In 4319 infants examined at birth who were without major birth defects those with a "remarkable" pregnancy outcome, i.e., low birth weight (less than 2500 g), long gestation (greater than or equal to 43 weeks), stillborn, or twin status, were more likely to have a minor birth defect than the remainder. With regard to the 2 most frequent defects, simian crease and folded helix, the increase in the former was of about the same order (1.6-2.1 -fold) in those with remarkable outcome of all types, but the increase in the latter was particularly great in twins (approximately 3.1-fold) compared with the other remarkable outcomes (approximately 1.3-fold). With regard to variants, which were defined as those features scored that occurred in 4% or more of the newborn population, some (flat and small hemangioma on face and scalp, Brushfield spots, flat nasal bridge, hyperflexed thumbs, hydrocele, and mild calcaneovalgus) exhibited a trend towards negative association with low birth weight and a trend to positive association (with exception of hemangioma and calcaneovalgus) with long gestation, suggesting they may simply be indirect markers of gestational age. There was a trend to a slight decrease in the frequency of minor defects with increasing maternal age, similar to the trend for major defects.
Numerous previous reports have suggested an association of elevation of the distal axial triradius on the palm with congenital heart disease. Our investigation, however, in which the maximum atd angles of children with (isolated) congenital heart malformation were compared with the measurement in children with functional heart murmurs (controls), revealed no statistically significant difference in any of seven types of heart defects investigated. Only in males with tetralogy of Fallot was there even a suggestive (but nonsignificant) trend towards elevation of the atd angle. The fact that in our study the data were corrected for age of the subjects may account for the difference between these observations and those of some earlier reports. It appears unlikely that screening the position of the distalmost axial triradius in ostensibly normal newborn infants will be useful in predicting the subsequent appearance of signs of a congenital heart malformation, as has been suggested by other workers.
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