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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
2.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 56-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123058

RESUMO

OBJECTIVE: To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN: National birth cohort study. SETTING: England and Wales 2006-2012. SUBJECTS: Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES: Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS: Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS: Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade Infantil/etnologia , Recém-Nascido Prematuro , Grupos Minoritários/estatística & dados numéricos , Pobreza , Causas de Morte , Estudos de Coortes , Anormalidades Congênitas/mortalidade , Inglaterra/epidemiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , País de Gales/epidemiologia
3.
J Pak Med Assoc ; 69(6): 846-851, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31189293

RESUMO

OBJECTIVE: To determine the causes of a relatively high infant mortality rate in a Turkish city compared to the nationwide rate. METHODS: The cross-sectional study was conducted at Gaziantep from January to March 2014, and comprised a representative sample of infant deaths that occurred between January and December 2013 in the city of Gaziantep, Turkey. Mothers of the deceased infants were interviewed using a structured questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 556 deaths, 114(20.5%) cases comprised the sample and their mothers formed the study universe. Of them, 3(2.6%) were aged below 18 years; 22(19.3%) were over 35 years; 20(17.5%) had 4 or more children, and 40(35.0%) had an interval of less than 2 years between two pregnancies. Consanguineous marriage was the case with 49(43.0%) mothers. Overall, 111(97.4%) mothers had received prenatal care. Of the births, 66(57.9%) had occurred in private hospitals and 41(36%) in state hospitals. A total of 77(67.5%) infants had been delivered by caesarean section. The most frequent causes of mortality were congenital abnormalities 33(28.9%), prematurity 29(25.4%), respiratory distress syndrome 24(21.1%) and congenital heart diseases 14(12.3%). CONCLUSIONS: A high rate of consanguineous marriages seemed to be one of the most important causes of the high infant death rate in Gaziantep compared to the rest of Turkey..


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil , Doenças do Recém-Nascido/mortalidade , Adolescente , Adulto , Consanguinidade , Estudos Transversais , Humanos , Lactente , Recém-Nascido , Mães/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Turquia/epidemiologia , Adulto Jovem
4.
Obstet Gynecol Surv ; 74(5): 298-302, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31098643

RESUMO

Importance: Bilateral renal agenesis is a rare congenital anomaly associated with poor prognosis. Objective: The aims of this article are to review and summarize evidence on prenatal diagnosis and outcomes of bilateral renal agenesis. Evidence Acquisition: A search was undertaken using PubMed and ClinicalTrials.gov databases from January 1, 1998, to September 1, 2018. Search terms include "prenatal diagnosis" OR "outcomes" AND "bilateral renal agenesis." Search was limited to English language. Results: Fetal ultrasonography is the primary imaging modality for prenatal diagnosis of fetal urogenital tract abnormalities. However, ultrasonography is limited by several factors; it is operator dependent and associated with small field of view, has limited soft-tissue acoustic contrast, and is also influenced by patient habitus and fetal position. Color Doppler ultrasonography can be used as an adjunct to exclude bilateral renal agenesis by visualizing renal arteries. In the literature, prenatal magnetic resonance imaging has been reported to be equal to or superior to prenatal ultrasonography. Bilateral renal agenesis with oligohydramnios/anhydramnios is associated with a poor prognosis; perinatal death occurs secondary to pulmonary hypoplasia in the majority of cases. Conclusions: Ultrasonography in combination with color Doppler ultrasonography permits the fetal urinary tract to be assessed in the first and early second trimester of gestation. The magnetic resonance imaging can be used as a complementary adjunctive modality in equivocal or inconclusive ultrasonographic findings.


Assuntos
Anormalidades Congênitas/diagnóstico por imagem , Nefropatias/congênito , Rim/anormalidades , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos , Anormalidades Congênitas/mortalidade , Feminino , Humanos , Rim/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Nefropatias/mortalidade , Oligo-Hidrâmnio/diagnóstico por imagem , Gravidez
5.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F624-F630, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30842208

