A 12-month prospective survey of perinatal outcome of liveborn neonates in Julu County, China

Background Population based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children＇s health care infrastructure.Methods The perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.Results There were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were bornprematurely. Mean （SD） birth weight （BW） was （3348±503） g. The low （〈2500 g） and very low BW （〈1500 g） infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births.Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants （12.8% of the live births）admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6%. （44/5822）, with 16 in delivery room and 28 in neonatal ward before discharge.Conclusions This study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem,which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.     

MR and cine-MR imaging in the diagnosis of infantile congenital heart disease

Objective　To assess the effectiveness of magnetic resonance imaging (MRI) and cine magnetic resonance imaging (cine-MRI) in the diagnosis of infantile congenital heart disease. Methods　A total of 34 cases were studied with MRI and cine-MRI. The data were analyzed and compared with those of two-dimensional echocardiography (2DE), cardioangiography (CAG) and surgery. Results　The size of the defect or its caliber obtained from MRI in 6 patients with left to right shunt congenital heart disease was compatible with that observed in surgery (P=0.924). Comparison of cine-MRI and CAG in 28 patients with complicated congenital heart disease showed that the diagnosis of 27 cases by cine-MRI was the same as that by CAG. Conclusion　Both MRI and cine-MRI play an important role in diagnosing infantile congenital heart disease.     

Persistent truncus arteriosus with intact ventricular septum diagnosed by echocardiography

Persistent truncus arteriosus （PTA） is a rare congenital cardiac anomaly, and has an incidence of about 0.5 to 0.9 per 10 000 live births, Almost all cases described in the literatures had a large ventricular septal defect, only few rare cases were reported with intact ventricular septum.2-5 From June 1998 to December 2008, cardiac angiography were performed in 10 880 patients with congenital heart disease in our hospital, 47 patients with PTA were diagnosed, one case with tricuspid atresia, hvooolastic right ventricle,     

Surgical repair of congenital tracheal stenosis associated with complex congenital heart disease in infants

Objective To evaluate results of one stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants. Methods Two infants with congenital stenosis associated with Tetralogy of Fallot were operated on at the age of 1. 5 and 3 years respectively. In the younger child, the 1. 2 cm long of tracheal stenosis was excised and anastomosed. The other case with 3 cm in length of stenosis at the mid-segment of trachea was excised and repaired with a patch. Results The postoperative progress was uneventful. The patients were followed-up for 6 months to 1 year without any complications. Conclusion One stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants has got satisfactory results. With cardiopulmonary bypass, the operation can be carried out safely. 6 refs,2 figs.     

Epidemiology of hospitalized pediatric glaucoma patients in Beijing Tongren Hospital

Background No population-based assessment of the prevalence and incidence of pediatric glaucoma in China are available. Here we describe the spectrum of hospitalized pediatric glaucoma patients in Beijing Tongren Hospital in China.
Methods We reviewed the charts of pediatric patients, from birth to 18 years old, with a discharge diagnosis of glaucoma in Beijing Tongren Hospital, from 2002 to 2008. All children were admitted for anti-glaucoma surgery, treating the sequelae of the glaucoma, or managing postoperative complications. We evaluated the demographic characteristics and the proportion of different glaucoma subtypes.
Results Pediatric patients （n=1452） accounted for 12.91% of the total glaucoma in-patients from 2002 to 2008, and at last data of pediatric glaucoma were presented for 1055 children who came from 28 provinces, municipalities and autonomous regions in China. Boys were more common in all subtypes and at all ages, with a total ratio of boys to girls of 2.32：1. Congenital glaucoma was the most common subtype, accounting for 46.07% in all patients and accounting for 69.95% in children under 3 years of age. The median presenting age of congenital glaucoma patients was 2 years. Patients with traumatic glaucoma were the second most common group （n=128, 12.13%）, and presented at older age （the median presenting age was 11 years）. The majority of traumatic glaucoma occurred in children between 10 and 15 years of age （n=72, 56.25%）. Aphakic glaucoma was the third most common （9.19%） subtype.
Conclusions Congenital glaucoma is the most prevalent glaucoma subtype in hospitalized pediatric patients in Beijing Tongren Hospital. The prevention and treatment of traumatic glaucoma can reduce the incidence of visual damage in developing countries. Close follow-up for glaucoma is important after pediatric cataract surgery.     

CLINICAL SIGNIFICANCE AND PROGNOSIS OF FETAL ARRHYTHMIAS

Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks‘ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, l case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were performed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart.All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conchusion The prognosis is well for most of the fetuses with arrhythrnias, with low incidence of heart deformation.     

