJECTIVES

Neural tube defects (NTDs) are an important cause of global morbidity worldwide. Well-planned global neurosurgery and public health efforts can aid vulnerable communities, but there is a need to elucidate the global burden of NTDs and identify regions without available data to better target interventions.

METHODS

A scoping review to quantify worldwide NTD prevalence using the PubMed/Medline and birth defects surveillance registries was conducted. Data published after January 1, 1990, encompassing prevalence values of at least the 2 most prevalent NTDs-spina bifida and encephalocele-were abstracted. Average NTD prevalence rates were aggregated by World Health Organization (WHO) region and World Bank classification, and differences were determined using the analysis of variance test. Differences in availability of nationally representative data by WHO region and World Bank classification were determined using χ2 tests.

RESULTS

This review captured 140 studies from a total of 93 of 194 WHO member countries. The percentage of countries within a geographic region with available NTD prevalence data was highest in the Eastern Mediterranean (EMR) (85.7%) and lowest in Africa (AFR) (31.3%). The NTD prevalence range was 0.9-269.6 per 10 000 births. Statistically significant differences in reported NTD prevalence rates existed by WHO Region (P = .00027) and World Bank income level of study country (P = .00193). Forty countries (43%) had conducted national-level studies assessing NTD prevalence. There was a statistically significant difference in the availability of nationally representative prevalence data depending on the WHO region (P = .0081) and World Bank classification of study country (P = .0017).

CONCLUSION

There is a gap in availability of NTD prevalence data worldwide, with many WHO member states lacking national-level NTD prevalence estimates. These findings highlight the need for greater NTD surveillance efforts to identify the countries with the greatest need for targeted global intervention.

Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil

Objective

The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in Brazil.

Methods

We collected data on the pediatric surgical workforce, surgical volume, Gross Domestic Product per capita, and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019.

Results

Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil, corresponding to 1414 pediatric surgeons (some pediatric surgeons are registered in more than one state), or 2.4 pediatric surgeons per 100 000 children 14 years of age and younger. There were 828 men and 586 women. The mean age was 51.5±12.8 years, and the mean time from graduation was 3.4±5.7 years. There is a higher concentration of pediatric surgeons in the wealthier Central-West, South, and Southeast regions. Individual surgical volume ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Of these, only nine (6.1%) were high-complexity (including neonatal) operations. MGITM tended to be higher in the poorer North and Northeast regions than in other regions of Brazil.

Conclusions

Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic status. Regions with an increased surgical workforce were associated with lower MGITM. The average number of complex operations performed annually by each pediatric surgeon was considerably low. Strategic investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil.

Level of evidence

Retrospective review; level IV.

Creation of a Pilot Surgical Program for the Comprehensive Management of Patients with Congenital Urological Malformations

Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders.

Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery.

Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800.

Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.

Análisis de concordancia entre la prueba prenatal no invasiva (NIPT) y el cariotipo prenatal para la detección de aneuploidías fetales

Introducción. La prueba prenatal no invasiva (NIPT, por su sigla en inglés) es una prueba de tamización de aneuploidías fetales con una mayor sensibilidad y especificidad que la tamización bioquímica prenatal tradicional. Objetivo. Evaluar la concordancia entre la NIPT y el cariotipo prenatal para la detección de aneuploidías fetales en embarazos de alto riesgo de dichas anomalías Materiales y métodos. Estudio piloto prospectivo realizado entre septiembre de 2019 y diciembre de 2020 en 20 pacientes con gestaciones clasificadas como de alto riesgo para aneuploidías fetales con base en los hallazgos ecográficos y atendidas en Bogotá y Medellín, Colombia. A cada paciente se le realizó una NIPT y una prueba invasiva confirmatoria (cariotipo prenatal). La concordancia entre ambos métodos se determinó mediante el coeficiente kappa de Cohen (nivel de significancia p<0.05), donde valores >0.7 se consideraron como un buen nivel de concordancia. Resultados. En 3 de las 20 gestaciones (15%) se detectaron aneuploidías mediante estudio citogenético invasivo: trisomía 21, trisomía 18 y monosomía X. La NIPT detectó la trisomía 21 y la monosomía X, pero falló en detectar la trisomía 18. Respecto al análisis de concordancia, el coeficiente de kappa de Cohen entre la NIPT y cariotipo prenatal fue 0.77, 1.0 y 0 para trisomía 21, monosomía X, trisomía 18, respectivamente. Además, la NIPT detectó 67% de las aneuploidías. Conclusión. En el presente estudio, primero en realizarse en Colombia, se observó una buena concordancia entre la NIPT y la prueba invasiva (cariotipo prenatal) para la detección de aneuploidías. Sin embargo, los resultados aquí reportados enfatizan la recomendación de utilizar la NIPT como prueba de tamización y no como prueba diagnóstica.

Population Prevalence and Trends of Oral Clefts in Colombia: Analysis by Departments

Determine the population prevalence and trends of cleft lip and/or palate (CL/P) by department for Colombia in the period 2009 to 2015.