RESUMO

OBJECTIVE: To investigate socioeconomic inequalities in cause-specific stillbirth and neonatal mortality to identify key areas of focus for future intervention strategies to achieve government ambitions to reduce mortality rates. DESIGN: Retrospective cohort study. SETTING: England, Wales, Scotland and the UK Crown Dependencies. PARTICIPANTS: All singleton births between 1 January 2014 and 31 December 2015 at ≥24 weeks' gestation. MAIN OUTCOME MEASURE: Cause-specific stillbirth or neonatal death (0-27 days after birth) per 10 000 births by deprivation quintile. RESULTS: Data on 5694 stillbirths (38.1 per 10 000 total births) and 2368 neonatal deaths (15.9 per 10 000 live births) were obtained from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). Women from the most deprived areas were 1.68 (95% CI 1.56 to 1.81) times more likely to experience a stillbirth and 1.67 (95% CI 1.48 to 1.87) times more likely to experience a neonatal death than those from the least deprived areas, equating to an excess of 690 stillbirths and 231 neonatal deaths per year associated with deprivation. Small for gestational age (SGA) unexplained antepartum stillbirth was the greatest contributor to excess stillbirths accounting for 33% of the deprivation gap in stillbirths. Congenital anomalies accounted for the majority (59%) of the deprivation gap in neonatal deaths, followed by preterm birth not SGA (24-27 weeks, 27%). CONCLUSIONS: Cause-specific mortality rates at a national level allow identification of key areas of focus for future intervention strategies to reduce mortality. Despite a reduction in the deprivation gap for stillbirths and neonatal deaths, public health interventions should primarily focus on socioeconomic determinants of SGA stillbirth and congenital anomalies.


Assuntos
Causas de Morte/tendências , Disparidades nos Níveis de Saúde , Mortalidade Infantil/tendências , Natimorto/epidemiologia , Anormalidades Congênitas/mortalidade , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Mortalidade Perinatal/tendências , Estudos Retrospectivos , Reino Unido/epidemiologia
6.
World J Surg ; 43(6): 1404-1415, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30523395

RESUMO

BACKGROUND: The global burden of pediatric surgical conditions continues to remain inadequately addressed, particularly in low- and middle-income countries. Among the many factors contributing to this gap are a lack of access to care secondary to resource shortages and inequitable distribution, underfinancing of healthcare systems, poor quality of care, and contextual challenges such as natural disasters and conflict. The relative contribution of these and other factors varies widely by region and even with countries of a region. METHODS: This review seeks to discuss the heterogeneity of global pediatric surgery and offer recommendations for addressing the barriers to high-quality pediatric surgical care throughout the world. RESULTS: There is significant heterogeneity in pediatric surgical challenges, both between regions and among countries in the same region, although data are limited. This heterogeneity can reflect differences in demographics, epidemiology, geography, income level, health spending, historical health policies, and cultural practices, among others. CONCLUSION: Country-level research and stakeholder engagement are needed to better understand the heterogeneity of local needs and drive policy changes that contribute to sustainable reforms. Key to these efforts will be improved financing, access to and quality of pediatric surgical care.


Assuntos
Serviços de Saúde da Criança , Saúde Global , Acesso aos Serviços de Saúde , Pediatria , Especialidades Cirúrgicas , Acidentes de Trânsito/mortalidade , Adolescente , Criança , Pré-Escolar , Anormalidades Congênitas/mortalidade , Recursos em Saúde , Humanos , Lactente , Qualidade da Assistência à Saúde
7.
BMC Pediatr ; 18(1): 393, 2018 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-30579351

RESUMO

BACKGROUND: In French Guiana, pregnant women may be exposed to infectious, environmental, and social risks leading to congenital malformation. The objective of the study was to study mortality rates from congenital malformations among infants < 1 year and to compare them with those in mainland France. METHODS: We used the CEPI DC (INSERM) database, which compiles annual data from death certificates in all French territories using the International Classification of Diseases. Annual deaths for French Guiana and mainland France between 2005 and 2015 were compiled. The age category studied was children less than 1 year and deaths from congenital malformations, deformations and chromosomal abnormalities were compiled. Crude risk ratios and 95% confidence intervals were calculated to quantify the excess risk of disease in French Guiana. RESULTS: In French Guiana between 2005 and 2015 there were 666 deaths of children aged < 1 year, among which, 132 (19.8%) were due to congenital malformations and chromosomal anomalies. Overall the risk ratio of death from congenital malformations and chromosomal anomalies between French Guiana and mainland France was 2.7 (1.5-4.7), P < 0.001 for neurological congenital malformations it was 4.8 (1.2-19.7), P = 0.01 and for congenital malformations of the circulatory system it was 3.3 (1.5-6.9), P = 0.001. CONCLUSIONS: The incidence of death from congenital malformations or chromosomal anomalies in French Guiana was significantly higher than in mainland France. Explanations for this may be infections, genetic causes, nutritional causes, and toxic causes that are prevalent. There is a need to identify factors that predispose children born in French Guiana to having a higher risk of congenital malformations and chromosomal anomalies.


