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ORIGINAL ARTICLE Table of Contents   
Year : 2014  |  Volume : 11  |  Issue : 1  |  Page : 39-43
Congenital anomalies in paediatric surgery in North India


1 Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
2 Department of Paediatric Surgery, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India

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Date of Web Publication20-Mar-2014
 

   Abstract 

Background: Congenitalmal formation represents defects in morphogenesis during early foetal life. Congenital anomalies account for 8-15% of perinatal deaths and 13-16% of neonatal deaths in India. The proportion of perinatal deaths due to congenital malformations is increasing as a result of reduction of mortality due to other causes owing to the improvement in perinatal and neonatal care. Materials and Methods: A retrospective record based study was conducted in the Paediatric Surgery Department of a Tertiary Care Institute of North India. The records of over a decade (2003-2012) were analysed. A total of 4305 cases of congenital anomalies were recorded in the study. All the data were entered in the excel spread sheet and analysed in SPSS version 17. (Statistical Package for the Social Sciences, a software package used for statistical analysis, officially named "IBM SPSS Statistics"). Results: Over the decade, a total of 14264 children were admitted in the paediatric surgery department with various problems. Out of these about one-third children (30.18%) had one or other type of congenital anomalies. This trend remained almost constant over the decade within a range of 26.8-33.6%. About half of the total congenital anomalies belonged to the gastro-intestinal tract, followed by genitourinary tract, central nervous system and other anomalies. All the anomalies were more common in males and were found in children belonging to rural communities. Conclusions: All the neonates should be examined with scrutiny for overt as well as occult congenital anomalies and Paediatric surgical care should be considered as an essential component of child health programmes in developing populations. Moreover, it is necessary to establish a registry system for congenital anomalies.

Keywords: Congenital, paediatric surgery, malformations

How to cite this article:
Jangra B, Singh M, Rattan KN, Kadian YS, Kaur A. Congenital anomalies in paediatric surgery in North India. Afr J Paediatr Surg 2014;11:39-43

How to cite this URL:
Jangra B, Singh M, Rattan KN, Kadian YS, Kaur A. Congenital anomalies in paediatric surgery in North India. Afr J Paediatr Surg [serial online] 2014 [cited 2019 Aug 25];11:39-43. Available from: http://www.afrjpaedsurg.org/text.asp?2014/11/1/39/129214

   Introduction Top


Congenital malformation represents defects in morphogenesis during early foetal life. According to the World Health Organization, the term congenital malformations should be confined to structural defects at birth. [1] About 3% of newborns have a 'major physical anomaly', meaning a physical anomaly that has cosmetic or functional significance. [2] The leading causes of infant morbidity and mortality in poorer countries are malnutrition and infections, whereas in developed countries they are cancer, accidents and congenital malformations. Congenital anomalies account for 8-15% of perinatal deaths and 13-16% of neonatal deaths in India. [3],[4] Patients with multiple congenital anomalies present a relatively infrequent but tremendously difficult challenge to the paediatrician. The proportion of perinatal deaths due to congenital malformations is increasing as a result of reduction of mortality due to other causes owing to the improvement in perinatal and neonatal care. In the coming decades, this is going to be a leading cause of morbidity and mortality in centres providing good neonatal care. The cause of 40-60% of congenital anomalies in humans is unknown. These are referred to as sporadic, a term that implies an unknown cause, random occurrence regardless of maternal living conditions and a low recurrence risk for future children. [5] For20-25% of anomalies, there seems to be a 'multifactorial' cause, meaning a complex interaction of multiple minor genetic anomalies with environmental risk factors. Another 10-13% of anomalies have a purely environmental cause (e.g. infections, illness, or drug abuse in the mother). Only 12-25% of anomalies have a purely genetic cause. Of these, the majority are chromosomal anomalies. [6]

Due to lack of facilities, even for routine medical examination, by a qualified doctor in rural areas, a large number of cases with malformations either die undetected or present with mental or physical handicap later in life. [7] Congenital anomalies contribute a significant proportion of infant mortality as well as foetal morbidity. As a consequence, it is essential to have basic epidemiological information of these anomalies. Congenital anomaly rates can also used for planning health services. Hence, this study was undertaken to determine the frequency and type of congenital malformation in children presenting in the department of paediatric surgery.