Prevalence study based on Individual Registry of Health Services in general population from 2009 to 2015. All people diagnosed with CL/P were included for all ages, type of diagnosis, and any type of health services in the mentioned period. The prevalence was calculated by period and point for each year, for each department and according to the type of cleft. Stationarity on time series was evaluated using (Dickey-Fuller) and (Phillips-Perron). A trend test was applied to estimate whether the increase in prevalence was significant in the period. The trend test used was a Poisson regression.

A total 15 225 people with CL/P were identified, where 53.3% were men. The national period prevalence of CL/P is 3.37 per 10 000 with upward trend (prevalence ratio = 1.34, P = .05) and nonstationary behavior. The national period prevalence of cleft lip is 0.93 per 10 000, cleft palate 1.17 per 10 000, and cleft lip and palate (CLP) 1.26 per 10 000, where CLP is subclassify into unilateral CLP (0.83 per 10 000) and bilateral CLP (0.43 per 10 000). At the departmental level, the highest CL/P prevalence is Guaviare (11.2), followed by Guainía (8.4) and the lowest Quindío (0.49).

In Colombia, the national period prevalence of CL/P is 3.37 per 10 000 with upward trend at national level indicates an increase in prevalence from 2009 to 2015. The 77% of the total CL/P population are infant or adolescent. Geographically, the central region has the highest availability of technologies.

Description and results of birth defects surveillance and follow-up programs in Bogotá and Cali, Colombia, 2002-2019

Birth defects are structural or functional defects present at birth and are caused by different factors that affect intrauterine development. They are the second most common cause of death under five years of age in Latin America and the Caribbean. In Bogotá and Cali, Colombia, there are two surveillance programs established to evaluate the prevalence of them. The purpose of the following article is to describe the experience and results of the surveillance of the Birth Defects Surveillance Programs in Bogotá and Cali, Colombia, 2002-2019. The information was taken from the surveillance programs that have an active hospital system in some institutions of the city (ECLAMC modality), and use data from the passive national system (Sistema Nacional de Vigilancia en Salud Pública - SIVIGILA) to expand their coverage. From 2002 until 2019, 1,289.650 births have been monitored through one of the surveillance programs, including both methodologies. The importance of surveillance programs relies on the amount of data obtained that allows the development of research, the detection of potential changes throughout time, and the guidance of public policies to improve promotion and prevention strategies.

Impact of pulmonary hypertension and congenital heart disease with hemodynamic repercussion on the severity of acute respiratory infections in children under 5 years of age at a pediatric referral center in Colombia, South America

BACKGROUND

Acute respiratory infection is one of the main causes of morbidity in children. Some studies have suggested that pulmonary hypertension and congenital heart disease with haemodynamic repercussion increase the severity of respiratory infections, but there are few publications in developing countries.

METHODS

This was a prospective cohort study evaluating the impact of pulmonary hypertension and congenital heart disease (CHD) with haemodynamic repercussion as predictors of severity in children under 5 years of age hospitalised for acute respiratory infection.

RESULTS

Altogether, 217 children hospitalised for a respiratory infection who underwent an echocardiogram were evaluated; 62 children were diagnosed with CHD with haemodynamic repercussion or pulmonary hypertension. Independent predictors of admission to intensive care included: pulmonary hypertension (RR 2.14; 95% CI 1.06-4.35, p = 0.034), respiratory syncytial virus (RR 2.52; 95% CI 1.29-4.92, p = 0.006), and bacterial pneumonia (RR 3.09; 95% CI 1.65-5.81, p = 0.000). A significant difference was found in average length of hospital stay in children with the cardiovascular conditions studied (p = 0.000).

CONCLUSIONS

Pulmonary hypertension and CHD with haemodynamic repercussion as well as respiratory syncytial virus and bacterial pneumonia were predictors of severity in children with respiratory infections in this study. Early recognition of cardiovascular risks in paediatric populations is necessary to lessen the impact on respiratory infections.

Skeletal dysplasias in Latin America

Skeletal dysplasias (SD) are disturbances in growth due to defects intrinsic to the bone and/or cartilage, usually affecting multiple bones and having a progressive character. In this article, we review the state of clinical and research SD resources available in Latin America, including three specific countries (Brazil, Argentina, and Chile), that have established multidisciplinary clinics for the care of these patients. From the epidemiological point of view, the SD prevalence of 3.2 per 10,000 births from nine South American countries included in the ECLAMC network represents the most accurate estimate not just in Latin America, but worldwide. In Brazil, there are currently five groups focused on SD. The data from one of these groups including the website www.ocd.med.br, created to assist in the diagnosis of SD, are highlighted showing that telemedicine for this purpose represents a good strategy for the region. The experience of more than 30 years of the SD multidisciplinary clinic in an Argentinian Hospital is presented, evidencing a solid experience mainly in the follow-up of the most frequent SD, especially those belonging the FGFR3 group and OI. In Chile, a group with 20 years of experience presents its work with geneticists and pediatricians, focusing on diagnostic purposes and clinical management. Altogether, although SD health-care and research activities in Latin America are in their early stages, the experience in these three countries seems promising and stimulating for the region as a whole.