Assuntos
Anormalidades Congênitas/mortalidade , Anormalidades Cardiovasculares/mortalidade , Transtornos Cromossômicos/mortalidade , Feminino , França/epidemiologia , Guiana Francesa/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Malformações do Sistema Nervoso/mortalidade
8.
West Afr J Med ; 35(3): 195-198, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30387093

RESUMO

BACKGROUND: Congenital malformations remain a leading cause of death in the neonatal period. The incidences of Congenital Malformations have been reported in other parts of Nigeria but there is paucity of data on Congenital Malformations in North-Eastern Nigeria. This review aims to determine the prevalence and pattern of Congenital Malformations in Federal Teaching Hospital Gombe, Northeastern Nigeria. METHODS: A retrospective review of records of all patients admitted into the Special Care Baby Unit of Federal Teaching Hospital Gombe who had a diagnosis of Congenital Malformations over a period of ten years (May 29, 2000-May 29, 2010) was carried out. RESULTS: Out of the 3,744 admissions during the period, 219 had congenital malformations, but 4 patients did not have complete information and were excluded from analysis. Two hundred and fifteen (215) were analyzed giving a prevalence of 5.7%. Among the subjects, 131(60.9%) were male and 84 (39.1%) female giving a male to female ratio of 1.6:1. Majority 110 (51.2%) of patients with congenital malformations were of Fulani ethnic group, followed by Hausa 39(18.1%). Neural tube defects were the commonest 95 (45.1%), while abnormalities of the musculoskeletal system were the lowest 4(1.9%). Outcome of the patients managed revealed that 131(61.2%) were discharged, 51(23.8%) died while 32(15.0%) signed and left against medical advice. CONCLUSION: The findings suggest that congenital malformations are common in Gombe, Neural tube defects were the commonest congenital malformations seen in this study and Fulanis were the most affected.


Assuntos
Anormalidades Congênitas/classificação , Anormalidades Congênitas/epidemiologia , Causas de Morte , Anormalidades Congênitas/mortalidade , Feminino , Hospitais de Ensino , Humanos , Incidência , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Nigéria/epidemiologia , Prevalência , Estudos Retrospectivos
9.
Rev. inf. cient ; 97(6): 1111-1123, nov.-dic. 2018. tab, graf
Artigo em Espanhol | CUMED | ID: cum-74032

RESUMO

Introducción: en el desarrollo histórico de la humanidad las malformaciones congénitas se han presentado teniendo distintas explicaciones, atribuyéndoles significados que oscilan entre ciencia y superstición. Con la expresión diagnóstica prenatal de los defectos congénitos se agrupan aquellas acciones diagnósticas encaminadas a descubrir durante el embarazo un defecto congénito. Objetivo: analizar el comportamiento de algunas variables en el pesquisaje de malformaciones congénitas en gestantes de la provincia de Guantánamo. Método: se realizó un estudio longitudinal retrospectivo sobre malformaciones congénitas en gestantes, en el período enero-diciembre de 2010. El universo está constituido por 7 585 nacimientos y la muestra por 76 malformaciones que se produjeron en ese período, con utilización del muestreo aleatorio simple. Se analizaron las siguientes variables: edad, municipio de procedencia, tipo de malformación congénita, vivo o fallecido, resultado de AFP, resultado de ultrasonido en el primer y segundo trimestre, diagnóstico prenatal de hemoglobinopatías, diagnóstico prenatal de errores innatos del metabolismo y resultado del diagnóstico prenatal citogenético. Resultados: las tasas más altas correspondiendo a los municipios de Caimanera, Baracoa y Maisí, con 11,2; 2,74 y 2,28; respectivamente. Las malformaciones más frecuentes se encontraron en el sistema nervioso central con el 23,68 por ciento, cardiovascular y osteomioarticular, con 19,73 y 18,42 por ciento, cada uno. Los municipios con mayor tasa de malformaciones congénitas fueron Imías, Caimanera y Niceto Pérez con 30,86; 28,09 y 12,98 por mil. Conclusiones: La frecuencia de malformaciones congénitas durante el año 2010 en la provincia Guantánamo fue inferior a la reportada en la literatura(AU)


