CUBAN MEDICAL LITERATURE

Infant Mortality Due to Congenital Malformations

Riceldys Caridad Ramos Soto, (1);
Yanela Molina Chui, (2);
Eglis García Alcolea, (3);
Tutor: Fara María Ricardo(4)

ABSTRACT: The following paper aims to clinically and epidemiologically characterize children under one year of age who have died as a result of congenital malformations in the last five years. A descriptive and cross-sectional study on infant mortality caused by congenital malformations was carried out among 134 patients in Santiago de Cuba province between January 1999 and December 2003. The variables considered in the study were sex, age at time of death, birthweight, intrauterine life, municipality of origin, clinical diagnosis, and maternal age. A study was undertaken of perinatal codification cards from the Statistics Department of the Provincial Health Board, of patients who died before one year old. In the five years studied, most children who died as a result of congenital malformations were female, born at term with normal birth weight, died more than 72 hours after birth, and were children of mothers of adequate reproductive age. The main cause of death was congenital heart disease, including interventricular septal defects. Santiago de Cuba stands out as the municipality with the highest incidence, followed by San Luís and Palma.

INTRODUCTION

Congenital malformations are macroscopic structural defects present at birth that originated during prenatal development as a result of a serious qualitative-quantitative alteration in embryofetal development. Their medical magnitude and importance vary considerably in relation to the type of defect. Embryonal and fetal development can be altered by various external factors such as radiation, heat, chemicals, infections, and maternal diseases. These external agents are called teratogens (from Greek: teratos = monster, and genes = births). Congenital anomalies may also be caused by genetic alteration of the fetus, or by the coupling of a teratogenic agent and a genetic alteration.

Congenital malformations are the number one cause of death in the world's most developed countries. In Cuba they are the second cause of death in children under one year of age, surpassed only by perinatal affections. In our province, they are the first cause of death in this age group; for this reason, we have written this paper to clinically and epidemiologically characterize children under one year old who have died as a result of congenital malformations over the last five years.

OBJECTIVE

To clinically and epidemiologically characterize children who have died under one year of age as a result of congenital malformations in the last five years.

METHOD

Descriptive and Cross-Sectional Study
Infant Mortality Caused by Congenital Malformations

Santiago de Cuba Province
January 1999 - December 2003

134 patients

Variables studied: sex, birthweight, age at time of death,
municipality of origin, clinical diagnosis, maternal age,
and intrauterine life

Study of perinatal codification cards of patients who died under one year of age.
Statistics Department, Provincial Health Board

Summary measurement: Absolute numbers and Percentage

Tables and graphics

RESULTS' ANALYSIS AND DISCUSSION

Graphic 1 shows female predominance.

Graphic 2 shows that birth weight ranged from 2500g to 4000g, i.e. normal weight.

Graphic 2: Children who Died under One Year of Age, According to Birthweight and Year of Death

Source: Perinatal codification card, form 1805

Graphic 3 shows predominance of children who were born between weeks 37 and 41.6 (at term).

Graphic 3: Children who Died under One Year of Age, According to Intrauterine Life and Year of Death

Source: Perinatal codification card, form 1805

Graphic 4 shows predominance of children who died whose mothers' ranged between 18 and 34 years of age, i.e. mothers at adequate reproductive age.

Graphic 4: Children who Died under One Year of Age, According to Mother's Age and Child's Year of Death

Table 1 shows predominance of children whose death occurred after the first 72 hours; there are 81 children (60.4%) in this group.

Table 1: Children who Died under One Year of Age Due to Congenital Malformations, According to Age at Death & Year of Death

Source: Perinatal codification cards, form 1805

Table 2 shows congenital heart disease as the main cause of death in these malformed children, (36 cases), among which interventricular septal defects shows the highest number, with 15 deceased children.

Table 2: Children who Died under One Year of Age Due to Congenital Malformations, According to Cause & Year of Death

Source: Perinatal codification cards, form 1805

Table 3 shows Santiago de Cuba as the municipality with the highest incidence, followed by San Luís and Palma.

Table 3: Children who Died under One Year of Age Due to Congenital Malformations, According to Municipality of Origin & Year of Death

Sources: Perinatal codification cards, form 1805

CONCLUSIONS

In the five-year period that was studied, most children dying from congenital malformations were female, born with normal birth weight and at term. The majority of deaths occurred after the first 72 hours of life, and most mothers were of adequate reproductive age. The main cause of death for these malformed children was congenital heart disease, with a high incidence of interventricular septal defects. Santiago de Cuba municipality shows the highest incidence, followed by San Luís and Palma.

THE AUTHORS

1. Second Year medical student at the Higher Institute of Medical Sciences, Santiago de Cuba
2. Second Year medical student at the Higher Institute of Medical Sciences, Santiago de Cuba
3. Fifth Year medical student at the Higher Institute of Medical Sciences, Santiago de Cuba
4. First Degree Specialist in Embryology at the Higher Institute of Medical Sciences, Santiago de Cuba