Fetal echocardiographic screening in twins for congenital heart diseases

Background Congenital heart disease (CHD) is the most common congenital disorder at birth. Yagel and colleagues’s method of heart examination has been proved valuable in finding CHD prenatally in single pregnancies. The aim of this study was to analyze the frequency of CHD in twin pregnancies and the sensitivity of the method. Methods A total of 1103 pregnant women with twins were enrolled in this study, including 127 cases with high-risk for CHD. Five transverse ultrasound measurements were used for fetal heart examination, including the upper abdomen view, four-chamber view, five-chamber view, pulmonary artery bifurcation view, and three-vessel view. In the fetuses who were diagnosed with CHD and whose parents requested termination of the pregnancy, autopsy of the fetal heart was performed after an abortion, and a blood sample was collected from the heart for chromosome evaluation. In the other fetuses, a close follow-up was conducted by echocardiography within one year after birth. Results Antenatally, CHD was found in 12 twins, of which 4 were from the high-risk group (3.15%), and 8 from the low-risk group (0.82%). In 2 pairs of the twins, the two fetuses had a same kind of CHD (one pair had tetralogy of Fallot (TOF), another pair had rhabdomyoma). Another pair had different types of anomaly (one fetus had TOF, and the other duodenal atresia with a normal heart). Termination of pregnancy was performed in these three pairs and the autopsy of the fetal heart confirmed the ultrasound findings. In the other 9 pairs, CHD was detected in one fetus, and a normal heart in the others. In the cases who received chromosome evaluation, 2 had abnormal chromosomes. During the follow-up after birth, heart examinations confirmed the prenatal diagnosis in 7 of the 9. The diagnosis of CHD was missed antenatally in 2 pairs of twins. In both the cases, one fetus was normal, and the other was confirmed as having CHD after birth (small ventricle septum defect in one, and persistent open ductus arteriosus in the other). Thus, the total frequency of CHD was 16 (7.3/1000), which was similar to that in single pregnancies. The sensitivity of fetal echocardiography was 87.5% and the specificity was 100%. Conclusions The frequency of CHD is the same in twin as in single pregnancies. Systemic ultrasound scanning with five transverse views is effective in diagnosing fetal CHD in twin pregnancies.     

Prenatal diagnosis of fetal aortopulmonary septal defect with ventricular septal defect by two-dimension echocardiography

Fetal aortopulmonary septal defect （APSD） is an extremely rare condition, accounting for 0.1%-0.2% of all cardiac defects in live births world wide. Hospital mortality is 13% and 33% for simple and complex APSD,respectively. This rare cardiac defect refers to a congenital malformation in the development of the arteriosus truncus septum, and is usually associated with a wide variety of other structural cardiac anomalies such as ventricular septal defect （VSD）, pulmonary valve stegnosis and so on. Prenatal diagnosis of an APSD is possible by echocardiography. In relevant literature, only two cases, which were diagnosed initially by prenatal echocardiography, have been reported.     

Surveillance of malformations in Sydney in 1976

The results of a pilot study of malformations in newborn infants in two regions of Sydney in 1976 showed that the incidence of major malformations was 11.31 per 1000 live births and stillbirths, and the incidence of minor malformations was 7.33 per 1000. There were 131 stillbirths among the 12816 births in the study. There were geographical and seasonal variation and "time place clustering" of cases. There was a higher incidence of congenital heart disease and chromosomal abnormalities than in the study carried out in 1966 by Stevenson. The need for accurate diagnosis and for the provision of support and genetic counseling for the parents soon after the birth of a baby with an abnormality is stressed; these should be an integral part of total patient care.     