Introduction: in the historical development of humanity, congenital malformations have been presented with different explanations, attributing meanings that oscillate between science and superstition. With the prenatal diagnostic expression of congenital defects are grouped those diagnostic actions aimed at discovering a congenital defect during pregnancy. Objective: to analyze the behavior of some variables in the screening of congenital malformations in pregnant women in the province of Guantánamo. Method: a retrospective longitudinal study was performed on congenital malformations in pregnant women, in the period January-December 2010. The universe is constituted by 7 585 births and the sample by 76 malformations that occurred in that period, using simple random sampling. The following variables were analyzed: age, municipality of origin, type of congenital malformation, alive or deceased, AFP result, ultrasound result in the first and second trimester, prenatal diagnosis of hemoglobinopathies, prenatal diagnosis of inborn errors of metabolism and outcome of the prenatal cytogenetic diagnosis. Results: the highest rates corresponding to the municipalities of Caimanera, Baracoa and Maisí, with 11.2; 2.74 and 2.28; respectively. The most frequent malformations were found in the central nervous system with 23.68 percent, cardiovascular and osteomyoarticular, with 19.73 and 18.42 percent, each. The municipalities with the highest rate of congenital malformations were Imías, Caimanera and Niceto Pérez with 30.86; 28.09 and 12.98 per thousand. Conclusions: the mortality rate due to congenital malformations in the province of Guantanamo during 2010 was higher than that reported nationally. The frequency of congenital malformations during the year 2010 in Guantanamo province was lower than that reported in the literature(AU)


Introdução: no desenvolvimento histórico da humanidade, malformações congênitas foram apresentadas com diferentes explicações, atribuindo significados que oscilam entre ciência e superstição. Com a expressão diagnóstica pré-natal de defeitos congênitos agrupam-se aquelas ações diagnósticas que visam descobrir um defeito congênito durante a gravidez. Objetivo: analisar o comportamento de algumas variáveis na triagem de malformações congênitas em gestantes da província de Guantánamo. Método: Um estudo retrospectivo longitudinal de defeitos congénitos em mulheres grávidas foi realizada em Janeiro-Dezembro de 2010. O universo consiste em 7585 nascimentos e as malformações amostra 76 que ocorreram durante o mesmo período, com o uso de amostragem aleatória . idade, cidade de origem, tipo de malformação congênita, viva ou morta, resultado AFP, o resultado da ultra-sonografia no primeiro e segundo diagnóstico pré-natal trimestre de hemoglobinopatias, diagnóstico pré-natal de erros inatos do metabolismo e resultar Foram analisadas as seguintes variáveis diagnóstico citogenético pré-natal. Resultados: as maiores taxas correspondentes aos municípios de Caimanera, Baracoa e Maisí, com 11,2; 2,74 e 2,28; respectivamente. Os defeitos mais comuns foram encontradas no sistema nervoso central, com 23,68 %, cardiovascular e osteomioarticular com 19,73 e 18,42 %, cada. Os municípios com maior índice de malformações congênitas foram Imías, Caimanera e Niceto Pérez com 30,86; 28,09 e 12,98 por mil. Conclusões: a taxa de mortalidade por malformações congênitas na província de Guantánamo em 2010 foi superior à relatada nacionalmente. A freqüência de malformações congênitas durante o ano de 2010 na província de Guantánamo foi menor do que a relatada na literatura. A faixa etária com predomínio de malformações congênitas foi de 20 a 29 anos de idade. Os meios diagnósticos mais utilizados foram a ultra-sonografia, seguida das alfa-fetoproteínas e os estudos citogenéticos(AU)


Assuntos
Humanos , Feminino , Gravidez , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/mortalidade
10.
J Pediatr ; 203: 68-75.e2, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30318370

RESUMO

OBJECTIVES: To prospectively assess rates and detailed predictors of morbidity and mortality among HIV-exposed uninfected children and HIV-unexposed children in Botswana in a more recent era. STUDY DESIGN: We enrolled HIV-infected and HIV-uninfected mothers and their children in the prospective observational Tshipidi study at 2 sites (1 city and 1 village) in Botswana from May 2010-July 2012. Live-born children and their mothers were followed for 24 months postpartum. Detailed sociodemographic data, health, and psychosocial characteristics were collected at baseline and prospectively, and health outcomes ascertained. Mothers chose infant feeding method with counselling. RESULTS: A total of 893 live-born HIV-uninfected children (436 HIV-exposed uninfected, 457 HIV-unexposed) were followed. HIV-infected mothers had a median CD4 count of 410 cells/mm3, 32% took 3-drug antiretroviral treatment during pregnancy, 67% took only zidovudine, and 1% took <2 weeks of any antiretrovirals antepartum. Twenty four-month vital status was available for 888 (99.4%) children. HIV-exposed uninfected children had a significantly higher risk of death compared with children of HIV-uninfected mothers (5.0% vs 1.8%) (adjusted hazard ratio 3.27, 95% CI 1.44-7.40). High collinearity between maternal HIV status and child feeding method precluded analysis of these factors as independent predictors of mortality. Preterm birth, low birth weight, and congenital anomaly were also associated with mortality (in separate analyses), but maternal socioeconomic factors, depression, substance use, and social support were not significant predictors. CONCLUSIONS: The strongest predictors of 24-month mortality among children in Botswana were HIV exposure and formula feeding, although the relative contribution of these factors to child health could not be separated.