   Materials and Methods Top


We conducted a retrospective record based study in the Paediatric Surgery Department of a Tertiary Care Institute of North India. This is the only government tertiary care institute in the state providing services to the entire population of the region. Nearly all paediatric-surgical facilities are provided in this institute. Hence, a reasonable coverage of all patients is expected. The records of over a decade (2003-2012) were analysed. Full record of all the patients admitted in the paediatric surgery department is accurately maintained by the trained hospital staff in the patient record registers. The record includes the identification data, socio-demographic data of all the patients, the diagnosis as per attending surgeon and the treatment provided.

All the cases attending the paediatric surgery department and diagnosed as having congenital anomalies during the study period were included in the study. Thus, a total of 4305 cases of congenital anomalies were recorded in the study. Information regarding age, sex, residence etc., was noted from the available records by the researcher. Total cases, irrespective of the diagnosis, admitted during the study period were also recorded. Although it was a record based study, but the records were well maintained such that there was no problem in recording the information. All the data were entered in the excel spread sheet. The data were analysed in percentages and proportions. Categorical data were analysed by Chi-square test. All the analysis was done in SPSS version 17. SPSS was purchased and installed by the dept. of Community Medicine during some project.


   Results Top


From January 2003 - July 2012, a total of 14264 children attended the Paediatric Surgery Department with various problems. Out of these about one-third children (30.18%) had one or other type of congenital anomalies. This trend remained almost constant over the decade within a range of 26.8-33.6% [Table 1]. About half of the total congenital anomalies belonged to the Gastro-intestinal Tract (GIT), followed by Genitourinary Tract (GUT), central nervous system (CNS) and other anomalies [Figure 1].
Figure 1: System-wise distribution of congenital anomalies

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Table 1: Distribution of paediatric surgical congenital anomalies over the decade

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When the year-wise distribution of the anomalies was plotted then the minimum variation was seen in GIT, CNS and other anomalies, but in GUT a dip was found in the year 2005 with the gradual rise in number of cases which peaked in the year 2010 [Figure 2].
Figure 2: Year-wise distribution of congenital anomalies (2003-2011)

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When sex-wise distribution was done then GIT anomalies were found more common in males, this difference was found statistically significant (P < 0.001). GUT anomalies were mainly the anomalies of male children. Meningomyelocele and hydrocephalus were more common male children, but the difference was found statistically non-significant (P = 0.221), other type of anomalies were also more common in males and the difference was statistically significant (P< 0.001) [Table 2].
Table 2: Sex-wise distribution congenital anomalies

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When distribution of the patient was seen as per their residence, then it was found that most of the patients were from rural communities and this difference was statistically significant in all types of anomalies except CNS anomalies, which did not have any significant association with the place of residence [Table 3].
Table 3: Residence-wise distribution of congenital anomalies

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   Discussion Top


This study was an effort to frame an actual picture of congenital anomalous babies in this tertiary care centre. In this institute a total of 14264 children presented with paediatric surgical problems over a decade, out of which 4305 children had one or other type of congenital anomalies.

The most common system involved in our study was the gastrointestinal system, followed by genitourinary tract. The findings were similar to a study done by Dutta et al. in which the malformations involving the gastrointestinal tract (26%) and genitourinary tract (25.8%) were the most common anomalies. [8]

In our study it was found that among GIT anomalies the most common anomaly was anorectal malformation followed by trachea-oesophageal fistula.The most common genitourinary malformation was hypospadias, while Meningomyelocele was the commonest congenital anomaly involving CNS. The results were same as what reported by Gorgan and Tehran. [9],[10]

When the distribution of anomalies was plotted over a decade then the minimum variation was seen in GIT, CNS and Other anomalies, but a curious dip was found in case of GUT in the year 2005 the reason of which is unclear, more research is needed to clear the reason.

Male preponderance was found in the study when the anomalies were analysed as per the sex of the child. The results were almost similar to other studies. [9],[11] Most important reason of male preponderance may be the better care of a male child as compared to the female in India. There is also social embarrassment associated with seeking consultation for the malformed genitourinary organs of the female child. Another reason is that some anomalies of GUT are confined to the male child e.g. hypospadias, un-descended testes and these defects of the GUT are more obvious in males.

When congenital anomalies were studied as per the residence of the child, then it was found that most of the children belonged to the rural communities and rural to urban ratio was 3:1. This may be due to the fact that in India around 70% population lives in rural communities. It might also be suggested that the rural population, which is mostly of low socio-economic background, goes to the government hospitals, while in the urban areas people usually prefer consulting the private doctors.

