hrvatski

Congenital malformations as a cause of neonatal death

The autopsy records were retrospectively reviewed of all newborns with congential malformations in a ten-year period (Jan 1980 - Dec 1989) who died during the period from 0-28 days after birth. The aim of the study was to determine the type and severity of all malformations as well as their contribution to the neonatal death. Congenital malformations were found in 163 out of 668 newborns (24.4%). Single malformations were more common than multiple (107 vs. 56 cases i.e. 65.7% vs. 34.3%, respectively). The newborns were grouped according to the cause of death in the following categories: congential malformations (44.5%), conditions associated with immaturity (24.5%), conditions associated with asphyxia (11%), infections (16.1%) and unknown (3.9%). Congenital malformations were statistially the most significant cause of death (Chi-squared = 8.986, d.f. = 1, p = 0.002). The majority of patients with multiple malformations (61.8%) died during the first 24 hours after birth, whereas significantly fewer children having single malformation died during the same period (36%, Chi-squared = 6.036, d.f. = 1, p = 0.012). In the period 0-7 days after birth 90.9% of multiply malformed newborns and 82% of those with a single malformation died. This difference was not statistically significant (Chi-squared = 0.088, d.f. = 1, p = 0.766). In conclusion, these results showed that congentital malformations, especially multiple ones, represent an important cause of neonatal death (10.3% of all newborns). An intensive ultrasound examination for the early recognition of these malformations is suggested. Postotak prirođenih nakaznosti (24, 4%) nešto je malo viši nego u razvijenim zemljama i značajno viši nego prije u Hrvatskoj. Prema našim neobjavljenim podatcima, u Zagrebu je u razdoblju 1923-27. godine obducirano 162 novorođenčadi u kojih su otkrivene 22 prirođene nakaznosti (13, 6%), dok je u razdoblju 1958-62. godine obducirano 516, od kojih su prirođene nakaznosti nađene u 74 novorođenčadi (14, 3%). Iz navedenih podataka razvidno je da je proporcija novorođenčadi s prirođenim nakaznostima postala statistički značajno veća (Hi-kvadrat = 14, 873, st. sl. = 1, p = 0, 0001), što se samo manjim dijelom može pripisati boljem poznavanju prirođenih nakaznosti. Prema našim podatcima prirođene nakaznosti uzrokuju smrt u 1, 3 / 1000 živorođenih. Ti podatci za Veliku Britaniju iznose 2, 5 / 1000, što je značajno više nego u Hrvatskoj. Razlog za navedenu razliku vidimo i u tome što je u Republici Hrvatskoj u usporedbi s razvijenim zemljama Zapada znatno veći postotak prijevremeno rođene djece izrazito niske porođajne težine (Dražančić et al., Liječ. Vjesn. 1991 ; 113:116-24), što je najčešće uzrokovano perinatalnim infekcijama i što ta skupina još uvijek ima velikog udjela u perinatalnom mortalitetu.

prirođene nakaznosti ; uzrok smrti ; novorođenče ; obdukcija ;

nije evidentirano