Congenital heart defects in Central Australia

OBJECTIVE: To determine the incidence of congenital heart defects (CHD) in Aboriginal and non-Aboriginal infants in Central Australia and to compare this with the incidence elsewhere in Australia. DESIGN AND SETTING: Data on cases were obtained from patient records of the Alice Springs Hospital, Central Australia, the sole referral centre for paediatric and initial cardiac diagnostic services for the region. PARTICIPANTS: Patients with CHD proven by echocardiography reported between 1 January 1993 and 30 June 2000. MAIN OUTCOME MEASURES: Incidence of CHD using all live births in Central Australia as the denominator. RESULTS: 108 patients with CHD were detected among 6156 live births (incidence, 17.5 per 1000; 95% CI, 14.9-21.7 per 1000); 57 of 2991 were Aboriginal (19.0 per 1000; 95% CI, 14.4-24.6 per 1000) and 51 of 3165 were non-Aboriginal (16.1 per 1000; 95% CI, 12.0-21.1 per 1000). The difference between the two groups was not statistically significant (relative risk, 1.18; 95% CI, 0.81-1.72). CHD incidence in Central Australia was significantly higher than that reported for other parts of Australia (4.3 per 1000 live births in New South Wales and the Australian Capital Territory, 1981-1984; 7.65 and 12 per 1000 total births in Western Australia, 1980-1989, and South Australia, 1993-2000, respectively). CONCLUSIONS: The high rates of CHD in Central Australia may partly reflect the high utilisation of echocardiography for assessing minor lesions. However, the incidence of both major and minor types of CHD was significantly higher than previously reported from other regions of Australia. The role of socioenvironmental factors in this high incidence should be explored.     

Estimates of Incidence and Prevalence of Mongolism and of Congenital Heart Disease in British Columbia

There is a need for accurate ascertainment of incidence and prevalence rates of congenital anomalies. In British Columbia the Registry for Handicapped Children and Adults used in conjunction with vital records has proved a valuable source of information. Birth notifications alone cannot be relied upon for incidence data. It was found that seven times as many cases of congenital heart disease were registered subsequently as were reported at birth. The estimated minimal incidence rates of mongolism and congenital heart disease per 1000 live births were 1.46 and 4.75, respectively. The well-known association of maternal age with mongolism was confirmed. Twice as many babies with congenital heart disease (without mongolism) were born to mothers over 39 years of age as would be expected on the basis of the maternal age distribution for all live births in the population. Prevalence estimates of these two diseases compared favourably with other published estimates.     

Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada

CONTEXT: Prenatal diagnosis and termination of affected pregnancies can prevent infant deaths due to congenital anomalies, but an effect at the population level has not been shown. OBJECTIVE: To examine the impact of recent changes in congenital anomaly-related fetal and infant deaths on overall population-based infant mortality. DESIGN, SETTING, AND SUBJECTS: Birth cohort-based study of all live births, stillbirths, and infant deaths in Canada (excluding Ontario) for 1991-1998. MAIN OUTCOME MEASURES: Cause-specific infant mortality rates and gestational age-specific fetal death rates. RESULTS: The birth cohort-based infant mortality rate fluctuated between 6.4 and 6.1 per 1000 live births between 1991 and 1995, then dropped to 5.4 per 1000 in 1996 and 5.5 per 1000 in 1997. The rate of infant death from congenital anomalies was stable between 1991 and 1995 but declined by 21% (95% confidence interval, 19%-32%) from 1.86 per 1000 in 1995 to 1.47 per 1000 in 1996 and 1997. Fetal deaths due to pregnancy termination at 20 to 23 weeks' gestation increased dramatically in 1994, while fetal deaths due to congenital anomalies at 20 to 21 weeks increased in 1995 and subsequently. Provinces/territories with high rates of fetal death due to pregnancy termination/congenital anomalies at 20 to 23 weeks had fewer infant deaths due to congenital anomalies. CONCLUSION: A large decrease in infant deaths due to congenital anomalies was associated with the most recent decline in infant mortality in Canada, suggesting that increases in prenatal diagnosis and pregnancy termination for congenital anomalies are related to decreases in overall infant mortality at the population level.     

A prospective study of congenital malformations among live born neonates at a University Hospital in Western Saudi Arabia

OBJECTIVE: To estimate the incidence of major and minor congenital malformations among liveborn infants at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Estimation of risk factors were also evaluated. METHODS: Between March 2004 and May 2005, a total of 5356 babies born at King Abdulaziz University Hospital, were enrolled in this study for malformations. Details of cases were recorded after parents' interviews, clinical, radiological, and laboratory evaluations. RESULTS: One hundred and forty-seven (27.06/1000 livebirth) and 13 (2.39/1000 birth) stillbirth had congenital anomalies. In all livebirth, incidences of major anomalies were 93.9% and minor were 6.1%. Mothers of 95.9% with congenital malformation were healthy, 3.4% were diabetic and 0.7% had cardiac malfomation. In 38.8% of cases parents were consanguineous. Among the liveborn births, the most common system involved was cardiovascular (7.1/1000), followed by musculoskeletal/limb (4.1/1000), external genitalia (2.8/1000), urinary (2.6/1000), multiple chromosomal (2.2/1000), orofacial (1.9/1000), central nervous system (1.9/1000), skin (1.7/1000), multiple single gene (1.3/1000), multiple sequence (0.75/1000), eyes (0.56/1000), unclassified (0.19/1000), musculoskeletal/abdominal (0.19/1000), endocrine (0.19/1000). CONCLUSION: High incidence of major malformation in Jeddah. Importance of Genetic Counseling is revealed in our study since more than three quarters of mothers were under 36 years, and may well plan future pregnancies.     