Assuntos
Infecções por HIV/epidemiologia , Fórmulas Infantis , Mortalidade Infantil , Complicações Infecciosas na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Adulto , Antirretrovirais/uso terapêutico , Botsuana/epidemiologia , Contagem de Linfócito CD4 , Anormalidades Congênitas/mortalidade , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro , Estudos Prospectivos
11.
J Perinatol ; 38(12): 1674-1684, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30237475

RESUMO

OBJECTIVE: We assessed survival, hospital length of stay (LOS), and costs of medical care for infants with lethal congenital malformations, and also examined the relationship between medical and surgical therapies and survival. STUDY DESIGN: Retrospective cohort study including infants born 1998-2009 with lethal congenital malformations, identified using a longitudinally linked maternal/infant database. RESULTS: The cohort included 786 infants: trisomy 18 (T18, n = 350), trisomy 13 (T13, n = 206), anencephaly (n = 125), bilateral renal agenesis (n = 53), thanatophoric dysplasia/achondrogenesis/lethal osteogenesis imperfecta (n = 38), and infants > 1 of the birth defects (n = 14). Compared to infants without birth defects, infants with T18, T13, bilateral renal agenesis, and skeletal dysplasias had longer survival rates, higher inpatient medical costs, and longer LOS. CONCLUSION: Care practices and survival have changed over time for infants with T18, T13, bilateral renal agenesis, and skeletal dysplasias. This information will be useful for clinicians in counseling families and in shaping goals of care prenatally and postnatally.


Assuntos
Anormalidades Congênitas/economia , Anormalidades Congênitas/mortalidade , Anormalidades Congênitas/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Florida/epidemiologia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Rim/anormalidades , Nefropatias/congênito , Nefropatias/economia , Nefropatias/mortalidade , Tempo de Internação/economia , Masculino , Anormalidades Musculoesqueléticas/economia , Anormalidades Musculoesqueléticas/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Síndrome da Trissomia do Cromossomo 13/economia , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/economia , Síndrome da Trissomía do Cromossomo 18/mortalidade
12.
Artigo em Inglês | MEDLINE | ID: mdl-30103420

RESUMO

This study aimed to analyse population-based mortality attributed to rare congenital anomalies (CAs) and assess the associated time trends and geographical differences in Spain. Data on CA-related deaths were sourced from annual mortality databases kept by the National Statistics Institute of Spain (1999⁻2013). Based on the ICD-10, only CAs corresponding to rare diseases definition were included in this study. Annual age-adjusted mortality rates were calculated and time trends were evaluated by joinpoint regression analysis. Geographical differences were assessed using standardised mortality ratios and cluster detection. A total of 13,660 rare-CA-related deaths (53.4% males) were identified in the study period. Annual age-adjusted mortality rates decreased by an average of -5.2% (-5.5% males, -4.8% females, p < 0.001). Geographical analysis showed a higher risk of rare-CA-related mortality in regions largely located in the south of the country. Despite their limitations, mortality statistics are essential and useful tools for enhancing knowledge of rare disease epidemiology and, by extension, for designing and targeting public health actions. Monitoring rare-CA-related mortality in Spain has shown a 15-year decline and geographical differences in the risk of death, all of which might well be taken into account by the health authorities in order to ensure equality and equity, and to adopt appropriate preventive measures.


Assuntos
Anormalidades Congênitas/mortalidade , Vigilância da População , Doenças Raras/mortalidade , Sistema de Registros/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Feminino , Humanos , Masculino , Mortalidade/tendências , Doenças Raras/epidemiologia , Espanha/epidemiologia , Regressão Espacial
13.
Clin Perinatol ; 45(2): 213-230, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29747884

RESUMO

Prenatal diagnosis has changed perinatal medicine dramatically, allowing for additional fetal monitoring, referral and counseling, delivery planning, the option of fetal intervention, and targeted postnatal management. Teams participating in the delivery room care of infants with known anomalies should be knowledgeable about specific needs and expectations but also ready for unexpected complications. A small number of neonates will need rapid access to postnatal interventions, such as surgery, but most can be stabilized with appropriate neonatal care. These targeted perinatal interventions have been shown to improve outcome in selected diagnoses.