Health status and barriers in health care for children with birth defects born between 2011 and 2017 in two institutions in Cali

Introducción.

Los defectos congénitos afectan entre el 2 y el 3 % de los recién nacidos, y son una carga importante entre las causas de morbilidad y mortalidad infantil en los primeros cinco años de vida. En Colombia, fueron la segunda causa de mortalidad infantil según los reportes del Departamento Administrativo Nacional de Estadística (DANE) para el 2011.

Objetivo.

Describir el estado de salud y las barreras en la atención de niños con defectos congénitos nacidos entre el 2011 y el 2017 en dos instituciones de salud de Cali.

Materiales y métodos.

Se hizo un estudio observacional descriptivo de corte transversal. Se incluyeron los nacidos entre enero de 2011 y diciembre de 2017 con, al menos, un defecto congénito, a quienes se les hizo seguimiento telefónico.

Resultados.

De 54.193 nacidos en el período analizado, 1.389 (2,56 %) tenían, por lo menos, un defecto congénito. Todos los casos se clasificaron según la escala de pronóstico y se incluyeron 881 en el seguimiento. El defecto congénito más frecuente fue la malformación congénita cardíaca, con 88 (9,99 %) casos; en segundo lugar, las malformaciones o defectos del riñón, con 73 (8,29 %) casos; en tercer lugar, el síndrome de Down, con 72 (8,17 %) casos, y en cuarto lugar, las anormalidades testiculares, con 56 (6,36 %). Ciento sesenta y uno (35,46 %) de los cuidadores de los 454 casos con seguimiento efectivo, manifestaron haber encontrado, por lo menos, un tipo de barrera en la atención.

Conclusión.

Se deben implementar programas de seguimiento de los pacientes con defectos congénitos, que contribuyan a disminuir la morbimortalidad.

Disorders of sex development: Genetic characterization of a patient cohort

Disorders of sex development (DSDs) are congenital conditions in which the external appearance of the individual does not coincide with the chromosomal constitution or the gonadal sex. In other words, there is an ambiguous or intermediate condition between the male and female phenotypes of the anatomical sex. These atypical conditions are manifested in several ways, ranging from genital ambiguity to phenotypes that are so attenuated that they can go unnoticed or appear normal. Currently, there is a lack of understanding of the factors responsible for these outcomes; however, they are likely to be conditioned by genetic, hormonal and environmental factors during prenatal and postnatal development. The present study determined the genetic etiology of DSDs in Colombian patients by conventional cytogenetic analysis, FISH and MLPA (for SF1, DAX1, SOX9, SRY and WNT4). A cohort of 43 patients with clinical phenotypes of sex development disorder was used in the present study. Using this multistep experimental approach, a diagnostic percentage of 25.58% was obtained: 17 patients (39.53%) were classified as having gonadal development disorders, the majority of which were ovotesticular disorders with numerical and/or structural alterations of the sex chromosomes, 9 patients (20.93%) were classified as having testicular DSD with a 46,XY karyotype, and 3 patients (6.98%) as having ovarian DSD with a 46,XX karyotype. The remaining 14 patients (32.56%) were classified as 'other' since they could not be grouped into a specific class of gonadal development, corresponding to hypospadias and multiple congenital anomalies. These findings highlight the importance of histological and cytogenetic studies in a gonadal biopsy. In 11/43 cases, the multistep experimental protocol presented in the present study yielded etiological or histological findings that could be used to define the medical management of patients with DSDs. In conclusion, for the etiological diagnosis of DSDs, a broad‑spectrum approach that includes endocrinological tests, conventional karyotyping, molecular karyotyping by FISH and, molecular tests is required, in addition to gonadal tissue analyses, to identify genetic alterations.

Birth defects surveillance: experiences in Argentina and Colombia

Birth defects (BDs) are structural or functional anomalies, sporadic or hereditary, of prenatal origin. Public health surveillance is defined as the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice. BD surveillance systems may have different characteristics according to design, coverage, type of surveillance, case ascertainment, case definition, BD description, maximum age of diagnosis, pregnancy outcomes, coding systems, and the location of the coding process (central or local). The aim of this article is to describe and compare methodology, applications, and results of birth defect surveillance systems in two South-American countries: Colombia and Argentina. In both countries, the surveillance systems developed activities in relation to the Zika virus emergency. For most BDs, a statistically significant higher prevalence is observed in Argentina-RENAC than in Colombian registries. This may be due to methodological reasons or real differences in prevalence. The strengths, weaknesses, and the future perspectives of the Argentine and Colombian systems are presented. When developing a surveillance system, the objectives, the available resources, and previous experiences in similar contexts must be taken into account. In that sense, the experience of Argentina and Colombia can be useful for others when developing a birth defect surveillance system.