The difference between the frequency and types of congenital malformation in different parts of the country and reports from other countries may be due not only to genetic background but also to geographic, nutritional and socioeconomic differences. More research, preferably community based, is needed to determine the prevalence and the factors underlying the various types of congenital malformation encountered in this area so that our medical workforce could be acquainted with and our medical set-up geared up for the existing challenges.


   Suggestions to Reduce Congenital Anomalies Top


  • Improving the diet of women throughout their reproductive years, ensuring an adequate dietary intake of vitamins and minerals such as folic acid and iodine and restricting harmful substances, particularly the abuse of alcohol. Controlling pre-conceptional and gestational diabetes.
  • Avoiding exposure to hazardous environmental substances (e.g. heavy metals, pesticides, some medicinal drugs) during pregnancy.
  • Improving vaccination coverage, especially with rubella virus, for children and women. This can be prevented through childhood vaccination. The rubella vaccine can also be given at least 1 month prior to pregnancy to women who are not already immune.
  • Increasing and strengthening education to health staff and others interested in promoting birth defects prevention.



   Conclusions Top


Congenital anomalies are a major cause of stillbirths and infant mortality. By thorough clinical examination, the life-threatening congenital malformation must be identified, as early diagnosis and surgical correction of the malformed babies offer the best chance for survival. To draw significant conclusions it is recommended that all neonates should be examined with scrutiny for overt as well as occult congenital anomalies.


   Recommendations Top


  • Screening of high risk cases, routine prenatal folic acid supplementation, early prenatal diagnosis and termination of foetus with lethal anomaly before attaining viability will reduce perinatal morbidity and mortality
  • Moreover, it is necessary to establish a registry system for congenital anomalies
  • More research is needed to determine the factors underlying the various types of congenital malformation encountered in this area
  • Paediatric surgical care should be considered an essential component of child health programmes in developing populations.


 
   References Top

1.Patel ZM, Adhia RA. Birth defects surveillance study. Indian J Pediatr 2005;72:489-91.  Back to cited text no. 1
    
2.Kumar, Abbas, Fausto, editors. Robbins and Cotran's Pathologic Basis of Disease. 7 th ed. Philadelphia: Elsevier Saunders; 2005. p. 470.  Back to cited text no. 2
    
3.Bhat BV, Ravikumara M. Perinatal mortality in India-need for introspection. Indian J Matern Child Health 1996;7:31-3.  Back to cited text no. 3
    
4.Agarwal SS, Singh U, Singh PS, Singh SS, Das V, Sharma A, et al. Prevalence & spectrum of congenital malformations in a prospective study at a teaching hospital. Indian J Med Res 1991;94:413-9.  Back to cited text no. 4
    
5.Bezerra Guimarães MJ, Marques NM, MeloFilho DA. Infant mortality rate and social disparity at Recife, the metropolis of the North-East of Brazil. Sante 2000;10:117-21.  Back to cited text no. 5
    
6.Kumar, Abbas, Fausto, editors. Robbins and Cotran's Pathologic Basis of Disease. 7 th ed. Philadelphia: Elsevier Saunders; 2005. p. 473.  Back to cited text no. 6
    
7.Van Regemorter N, Dodion J, Druart C, Hayez F, Vamos E, Flament-Durand J, et al. Congenital malformations in 10,000 consecutive births in a university hospital: Need for genetic counseling and prenatal diagnosis. J Pediatr 1984;104:386-90.  Back to cited text no. 7
[PUBMED]    
8.Dutta HK, Bhattacharyya NC, Sarma JN, Giriraj K. Congenital malformations in Assam. J Indian AssocPediatrSurg 2010;15:53-5.  Back to cited text no. 8
    
9.Golalipour MJ, Ahmadpour-Kacho M, Vakili MA. Congenital malformations at a referral hospital in Gorgan, Islamic republic of Iran. East Mediterr Health J 2005;11:707-15.  Back to cited text no. 9
    
10.Tootoonchi P. Easily identification congenital anomalies, prevalence and risk factors. Acta Med Iran 2003;41:15-9.  Back to cited text no. 10
    
11.Shamohamdi F, Ahadi MA. The survey of congenital malformations in live births in Taleghani hospital, Arak, Iran. J Arak Univ Med Sci 1997;1:23-9.  Back to cited text no. 11
    

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Correspondence Address:
Babita Jangra
Department of Community Medicine, 11/11J (UH), Medical Campus, Pt.B.D. Sharma PGIMS, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.129214

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