Assuntos
Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/cirurgia , Assistência Perinatal/métodos , Mortalidade Perinatal/tendências , Ultrassonografia Pré-Natal/métodos , Anormalidades Congênitas/mortalidade , Feminino , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Masculino , Gravidez , Diagnóstico Pré-Natal/métodos , Prognóstico , Medição de Risco
14.
BMC Pregnancy Childbirth ; 18(1): 180, 2018 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-29792180

RESUMO

BACKGROUND: Congenital malformations contribute significantly to the disease burden among children globally. A study conducted in Kenya on understanding the burden of surgical congenital anomalies, highlights the need for Kenyan health systems to go beyond the medical dimensions of illness. This could be achieved by linking knowledge of the severe congenital anomalies (CAs) and their impact of varying disability to the delivery of local health services and public health program planning. Subsequently, early detection of these congenital anomalies is vital and can be achieved through fetal ultrasonography. Studies have proven that antenatal ultrasound can successfully diagnose fetal abnormalities in many cases and therefore aid in counseling of parents and planning for early intervention. Although there are studies on screening of congenital anomalies in various populations, very few have been done in the African population and none to the best of our knowledge has been done in Kenya. METHODS: The patients, who underwent routine obstetric ultrasounds, were recruited into the study. The study population comprised patients who were referred from the obstetric clinic, casualty and other clinics within the hospital vicinity. Data of antenatal ultrasounds was statistically analyzed on structured data collection form to determine the prevalence of congenital anomalies. RESULTS: Fifteen fetal anomalies were diagnosed in 500 women who came for routine ultrasound (3%). The mean age of the mothers was 28.2 years (SD ± 4.5) with an age range from 15 to 44 years. 400 (80%) of the mothers were aged between 27 and 34 years. The most frequently observed fetal anomalies involved the head (8/ 500; 1.6%). Each of the remaining anomalies affected less than 1% of the fetuses and included anomalies of the spine (2/ 500; 0.4%), pulmonary (2/ 500; 0.4%), renal and urinary tract (2/ 500; 0.4%) and skeletal systems (2/ 500; 0.4%). Majority, 9 of 15 (60%) of the fetuses with anomalies detected on prenatal ultrasound resulted in postnatal mortality within days of delivery. CONCLUSION: Congenital anomalies prevalence in our setting compares with those found in other studies. From this study, major birth defects are a major cause of perinatal mortality.


Assuntos
Anormalidades Congênitas/epidemiologia , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/mortalidade , Feminino , Humanos , Recém-Nascido , Quênia/epidemiologia , Mortalidade Perinatal , Gravidez , Prevalência , Adulto Jovem
15.
NCHS Data Brief ; (300): 1-8, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29638212

RESUMO

The leading causes of infant death vary by age at death but were consistent from 2005 to 2015 (1-6). Previous research shows higher infant mortality rates in rural counties compared with urban counties and differences in cause of death for individuals aged 1 year and over by urbanization level (4,5,7,8). No research, however, has examined if mortality rates from the leading causes of infant death differ by urbanization level. This report describes the mortality rates for the five leading causes of infant, neonatal, and postneonatal death in the United States across rural, small and medium urban, and large urban counties defined by maternal residence, as reported on the birth certificate for combined years 2013-2015.


Assuntos
Mortalidade Infantil/tendências , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Anormalidades Congênitas/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Mortalidade Perinatal/tendências , Gravidez , Complicações na Gravidez/mortalidade , Fatores Socioeconômicos , Morte Súbita do Lactente/epidemiologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/mortalidade
17.
PLoS Med ; 15(3): e1002531, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29558463