Pediatric diabetic ketoacidosis in a patient with Down syndrome. Case report

Introduction:. Patients with Down syndrome (DS) have an increased risk of developing autoimmune diseases. This is a rare case of a pediatric patient with DS with an initial clinical profile of diabetic ketoacidosis.Case presentation:. 6-year-old male patient with symptoms suggestive of diabetes mellitus type 1 (DM1) of 15 days of evolution (polyuria, polydipsia, polyphagia and loss of 2 kilos of weight), who was admitted to the emergency department of the Hospital de San José, in Bogotá, Colombia, with uncontrollable vomiting and dehydration. The tests performed confirmed moderate ketoacidosis: glycometry: 592 mg/dL, pH: 7.19, HCO3: 10 mmol/L, PCO2: 45, PO2: 95 and lactic acid: 1.4 mmol/L. Management with isotonic fluids and intravenous insulin therapy was initiated and the patient was transferred to the pediatric intensive care unit, where ketoacidosis was controlled in approximately 10 hours. Subcutaneous insulin schedule was initiated without complications.Discussion:. This case highlights the importance of monitoring possible autoimmune complications in patients with DS, since the risk of developing them is 4.2 times higher than in the general population.Conclusion:. This case calls on to contemplate autoimmune complications in patients with DS during clinical practice. Although they are not part of the most frequent reasons for consultation, they cannot be underestimated and should be suspected and treated in a timely manner.

22q11.2 Deletion Syndrome in Colombian Patients With Syndromic Cleft Lip and/or Palate

The objective of this work was to identify 22q11.2 chromosomal deletion in patients with cleft lip and/or cleft palate and suggestive syndromic phenotype in Colombian patients. We studied 49 patients with cleft lip and/or cleft palate, exhibiting additional clinical findings linked to 22q11.2 deletion syndrome. All patients underwent high-resolution G-banded karyotyping, multiplex ligation-dependent probe amplification, and clinical evaluation by a geneticist. Seven patients presented 22q11.2 deletion and 2 patients had other chromosomal abnormalities. In conclusion, this study contributes with new data for genetic etiology in syndromic conditions of oral fissures.

Characterization of congenital craniofacial anomalies in a specialized hospital of Risaralda, Colombia. 2010-2014

Introducción. Los defectos craneofaciales congénitos pueden causar un impacto en la vida de los niños y de sus familias cuando comprometen el rostro. Además, pueden estar acompañados de alteración de las funciones cerebrales o de la apariencia facial. No se tienen datos concluyentes sobre la presencia de estos defectos en el Eje Cafetero.Objetivo. Identificar la frecuencia de las malformaciones craneofaciales congénitas en un periodo de cuatro años en una institución privada de la ciudad de Pereira, en Risaralda, Colombia.Materiales y métodos. Estudio trasversal retrospectivo. La información fue recolectada a través del sistema de información de historias clínicas de pacientes que consultaron por primera vez en una institución privada de salud. El análisis estadístico fue realizado mediante el software R y Microsoft Excel versión 2007.Resultados. Entre enero del 2010 y diciembre del 2014 se atendieron 1 807 pacientes con malformaciones craneofaciales congénitas, lo que corresponde al 19.5% del total de las anomalías congénitas. La hendidura labio-palatina fue la más frecuente.Conclusiones. Aunque las malformaciones craneofaciales congénitas se presentan con frecuencia, se sabe muy poco de su etiología. El diagnóstico temprano puede prevenir futuras complicaciones que deterioren la salud o que generen un sobrecosto para el sistema de salud.

Translation and cultural adaptation of the CLEFT-Q for use in Colombia, Chile, and Spain

BACKGROUND

Cleft lip and/or palate (CL/P) is a common congenital craniofacial anomaly that may negatively affect an individual's appearance, health-related quality of life, or speech. In Spain, Colombia, and Chile the overall prevalence of CL/P ranges from 0.53 to 1.59 cases per 1000 live births. Currently, there is no patient-reported outcome (PRO) instrument that is specific for patients with CL/P. The CLEFT-Q is a new PRO instrument developed to measure outcomes of treatment in patients 8 to 29 years of age with CL/P. The aim of this study was to translate and culturally adapt the CLEFT-Q for use in Colombia, Chile, and Spain.

METHODS

The CLEFT-Q was translated from English to 3 Spanish language varieties (Colombian, Chilean, and Spanish (Spain)) and Catalan. Translation and cultural adaptation guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research were followed.

RESULTS

The field- test version of the CLEFT-Q consisted of 13 scales (total 154 items) measuring appearance, health-related quality of life, and facial function. Forward translations revealed 10 (7%) items that were difficult to translate into Chilean, and back translations identified 34 (22%) and 21 (13%) items whose meaning differed from the English version in at least 1 of the 3 Spanish varieties and Catalan respectively. Twenty-one participants took part in cognitive debriefing interviews. Participants were recruited from plastic surgery centres in Bogotá, Colombia (n = 4), Santiago, Chile (n = 7), and Barcelona, Spain (n = 10). Most participants were males (n = 14, 67%) and were diagnosed with CL/P (n = 17, 81%). Participants reported difficulty understanding 1 item in the Colombian, 1 item in the Spanish (Spain), and 11 items from the Catalan version. Comparison of the 3 Spanish varieties revealed 61 (40%) of the 154 items whose wording differed across the 3 Spanish versions.