超声心动图在诊断胎儿先心病中的价值

目的探讨超声心动图筛查胎儿先天性心脏病的可行性及临床价值、意义。方法对5 851例孕妇进行超声心动图检查,筛查严重的胎儿先天性心脏病。结果经5 851例胎儿超声心动图探查,共检出88例胎儿心血管畸形。5 851例胎儿中漏诊肌部室间隔缺损3例。部分孕妇到上级医院进一步检查得到证实,部分生后超声心动图随访结果与产前诊断相符。结论胎儿超声心动图是检查胎儿心脏畸形的有价值的无创性检测技术,可以早期发现严重先心病胎儿,应用超声心动图筛查胎儿先天性心脏病是可行的。     

Trends in ectopic pregnancy in Canada.

The incidence in Canada of one complication of sexually transmitted disease, ectopic pregnancy, was examined by age group for the years 1971 through 1980 by means of hospital statistics provided by Statistics Canada. The denominator was "reported pregnancies"--the total of live births, stillbirths, legal abortions and ectopic pregnancies in a given year. In 1980, 4123 ectopic pregnancies (9.3/1000 reported pregnancies) were reported, a 63% increase from 1970. The incidence had increased in each age stratum. This trend may be related to increasing rates of gonococcal infection and of hospitalization for pelvic inflammatory disease and lends confirmation to data from other countries that relate the increase in the rate of ectopic pregnancy to rising rates of sexually transmitted disease.     

新生儿先天性心脏畸形的早期诊断及产前致病因素分析

目的：探讨新生儿先天性心脏畸形的早期诊断及产前致病因素。方法：采用以医院为基础的监测方法收集资料。调查对象为孕28周至产后7d在我院住院分娩的围产儿，包括活产、死胎和死产。所有病例均经彩色多普勒超声心动图(简称彩超)诊断，死亡病例经尸解证实。结果：共监测围产儿6518例，检出新生儿先天性心脏畸形43例，发生率为65．97／万，其中单发心脏畸形35例，占81．40／万，心脏外合并畸形8例，占18．60％。先天性心脏病发生率由2000年的56．40／万上升为2004年的80．24／万。城镇高于乡村，无明显性别差异。结论：先天性心脏畸形的发生率有上升趋势，彩超为确诊的主要手段。孕早期各种致畸因子与先天性心脏畸形的发生有一定关系。     

A study of neonatal deaths in the tea gardens of Dibrugarh district of upper Assam

A total of 2432 live births and 46 stillbirths were studied in some of the tea gardens of Dibrugarh district of upper Assam. The neonatal mortality rate was 46.5 per 1000 live births per year. Immaturity (21.2%), fever/sepsis (13.3%), breathing disorder (12.4%), neonatal tetanus (11.5%) and neonatal diarrhoea (8.8%) accounted for most of the neonatal deaths. There were 42.9% low birth weight infants and this was associated with 92.8% of total neonatal deaths and 34.3% of preterm babies were associated with 90.7% of neonatal deaths. The case fatality rate among low birth weight and preterm babies was 9% and 11% respectively. High risk of neonatal deaths had been found among the neonates in case of no maternal immunisation, delivery attended by untrained person and newborn care at home.     

A survey on the constitutional status of perinates in China

Data of all categories of birth defects among live and still births from 28 weeks of gestation to a period within 7 days after delivery were collected. During a period of 12 months (1986.10-1987.9), there were 1,243,284 perinates monitored in 945 hospitals of 29 provinces, cities and autonomous regions. Among these, 16,172 perinates were with birth defects. Altogether, 101 categories of birth defects were noted. The total incidence of the 101 categories of birth defects in China was 130.1 per 10,000. The 5 leading categories of major birth defects by frequency were: anencephaly, hydrocephaly, spina bifida, cleft lip with cleft palate, and congenital heart diseases. Perinatal deaths totaled 33,137 and the perinatal mortality was 26.7 per 10,000. Among the causes of perinatal death, congenital malformation accounted for 17.8%. There were 44,469 births (35.8%) of full-term low birth weight infants, and 1,748 of them were with birth defects. The incidence of birth defects in full-term low birth weight infants was 393.1 per 10,000.