RESUMO

BACKGROUND: While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births. METHODS AND FINDINGS: Linked birth and death records for the period 2010-2012 were used to identify the state- and cause-specific burden of infant mortality among full-term infants (born at 37-42 weeks of gestation). Multivariable logistic models were used to assess the extent to which state-level differences in full-term infant mortality (FTIM) were attributable to observed differences in maternal and birth characteristics. Random effects models were used to assess the relative contribution of state-level variation to FTIM. Hypothetical mortality outcomes were computed under the assumption that all states could achieve the survival rates of the best-performing states. A total of 10,175,481 infants born full-term in the US between January 1, 2010, and December 31, 2012, were analyzed. FTIM rate (FTIMR) was 2.2 per 1,000 live births overall, and ranged between 1.29 (Connecticut, 95% CI 1.08, 1.53) and 3.77 (Mississippi, 95% CI 3.39, 4.19) at the state level. Zero states reached the rates reported in the 6 low-mortality European countries analyzed (FTIMR < 1.25), and 13 states had FTIMR > 2.75. Sudden unexpected death in infancy (SUDI) accounted for 43% of FTIM; congenital malformations and perinatal conditions accounted for 31% and 11.3% of FTIM, respectively. The largest mortality differentials between states with good and states with poor FTIMR were found for SUDI, with particularly large risk differentials for deaths due to sudden infant death syndrome (SIDS) (odds ratio [OR] 2.52, 95% CI 1.86, 3.42) and suffocation (OR 4.40, 95% CI 3.71, 5.21). Even though these mortality differences were partially explained by state-level differences in maternal education, race, and maternal health, substantial state-level variation in infant mortality remained in fully adjusted models (SIDS OR 1.45, suffocation OR 2.92). The extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services could not be determined due to data limitations. Overall, our estimates suggest that infant mortality could be reduced by 4,003 deaths (95% CI 2,284, 5,587) annually if all states were to achieve the mortality levels of the best-performing state in each cause-of-death category. Key limitations of the analysis are that information on termination rates at the state level was not available, and that causes of deaths may have been coded differentially across states. CONCLUSIONS: More than 7,000 full-term infants die in the US each year. The results presented in this paper suggest that a substantial share of these deaths may be preventable. Potential improvements seem particularly large for SUDI, where very low rates have been achieved in a few states while average mortality rates remain high in most other areas. Given the high mortality burden due to SIDS and suffocation, policy efforts to promote compliance with recommended sleeping arrangements could be an effective first step in this direction.


Assuntos
Asfixia , Declaração de Nascimento , Atestado de Óbito , Mortalidade/etnologia , Assistência Perinatal , Morte Súbita do Lactente , Nascimento a Termo , Asfixia/epidemiologia , Asfixia/mortalidade , Causas de Morte , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/mortalidade , Escolaridade , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Determinação de Necessidades de Cuidados de Saúde , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/prevenção & controle , Estados Unidos/epidemiologia
18.
Ann Thorac Surg ; 105(6): 1819-1826, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29452118

RESUMO

BACKGROUND: This study analyzed outcomes of interrupted aortic arch (IAA) repair using a standardized technique to interpret the role of the arch repair on late outcomes in a complex and heterogeneous group of patients. METHODS: This single institution study covered the period from 1988 to 2015. A total of 120 cases of IAA were divided into four groups: IAA with ventricular septal defect (VSD) (n = 38), IAA with a Norwood or Damus-Kaye-Stansel procedure (n = 41), IAA with truncus arteriosus (n = 24), and a miscellaneous group (n = 17). Arch repair was performed using a standard technique of direct anastomosis with homograft patch augmentation. RESULTS: IAAs were predominantly type B (n = 81, 68%), and type A (n = 34, 28%), with a significant association of type B with truncus arteriosus and of type A with an aortopulmonary window (p < 0.01). Survival was similar in all groups. The incidence of catheter or surgical reintervention was 18% (confidence interval [CI], 10% to 25%) at 5 years and 18% (CI, 10% to 25%) at 10 years, with catheter reintervention more common and occurring before 18 months. Surgical reintervention occurred in 7% (CI, 2% to 13%) at 5 and 10 years and at 10 years the reintervention rate was lower in the group with truncus arteriosus (0%) and in the group with a Norwood or Damus-Kaye-Stansel procedure (5%). There was no bronchial obstruction or aortic aneurysm. The Cox proportional hazard model showed that weight at surgery <2.5 kg and era of surgery were predictive of outcome, with surgical mortality rates in all variants dropping to 8.3% in the last 15 years of the study. CONCLUSIONS: Repair of IAA using direct anastomosis and patch augmentation is applicable to all variants and provides good long-term arch patency. Survival is strongly associated with weight at surgery.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Implante de Prótese Vascular/métodos , Estudos de Coortes , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/mortalidade , Anormalidades Congênitas/cirurgia , Bases de Dados Factuais , Feminino , Seguimentos , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/mortalidade , Comunicação Interventricular/cirurgia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular/métodos , Enxerto Vascular/mortalidade , Malformações Vasculares/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/mortalidade
19.
Arch Dis Child ; 103(11): 1027-1032, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29436407