CONCLUSION

Translation and cultural adaptation processes provided evidence of transferability of the CLEFT-Q scales into 3 Spanish varieties and Catalan, as semantic, idiomatic, experiential, and conceptual equivalence of the items, instructions, and response options were achieved.

Epidemiology of congenital heart diseases in Bogotá, Colombia, from 2001 to 2014: Improved surveillance or increased prevalence?

Introducción. Las cardiopatías congénitas son alteraciones estructurales y funcionales del corazón, sistema circulatorio y grandes vasos que se desarrollan durante la embriogénesis cardiaca. A nivel mundial dichos defectos son una causa importante de morbi-mortalidad en la población infantil.Objetivo. Determinar la prevalencia de cardiopatías congénitas en la ciudad de Bogotá, durante el periodo de 2001 a 2014 y evaluar la tendencia en el tiempo.Material y métodos. Se analizaron 405.408 recién nacidos del Programa de Vigilancia y Seguimiento de Niños con Anomalías Congénitas de la Secretaría de Salud de Bogotá calculando la prevalencia de las cardiopatías congénitas a través de un registro diario de nacimientos y su evaluación clínica y paraclínica. Se clasificaron en aisladas, complejas y asociada y se halló la prevalencia por año. Se evaluó la mortalidad en las primeras horas de vida.Resultados. La prevalencia de cardiopatías congénitas fue de 15,1 por cada 10.000 recién nacidos en todo el período, pero se evidenciaron valores por encima de 20x10.000 en los últimos 3 años. Del total, 46% fueron de sexo femenino, 53,16% de sexo masculino y 0.33% indeterminado. De los nacidos malformados, 397 cardiopatías fueron aisladas, 142 asociadas a otras malformaciones extracardiacas y 74 complejas.Conclusiones. Las cardiopatías tienen gran impacto en la salud de la población infantil y aunque la prevalencia es menor que en otros países, esto puede deberse a subregistro a nivel nacional. Se nota un aumento en la prevalencia en los últimos 3 años que puede corresponder a la implementación de los programas de vigilancia nacional y local. Sugerimos continuar el desarrollo de programas que incrementen e incentiven el tamizaje y registro de estas patologías. 

Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999-2008

OBJECTIVE

To describe fetal and neonatal mortality due to congenital anomalies in Colombia.

METHODS

We analyzed all fetal and neonatal deaths due to a congenital anomaly registered with the Colombian vital statistics system during 1999-2008.

RESULTS

The registry included 213,293 fetal deaths and 7,216,727 live births. Of the live births, 77,738 (1.08%) resulted in neonatal deaths. Congenital anomalies were responsible for 7321 fetal deaths (3.4% of all fetal deaths) and 15,040 neonatal deaths (19.3% of all neonatal deaths). The fetal mortality rate due to congenital anomalies was 9.9 per 10,000 live births and fetal deaths; the neonatal mortality rate due to congenital anomalies was 20.8 per 10,000 live births. Mortality rates due to congenital anomalies remained relatively stable during the study period. The most frequent fatal congenital anomalies were congenital heart defects (32.0%), central nervous system anomalies (15.8%), and chromosomal anomalies (8.0%). Risk factors for fetal and neonatal death included: male or undetermined sex, living in villages or rural areas, mother's age >35 years, low and very low birthweight, and <28 weeks gestation at birth.

CONCLUSIONS

Congenital anomalies are an important cause of fetal and neonatal deaths in Colombia, but many of the anomalies may be preventable or treatable.

Caracterización de las anomalías congénitas desde la inclusión en el sistema de vigilancia Sivigila en Colombia, 2010-2013

<p><strong>Introducción:</strong> las anomalías congénitas son una alteración estructural o funcional con impacto en la morbilidad-mortalidad infantil y la discapacidad mundial. Las estrategias orientadas a disminuir su impacto las respaldan sistemas de vigilancia. En Colombia, desde el 2010 se incluyó el formato de notificación de anomalías congénitas en el Sistema de Vigilancia (Sivigila). <strong>Objetivo:</strong> caracterizar epidemiológicamente la notificación del evento desde su inclusión. <strong>Materiales y métodos:</strong><em> </em>análisis descriptivo de los eventos notificados entre enero de 2010 y diciembre de 2013. <strong>Resultados:</strong><em> </em>se encontró una prevalencia de malformaciones del 0,35 % en Colombia durante el periodo analizado. Las anomalías congénitas con mayor notificación fueron las del sistema nervioso central y las anomalías de extremidades. <strong>Conclusiones:</strong> la prevalencia notificada para malformaciones congénitas en Colombia es baja. La baja tasa de notificación de anomalías congénitas evidencia la necesidad de realizar capacitaciones para mejorar esta notificación, tener un registro más cercano a la realidad de la población y así poder tomar decisiones para el beneficio de la población y en la generación de conocimiento en este tema. <strong></strong></p>

[Prevalence of birth defects in Risaralda, 2010-2013]

INTRODUCTION

The data regarding birth defects at local levels in developing countries like Colombia are scarce.

