Prevalence of congenital anomalies in the Dutch Caribbean islands of Aruba, Bonaire, and Curaçao.

BACKGROUND: Congenital anomalies represent an important global health issue. Data on the prevalence and pattern of congenital anomalies in the Caribbean region are scarce and lacking altogether in Aruba, Bonaire and Curaçao (ABC islands). METHODS: We performed a population-based surveillance study to determine the prevalence of structural congenital anomalies in the ABC islands, including all live births and stillbirths between January 1, 2008 and December 31, 2017 with major congenital anomalies according to EUROCAT guide 1.5. Terminations of pregnancy for fetal anomaly were included as well. Cases were identified by active case ascertainment, using multiple sources including pediatric patient files and discharge letters, delivery records, and clinical genetic patient files. Total and subgroup prevalence rates were compared between the three islands and to the French West Indies and Northern Netherlands. RESULTS: Total prevalence of congenital anomalies on the ABC islands was 242.97 per 10,000 births. Total prevalence of congenital anomalies in Bonaire (325.15 per 10,000 births) was higher compared to Aruba (233.29 per 10,000 births) and Curaçao (238.58 per 10,000 births), which was mainly attributable to a higher prevalence of limb anomalies, in particular polydactyly, in Bonaire. Total prevalence of congenital anomalies on the ABC islands was comparable to the French West Indies (248.69 per 10,000 births) but significantly lower compared to the Northern Netherlands (298.98 per 10,000 births). In the subgroup prevalence analysis, the prevalence of polydactyly and atrial septal defect on the ABC islands was significantly higher compared with the French West Indies and the Northern Netherlands, while the prevalence of congenital anomalies of the kidney and urinary tract and genetic disorders was significantly lower. CONCLUSIONS: This is the first study to establish the prevalence and pattern of congenital anomalies on the ABC islands, which is important to inform healthcare managers and policymakers and to provide a basis for continuous surveillance of congenital anomalies.

Re-evaluating the role of cerebroplacental ratio in predicting adverse perinatal outcome.

AIM: This meta-analysis evaluates the use of cerebroplacental ratio (CPR) in predicting adverse perinatal outcome. METHODS: An electronic search of PubMed, Embase, Google scholar, Cochrane Library and Up-to-Date was done using variations of 'cerebroplacental ratio' and 'cerebroumbilical ratio'. We included studies where CPR was measured and postpartum outcomes were available. Selected articles were evaluated for quality of study methodology using the Newcastle-Ottawa Scale, and aggregate statistics for relative risks, odds ratios and 95% confidence interval were calculated. RESULTS: Data from 66,392 patients in 47 studies was extracted. There were 25 prospective, 17 retrospective and 5 case-control studies. Data on each obstetric or perinatal outcome was separately analysed. When analysing the prospective data, it showed abnormal CPR can predict the need for operative delivery due to foetal distress [RR: 2.52, 95%CI: 2.10-3.02; I2 = 65.78, P < 0.001], low pH [RR: 2.19, 95%CI: 1.01-4.75; I2 = 70.26, P = 0.005] and low Apgar score [RR: 2.05, 95%CI: 1.39-3.03; I2 = 37.15, P = 0.10], foetal or neonatal demise [RR: 2.49, 95%CI: 1.00-6.20], as well as NICU admission [RR: 2.23, 95%CI: 1.84-2.70; I2 48.53, P = 0.14].The retrospective data showed a statistically significant correlation in all outcomes but the low pH. CONCLUSION: Our meta-analysis shows that CPR can be used to identify foetuses with higher risk of operative delivery due to foetal distress, low Apgar score, NICU admission, neonatal morbidity as well as stillbirth and neonatal death rates.