RESUMO

OBJECTIVE: We aimed to assess Child Death Overview Panel (CDOP) data validity, and cause of death classification, by comparison with information from a local birth cohort study (Born in Bradford, BiB), and another cause of death coding system (causes of death and associated conditions-CODAC). We then aimed to use CDOP data to calculate ethnic-specific infant mortality rates (IMRs), and compare characteristics of infants who died of congenital anomalies (CA) with those who died from other causes (non-CA). DESIGN: Retrospective cohort study. SETTING: Bradford Metropolitan District. PATIENTS: All infant deaths, 2008 to 2013. MAIN OUTCOME MEASURES: Infant mortality rates from CA and non-CA causes. RESULTS: 315 infant deaths were included, 56 of whom were BiB recruits. Agreement between CDOP and BiB was moderate to perfect for all characteristics except ethnicity, which showed weak agreement (kappa=0.58). The same deaths (27/56) were classified as CA by CDOP and CODAC. IMRs (per 1000 live births, 2009-2013) were highest in Pakistani infants (all causes 9.8, CA cause 5.5) compared with white British (all causes 4.3, CA cause 1.3) and other infants (all causes 5.1, CA cause 1.4). In multivariate analysis, infants who died of CA cause were more likely to have been born at term (OR 3.18) and to consanguineous parents (OR 3.28) than infants who died of non-CA cause. CONCLUSIONS: Excess Pakistani mortality appears to be partly explained by an excess of deaths from CA, which in this population appears associated with a greater prevalence of consanguinity.


Assuntos
Anormalidades Congênitas/mortalidade , Grupos Étnicos/estatística & dados numéricos , Morte do Lactente , Mortalidade Infantil/etnologia , Causas de Morte , Consanguinidade , Atestado de Óbito , Crianças com Deficiência , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Estudos Retrospectivos
20.
Ultrasound Obstet Gynecol ; 52(2): 165-173, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29484752

RESUMO

OBJECTIVE: To quantify from the published literature survival and neurodevelopmental outcome of fetuses with prenatally detected isolated severe bilateral ventriculomegaly. METHODS: MEDLINE, EMBASE and the Cochrane Library were searched electronically. Only cases with a prenatal diagnosis of apparently isolated severe ventriculomegaly and postnatal neurodevelopmental assessment were selected and included. Severe ventriculomegaly was defined as enlargement of the ventricular atria, with a diameter of greater than 15 mm in the transventricular plane. All cases in which the investigators were unable to detect associated structural abnormality, chromosomal abnormality or fetal infection, and in which the ventriculomegaly was therefore regarded as apparently isolated, were included. Those for which the etiology was identified prenatally were excluded, whereas those with postnatal identification of the underlying cause were not excluded, since this information was not available prenatally. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies. Pregnancy outcomes such as termination, stillbirth, neonatal survival and developmental outcome of the baby, were recorded. The degree of disability was classified as no, mild or severe disability. Statistical assessment was performed by meta-analysis of proportions to combine data, weighting the studies using the inverse variance method and a random-effects model. Proportions and CIs were reported. RESULTS: Eleven studies including 137 fetuses were found. Twenty-seven pregnancies underwent termination and were excluded. The remaining 110 fetuses with apparently isolated severe ventriculomegaly for which continuation of pregnancy was intended, form the study population. Overall quality assessed using NOS for cohort studies was good. Survival was reported in 95/110 (pooled proportion 87.9% (95% CI, 75.6-96.2%)) cases. In 15/110 (pooled proportion 12.1% (95% CI, 3.8-24.4%)), either stillbirth or neonatal demise was reported. No disability was reported in 41/95 survivors (pooled proportion 42.2% (95% CI, 27.5-57.6%)). However, 17/95 showed mild/moderate disability (pooled proportion 18.6% (95% CI, 7.2-33.8%)) and 37/95 were reported to have severe disability (pooled proportion 39.6% (95% CI, 30.0-50.0%)). CONCLUSIONS: Four-fifths of fetuses with severe ventriculomegaly survive and, of these, just over two-fifths show normal neurodevelopment. The overall survivors without disability account for more than one third of the total. Given that many cases undergo termination of pregnancy and require longer follow-up in order to detect subtle abnormalities, mortality and prevalence of developmental delay may be even higher than that reported in this paper. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Ventrículos Cerebrais/anormalidades , Ventrículos Cerebrais/embriologia , Anormalidades Congênitas/embriologia , Anormalidades Congênitas/mortalidade , Feminino , Doenças Fetais/mortalidade , Humanos , Recém-Nascido , Transtornos do Neurodesenvolvimento/mortalidade , Transtornos do Neurodesenvolvimento/fisiopatologia , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Índice de Gravidade de Doença , Análise de Sobrevida
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