OBJECTIVE

To describe the profile of congenital abnormalities in the province of Risaralda, Colombia.

MATERIALS AND METHODS

We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10®.

RESULTS

We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome.

CONCLUSIONS

Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects.

Altitude as a risk factor for the development of hypospadias. Geographical cluster distribution analysis in South America

OBJECTIVE

Hypospadias is the most common congenital anomaly affecting the genitals. It has been established as a multifactorial disease with increasing prevalence. Many risk factors have been identified such as prematurity, birth weight, mother's age, and exposure to endocrine disruptors. In recent decades multiple authors using surveillance systems have described an increase in prevalence of hypospadias, but most of the published literature comes from developed countries in Europe and North America and few of the published studies have involved cluster analysis. Few large-scale studies have been performed addressing the effect of altitude and other geographical aspects on the development of hypospadias. Acknowledging this limitation, we present novel results of a multinational spatial scan statistical analysis over a 30-year period in South America and an altitude analysis of hypospadias distribution on a continent level.

METHOD

A retrospective review was performed of the Latin American collaborative study of congenital malformations (ECLAMC). A total of 4,020,384 newborns was surveyed between 1982 and December 2011 in all participating centers. We selected all patients with hypospadias. All degrees of clinical severity were included in the analysis. Each participating center was geographically identified with its coordinates and altitude above sea level. A spatial scan statistical analysis was performed using Kulldorf's methodology and a prevalence trend analysis over time in centers below and above 2000 m.

RESULTS

During the study period we found 159 hospitals in six different countries (Colombia, Bolivia, Brazil, Argentina, Chile, and Uruguay) with 4,537 cases of hypospadias and a global prevalence rate of 11.3/10,000 newborns. Trend analysis showed that centers below 2000 m had an increasing trend with an average of 10/10,000 newborns as opposed to those centers above 2000 m that showed a reducing trend with an average prevalence of 7.8 (p = 0.1246). We identified clusters with significant increases of prevalence in five centers along the coast at an average altitude of 219.8 m above sea level (p > 0.0000). Reduction in prevalence was found in clusters located in two centers on the Andes mountains. Altitude of 2,000 m was associated with hypospadias (Figure), with an OR 0.59 (0.5-0.69). There are ethnic arguments to support our results supported by protective polymorphism distribution in high lands.

CONCLUSION

Altitude above 2,000 m is suggested to have a protective effect for hypospadias. Specific clusters have been identified with increased risk for hypospadias. Environmental risk factors in these areas need to be further studied given the association seen between altitude and the distribution of more severe cases.

[Geographic distribution of perinatal mortality due to congenital malformations in Colombia, 1999-2008: An analysis of vital statistics data]

INTRODUCTION

During 2012, 13% of the deaths worldwide in children under the age of 28 days were due to congenital malformations. In Colombia, congenital malformations are the second leading cause of infant mortality. Objective: To determine the geographical distribution of extended perinatal mortality due to congenital malformations in Colombia between 1999 and 2008. Materials and methods: We conducted a cross-sectional study. We revised all death certificates issued between 1999 and 2008. We defined perinatal mortality as fetal or non-fetal deaths within the first 28 days after delivery in children with body weight ≥500 grams, and congenital malformations according to ICD-10 diagnostic codes Q000 - Q999. The annual birth projection was used as the denominator. We defined high mortality areas due to congenital malformations as those in the 90th percentile. Results: We recorded 22,361 perinatal deaths due to congenital malformations. The following provinces exceeded the 90th perinatal mortality percentile: Antioquia, Caldas, Risaralda, Huila, Quindío, Bogotá, Valle del Cauca and Guainía. Among the municipalities, the highest perinatal mortality rates were found in Giraldo, Ciudad Bolívar, Riosucio, Liborina, Supía, Alejandría, Sopetrán, San Jerónimo, Santa Fe de Antioquia and Marmato (205.81 and 74.18 per 10.000 live births).The perinatal mortality rate due to malformations of the circulatory system was 28.1 per 10.000 live births, whereas the rates for central nervous system defects and chromosomal abnormalities were 13.7 and 7.0, respectively.

CONCLUSIONS

The Andean region showed high perinatal mortality rates due to congenital malformations. There is an urgent need to identify possible risk factors of perinatal mortality and implement successive prevention programs in that particular region.

Describing the Prevalence of Neural Tube Defects Worldwide: A Systematic Literature Review

BACKGROUND

Folate-sensitive neural tube defects (NTDs) are an important, preventable cause of morbidity and mortality worldwide. There is a need to describe the current global burden of NTDs and identify gaps in available NTD data.

