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      Epidemiological Study of Congenital Anomalies and Risk Factors in Newborn Infants at a Tertiary Care Hospital in Bangladesh

      research-article
      Author(s): 1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8
      Publication date (Print):
      Journal: Newborn
      Publisher: Jaypee Brothers Medical Publishers
      Keywords: Ambiguous genitalia, Anencephaly, Atrial septal defect, Bangladesh, Birth-defect registries, Chromosomal abnormalities, Cleft palate, Cleft lip, talipes, Congenital anomalies, Congenital diaphragmatic hernia, Cytomegalovirus, Duodenal atresia, Embryonic development, Environmental contaminants, Epidemiological profile, Epidemiology, External teratogens, Fetal development, Folic acid deficiency, Global Burden of Disease study, Hydrocephalus, Hypospadias, ICD-9, ICD-10, Infant, Inguinal hernia, Iodine deficiency, Iimperforate anus, Meningomyelocele, Micronutrients, Multifactorial transmission, Newborn, Patent ductus arteriosus, Pesticides, Polydactyly, Radiation, Rubella, Single-gene disorders, Spina bifida, Syndactyly, Tetralogy of Fallot, Tracheoesophageal fistula, Undescended testis, Ventricular septal defect

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          ABSTRACT

          Background

          Congenital anomalies are structural/functional defects in various organs (systems) that are apparent at birth. These anomalies originate prior to birth due to altered embryonic/fetal development. These are significant contributors to stillbirths/infant mortality over the world; the global variation in incidence is possibly related to regional differences in exposure to various etiological factors.

          Objectives

          To investigate the epidemiological profile of various congenital abnormalities in newborn infants in Bangladesh.

          Materials and methods

          This cross-sectional observational study was conducted in Central Medical College Hospital, Cumilla, Bangladesh. We recorded 100 consecutive congenital anomalies in 54,800 infant visits in our outpatient clinics. Data were collected from families after informed written consent.

          Results

          Out of the 100 infants with congenital anomalies, 69 infants were male and 31 were female (gender ratio 2.2:1). Congenital abnormalities were seen in the central nervous system (CNS) in 30, in the musculoskeletal system in 24, gastrointestinal in 24, cardiovascular in 13, and the genitourinary system in 9 infants. Thirty-eight infants had a history of antenatal exposure to radiation, and 35 of them to pesticides. Twenty-two were born to mothers with diabetes, and 18 to mothers with hypertension.

          Conclusion

          We identified antenatal exposure to radiation, pesticides, maternal diabetes, and maternal hypertension as important predisposing factors for congenital anomalies. Congenital anomalies of the CNS and musculoskeletal/gastrointestinal defects were seen most frequently. Identification of risk factors can help in designing appropriate interventions.

          How to cite this article

          Alam MZ, Tareq MR, Shapna DS, et al. Epidemiological Study of Congenital Anomalies and Risk Factors in Newborn Infants at a Tertiary Care Hospital in Bangladesh. Newborn 2023;2(3):185–190.

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          Most cited references25

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          Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

          Haidong Wang, Zulfiqar Bhutta, Matthew M Coates … (2016)
          Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.
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            Guidelines for case classification for the National Birth Defects Prevention Study.

            Lars S Rasmussen, M Keppler, R S Olney … (2003)
            Previous studies have suggested that etiologic heterogeneity may complicate epidemiologic analyses designed to identify risk factors for birth defects. Case classification uses knowledge of embryologic and pathogenetic mechanisms to make case groups more homogeneous and is important to the success of birth defects studies. The goal of the National Birth Defects Prevention Study (NBDPS), an ongoing multi-site case-control study, is to identify environmental and genetic risk factors for birth defects. Information on environmental risk factors is collected through an hour-long maternal interview, and DNA is collected from the infant and both parents for evaluation of genetic risk factors. Clinical data on infants are reviewed by clinical geneticists to ensure they meet the detailed case definitions developed specifically for the study. To standardize the methods of case classification for the study, an algorithm has been developed to guide NBDPS clinical geneticists in this process. Methods for case classification into isolated, multiple, and syndrome categories are described. Defects considered minor for the purposes of case classification are defined. Differences in the approach to case classification for studies of specific defects and of specific exposures are noted. The case classification schema developed for the NBDPS may be of value to other clinicians working on epidemiologic studies of birth defects etiology. Consideration of these guidelines will lead to more comparable case groups, an important element of careful studies aimed at identifying risk factors for birth defects.
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              Estimating Global Burden of Disease due to congenital anomaly: an analysis of European data

