Dysmorphism and major anomalies are a main predictor of survival in newborns admitted to the neonatal intensive care unit in the Democratic Republic of Congo

Abstract

In Central‐Africa, neonatal infections, asphyxia and prematurity are main reasons for admission to the neonatal intensive care unit and major determinants of newborn survival. Also, the outcome of newborns with congenital anomalies is expected to be poor, due to a lack of state‐of‐the art care. We conducted a study of 102 newborns recruited in the Neonatal Intensive Care Unit (NICU) at the University Hospitals of Kinshasa, DR Congo, to assess the impact of congenital anomalies. The presence of a major anomaly was associated with a hazard ratio of death of 13.2 (95%CI: 3.7–46.7, p < .001). In addition, the presence of three or more minor anomalies was associated with a 4.5‐fold increased risk of death (95%CI: 1.1–18.6, p = .04). We conclude that like major anomalies, the presence of three or more minor anomalies should also be given particular attention and that the evaluation of dysmorphism should be promoted in NICU.

Objective evaluation of facial features in Congolese newborns by facial measurements. The need for population‐specific measurements

“…As reported before (Mubungu et al, 2020), in this series, 148 newborns presented more than one minor anomalies, and 13 presented one major anomaly. None of them had a recognizable syndrome.…”

“…We therefore did not account for gestational age in our study but 45 newborns (7.4%) with a birth weight below 2.5 kg (or unknown, n = 1) were excluded from the analysis because these newborns are likely to be preterm or small for gestational age. There was no difference in the incidence of low birth weight (below 2.5 kg) between males (6.3%) and females (9.5%) (p = 0.15), and the (reported) gestational age was comparable in both (38.2 vs. 38.1 weeks, p = 0.8) As reported before (Mubungu et al, 2020), in this series, 148 newborns presented more than one minor anomalies, and 13 presented one major anomaly. None of them had a recognizable syndrome.…”

“…Data were obtained from a cohort of 598 newborns recruited within the first 24 h of life, in two large maternity hospitals in Kinshasa, DR Congo, as described previously (Mubungu et al, 2020). The maternity hospitals were visited on preset days and all newborns born on the day preceding our visit were recruited.…”

“…It is therefore not surprising that the number of minor anomalies is a robust indicator of the presence of a broader underlying condition, with an increased risk of major anomalies (Hennekam, 2011; Leppig et al, 1987; Mehes, 1985; Tsai et al, 1999). Moreover, newborns with three or more minor anomalies face an increased mortality rate, even without a clinically detectable major anomaly (Mubungu et al, 2021). Genetic causes have a prominent role in the etiology of congenital anomalies.…”

“…anomaly (Mubungu et al, 2021). Genetic causes have a prominent role in the etiology of congenital anomalies.…”