METHODS AND FINDINGS

We conducted a systematic review and searched multiple databases for NTD prevalence estimates and abstracted data from peer-reviewed literature, birth defects surveillance registries, and reports published between January 1990 and July 2014 that had greater than 5,000 births and were not solely based on mortality data. We classified countries according to World Health Organization (WHO) regions and World Bank income classifications. The initial search yielded 11,614 results; after systematic review we identified 160 full text manuscripts and reports that met the inclusion criteria. Data came from 75 countries. Coverage by WHO region varied in completeness (i.e., % of countries reporting) as follows: African (17%), Eastern Mediterranean (57%), European (49%), Americas (43%), South-East Asian (36%), and Western Pacific (33%). The reported NTD prevalence ranges and medians for each region were: African (5.2-75.4; 11.7 per 10,000 births), Eastern Mediterranean (2.1-124.1; 21.9 per 10,000 births), European (1.3-35.9; 9.0 per 10,000 births), Americas (3.3-27.9; 11.5 per 10,000 births), South-East Asian (1.9-66.2; 15.8 per 10,000 births), and Western Pacific (0.3-199.4; 6.9 per 10,000 births). The presence of a registry or surveillance system for NTDs increased with country income level: low income (0%), lower-middle income (25%), upper-middle income (70%), and high income (91%).

CONCLUSIONS

Many WHO member states (120/194) did not have any data on NTD prevalence. Where data are collected, prevalence estimates vary widely. These findings highlight the need for greater NTD surveillance efforts, especially in lower-income countries. NTDs are an important public health problem that can be prevented with folic acid supplementation and fortification of staple foods.

Descriptive analysis of high birth prevalence rate geographical clusters of congenital anomalies in South America

BACKGROUND

The birth prevalence rate (BPR) of congenital anomalies (CAs) is heterogeneous and exhibits geographical and sociocultural variations throughout the world. In South America (SA), high birth prevalence regions of congenital anomalies have been observed. The aim of this study was to identify, describe, and characterize geographical clusters of congenital anomalies in SA.

METHODS

This observational descriptive study is based on clinical epidemiological data registered by the Latin-American Collaborative Study of Congenital Malformations network. Between 1995 and 2012, a total of 25,082 malformed newborns were ascertained from 2,557,424 births at 129 hospitals in SA. The spatial scan statistic was used to determine geographical regions with high BPR of CAs. The BPR was obtained with a Poisson regression model. Odds ratios were estimated for several risk factors inside the geographical clusters.

RESULTS

We confirmed the existence of high BPR regions of CAs in SA. Indicators of low socioeconomic conditions, such as a low maternal education, extreme age childbearing, infectious diseases, and medicine use during pregnancy were detected as risk factors inside these regions. Native and African ancestries with high frequency of consanguineous marriages could explain partially these high BPR clusters.

CONCLUSION

The recognition of clusters could be a starting point in the identification of susceptibility genes associated with the occurrence of CA in high BPR regions.

Clinical and genetic study on 356 Brazilian patients with a distinct phenotype of cleft lip and palate without alveolar ridge involvement

Oral clefts include cleft lip (CL), cleft lip with cleft palate (CLP) and cleft palate (CP), with wide variations in clinical presentation and degree of severity. We described a sample of individuals with CL and CP without alveolar arch involvement (CL + CP) to verify if the characteristics of this group are distinct from those with CL with or without CP (CL/P) described in literature. The sample was composed of 356 patients with CL + CP, registered at HRCA-USP, Bauru-SP-Brazil. The following characteristics were investigated: sex ratio, parental age at the time of conception, parental consanguinity, familial recurrence, laterality of the cleft and associated anomalies. A subgroup of 30 individuals with microforms of CL and CP were taken from the sample and compared with the remaining cases. Statistical differences were found between this CL + CP sample and the literature data for groups with CL/P regarding laterality, sex ratio, consanguinity, familial recurrence, and the presence of associated anomalies. The microform sample showed a statistical difference in paternal age. In most evaluated aspects, this sample presents similar characteristics to the consulted literature data for CL/P; as do the group of microform cleft cases when compared with the remaining CL + CP sample in this study. Microforms of cleft can represent a target group for investigation into the embryogenetic mechanisms of oral clefts and their phenotypic variability.

Intra-hospital mortality among neonates transported by ambulance in Colombia

BACKGROUND

The aims of this study were to identify the main variables associated with intra-hospital mortality among patients transferred to a specialized neonatal care center, and to evaluate agreement and accuracy of referring and admission diagnoses.

METHODS

A 6 month observational study was conducted to obtain clinical variables for intra-hospital mortality among patients requiring interfacility transport. Association among variables was estimated using Poisson regression with robust variance. Agreement was evaluated between diagnosis before and after transfer using Cohen's kappa, sensitivity, specificity and Youden's I.