              Breidge Boyle, Marie-Claude Addor, Larraitz Arriola … (2017)
              Objective To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics. Design, setting and outcome measures EUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks’ gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005–2009, and infant mortality (deaths of live births at age <1 year) compared with the WHO Mortality Database. Eight EUROCAT countries were excluded from further analysis on the basis that this comparison showed poor ascertainment of survival status. Results According to WHO, 17%–42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly. Conclusions By excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.
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                Author and article information

                Journal
                Journal ID (publisher-id): JNB
                Title: Newborn
                Abbreviated Title: JNB
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Electronic): 2769-514X
                Publication date (Print): July-September 2023
                Volume: 2
                Issue: 3
                Pages: 185-190
                Affiliations
                [1 ]Department of Pediatrics, Central Medical College, Cumilla, Bangladesh
                [2 ]Department of Orthopedics, Cumilla Medical College, Cumilla, Bangladesh
                [3 ]Department of Gynecology, Upazilla Health Complex, Cumilla, Bangladesh
                [4 ]Department of Pediatrics, Louisiana State University – Shreveport, Shreveport, Louisiana, United States of America; Global Newborn Society, Clarksville, Maryland, United States of America
                [5,7 ]Department of Orthopedics, Central Medical College, Cumilla, Bangladesh
                [6 ]Department of Child Health, Combined Military Hospital, Chittagong, Bangladesh
                [8 ]Department of Medicine, Central Medical College, Cumilla, Bangladesh
                Author notes
                Md Zahirul Alam, Department of Pediatrics, Central Medical College, Cumilla, Bangladesh, Phone: +880 1742-745005, e-mail: dr.zahir26@ 123456gmail.com
                Article
                DOI: 10.5005/jp-journals-11002-0071
                SO-VID: 62acf00a-7d02-41ca-9309-cdca83dcd6c5
                Copyright © Copyright © 2023; The Author(s).
                License:

                © The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 18 June 2023
                Date accepted : 04 August 2023
                Date: 25 September 2023
                Categories
                Subject: ORIGINAL RESEARCH
                Custom metadata
                file-pdf jnb-02-185.pdf

                ScienceOpen disciplines: Pediatrics
                Keywords: Duodenal atresia,Embryonic development,Environmental contaminants,Epidemiological profile,Epidemiology,External teratogens,Fetal development,Folic acid deficiency,Global Burden of Disease study,Hydrocephalus,Hypospadias,ICD-9,ICD-10,Infant,Inguinal hernia,Iodine deficiency,Iimperforate anus,Meningomyelocele,Micronutrients,Congenital anomalies,Newborn,Patent ductus arteriosus,Pesticides,Polydactyly,Radiation,Rubella,Single-gene disorders,Spina bifida,Syndactyly,Tetralogy of Fallot,Tracheoesophageal fistula,Undescended testis,Ventricular septal defect,Multifactorial transmission,Congenital diaphragmatic hernia,Cytomegalovirus,talipes,Cleft lip,Cleft palate,Chromosomal abnormalities,Birth-defect registries,Bangladesh,Atrial septal defect,Anencephaly,Ambiguous genitalia
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: Duodenal atresia, Embryonic development, Environmental contaminants, Epidemiological profile, Epidemiology, External teratogens, Fetal development, Folic acid deficiency, Global Burden of Disease study, Hydrocephalus, Hypospadias, ICD-9, ICD-10, Infant, Inguinal hernia, Iodine deficiency, Iimperforate anus, Meningomyelocele, Micronutrients, Congenital anomalies, Newborn, Patent ductus arteriosus, Pesticides, Polydactyly, Radiation, Rubella, Single-gene disorders, Spina bifida, Syndactyly, Tetralogy of Fallot, Tracheoesophageal fistula, Undescended testis, Ventricular septal defect, Multifactorial transmission, Congenital diaphragmatic hernia, Cytomegalovirus, talipes, Cleft lip, Cleft palate, Chromosomal abnormalities, Birth-defect registries, Bangladesh, Atrial septal defect, Anencephaly, Ambiguous genitalia

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