Prevalence and Pattern of Birth Defects among Pediatric Surgical Patients: A 12-Year Analysis in a Tertiary-level Government Hospital in Bangladesh

Abstract

Aims: Birth defects are structural or functional abnormalities which occur during the intrauterine life but can be identified at birth or a later age. Birth defects are major public health concerns and the World Health organization (WHO) is supporting countries for earlier diagnosis and better treatment of these conditions. The aim of the study was to assess the hospital-based prevalence and types of birth defects among the surgical children from a part of the world where these are underreported.
 Materials and Methods: We retrospectively analyzed patients of birth defects admitted in the Department of Pediatric Surgery, Chattogram Medical College Hospital, Bangladesh for a period of 12 years (2008-2019). Data were extracted from annual admission reports, annual audits, mortality and morbidity audits, death registers and computerize data base. Yearly distribution of birth defects, type of defects and their systemic distribution and mortality were analyzed.
 Results: Among a total of 30,301 admitted patients 30.72% (9307 patients) had birth defects. The most common system involved with birth defects was gastrointestinal (GI) system, 30.61% followed by genitourinary (GU), 29.15% system. Congenital inguinal hernia (17.50%) was the most common disease, followed by hypospadias (14.54%) and anorectal malformation (ARM); 13.98%. Mortality from birth defects were 53.25% of all mortalities. ARM was the most common cause of death (23%), followed by gastroschisis (16%) and intestinal atresia (11%). Highest mortality rates were in tracheo-esophageal fistula/esophageal atresia (TEF/EA)- 83.33%, gastroschisis-80.92%; intestinal atresia-42.53%; omphalocele-32.48%; and congenital diaphragmatic hernia (CDH)- 27.78%.
 Conclusion: Pattern of birth defects and outcome varied from other countries. The prevalence is 31% among pediatric surgical admissions. Some conditions have extremely high mortality rates and need better management.

Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life

“…Mortality from birth defects in a tertiary center in Bangladesh over 12 years ( n = 657). ARM anorectal malformation, HPD Hirschsprung disease, PUV posterior urethral valves, NIO neonatal intestinal obstruction, CDH congenital diaphragmatic hernia, TEF tracheoesophageal fistula [62]…”

“…A comprehensive literature review on pediatric surgical outcomes in African LMIC demonstrated ARM mortality ranging from 0 to 25% and Hirschsprung’s disease mortality ranging from 0 to 23% [13]. Meanwhile, in a pediatric surgical ward in Bangladesh anorectal malformations were the most common cause of death [62] (Fig. 2).…”

“…2 Mortality from birth defects in a tertiary center in Bangladesh over 12 years (n = 657). ARM anorectal malformation, HPD Hirschsprung disease, PUV posterior urethral valves, NIO neonatal intestinal obstruction, CDH congenital diaphragmatic hernia, TEF tracheoesophageal fistula [62] neonatal infections. In sub-Saharan Africa, it is estimated that more than 100,000 newborns annually develop hydrocephalus before age one [35].…”