RESULTS

The study included 191 neonates, 12.57% of whom died. Increased mortality was associated with the Transport Risk Index of Physiologic Stability (TRIPS). The associated variables were as follows: TRIPS (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI]: 1.02-1.08), weight 1500-2499 g (aPR, 0.08; 95%CI: 0.01-0.40), weight >2500 g (aPR, 0.56; 95%CI: 0.02-0.19), cardiopathy (aPR, 0.20 95%CI: 0.05-0.75), congenital defects (aPR, 4.59; 95%CI: 0.97-21.82) and renal failure (aPR, 3.69; 95%CI: 1.26-10.78). Diagnosis remained unchanged for 71.15% of the neonates. The greatest differences were hyaline membrane disease (49.4%) followed by transient tachypnea (59.9%). Youden's I for referral diagnosis was 0.22 for transient tachypnea, 0.66-0.69 for cardiopathy, esophageal atresia and pneumonia, 0.72-0.74 for hyaline membrane disease and pulmonary hypertension, and >0.90 for the remaining diagnoses.

CONCLUSIONS

Weight <1500 g, renal failure, congenital defects (except congenital cardiopathies) and high TRIPS were associated with a higher risk of intra-hospital mortality. The findings suggest that improving transfer time and quality of care in ambulances would decrease mortality.

Congenital malformations of pediatric surgical interest: prevalence, risk factors, and prenatal diagnosis between 2005 and 2012 in the capital city of a developing country. Bogotá, Colombia

BACKGROUND

Congenital anomalies (CAs) cause nearly one third of infant deaths worldwide. Various surveillance systems have been established, such as the Bogota Congenital Malformations Surveillance Program (BCMSP). Some CAs are of special interest to pediatric surgeons: omphalocele, gastroschisis, intestinal and esophageal atresia, anorectal malformations, vascular anomalies, diaphragmatic hernias, hypospadias and cryptorchidism. The aim of this study is to determine the prevalence of such CAs, and identify possible risk factors.

METHODS

Data from the BCMSP were collected between January 2005 and April 2012. CAs were classified in accordance with the ICD-10 and grouped for analysis purposes. Data on CA frequencies were obtained from the BCMSP. Association analyses were performed using the case-control methodology.

RESULTS

282,523 births were registered. 4682 (1.66%) had one or more CAs at birth. The prevalence of CAs requiring pediatric surgery was 1 in 1000. The most frequent CAs were vascular anomalies, hypospadias, and anorectal malformations. Exposure to external factors was significantly associated with selected CAs. 51% of selected birth defects were not diagnosed in prenatal ultrasound.

CONCLUSIONS

This study highlights the importance of evaluating the local prevalence of congenital malformations. We propose the creation of specialized centers in Bogota to manage patients with CAs.

Neural tube defects in Latin America and the impact of fortification: a literature review

OBJECTIVE

Data on the prevalence of birth defects and neural tube defects (NTD) in Latin America are limited. The present review summarizes NTD prevalence and time trends in Latin American countries and compares pre- and post-fortification periods to assess the impact of folic acid fortification in these countries.

DESIGN

We carried out a literature review of studies and institutional reports published between 1990 and 2010 that contained information on NTD prevalence in Latin America.

RESULTS

NTD prevalence in Latin American countries varied from 0·2 to 9·6 per 1000 live births and was influenced by methods of ascertainment. Time trends from Bogota, Costa Rica, Dominican Republic, Guatemala City, Mexico and Puerto Rico showed average annual declines of 2·5 % to 21·8 %. Pre- and post-fortification comparisons were available for Argentina, Brazil, Chile, Costa Rica, Puerto Rico and Mexico. The aggregate percentage decline in NTD prevalence ranged from 33 % to 59 %.

CONCLUSIONS

The present publication is the first to review data on time trends and the impact of folic acid fortification on NTD prevalence in Latin America. Reported NTD prevalence varied markedly by geographic region and in some areas of Latin America was among the lowest in the world, while in other areas it was among the highest. For countries with available information, time trends showed significant declines in NTD prevalence and these declines were greater in countries where folic acid fortification of staples reached the majority of the population at risk, such as Chile and Costa Rica.

A comparative study of facial asymmetry in philippine, colombian, and ethiopian families with nonsyndromic cleft lip palate

Objective. To compare the asymmetry displayed by Philippine, Colombian, and Ethiopian unaffected parents of patients with nonsyndromic cleft palate (NSCLP) and a control population. Methods. Facial measurements were compared between unaffected parents of NSCLP patients and those in the control group for three populations from South America, Asia, and Africa by anthropometric and photographic measurements. Fluctuating and directional asymmetries, height and width proportions, were analyzed and compared. Results. Fluctuating asymmetries (ear length, middle line to Zigion perpendicular for left and right sides) and variations in the facial thirds demonstrated statistical significance in the study group of unaffected parents from Colombia and Philippines, while increased interorbital distance was evident in the unaffected Ethiopian parents of NSCLP patients. Conclusions. The facial differences in unaffected parents could indicate an underlying genetic liability. Identification of these differences has relevance in the understanding of the etiology of NSCLP.