Cardiovascular System Anomalies Research Articles

Profile of various congenital anomalies in fetus detected during antenatal period among high risk mothers by Ultrasonography at Tertiary Care Centre, South Gujarat

Background: With the improvement of basic maternal and child health care services, the deaths due to malnutrition and infections are on a descending trend and due to westernization and lifestyle modifications, perinatal deaths due to anomalies are in ascending trend. Aim & Objectives: The purpose of this study was to estimate the antenatal proportion of congenital anomalies, types, pattern of anomalies and factors associated with anomalies in Tertiary Care Centre, South Gujarat. Settings and Design: Cross-sectional study in Department of Fetal Medicine of New Civil Hospital, Surat. Methods and Material: Sample size was 435. First 10 consecutive high-risk ANC patients, who were referred to Fetal Medicine department from Obstetrics and Gynecology department per day were selected. Data was collected during September 2021 to February 2022. Statistical analysis used: Frequencies, proportions and tests of significance was applied for testing the association of socio-demographic variables, clinical variables etc on presence or absence of congenital anomalies. Results: Proportion of different types of congenital anomalies in high risk pregnant mother was 17.2%. There was significant association between presence of congenital anomalies with history of irregular menstruation (p value: 0.001, OR: 5.19, [CI: 1.76-15.27]) and inadequate amniotic fluid (p value: 0.00, OR: 14.5[CI: 7.23-29.06]). Among total detected anomalies in Ultrasonography scanning, most common anomalies were Cardio-vascular system anomalies (36.4%) and Central Nervous System anomalies (24%). Conclusions: Congenital anomalies were present in about 17 % of high risk antenatal mothers.

A Retrospective Analysis of Fetal Cardiovascular System Anomalies in a Tertiary Center

A Retrospective Analysis of Fetal Cardiovascular System Anomalies in a Tertiary Center

Incidence of Birth Defects among Live Born Neonates at Tertiary Level Maternity Hospital in Nepal

Introduction: Birth defects are structural and functional anomalies that present before, at birth, or later in life. This study aimed to find out total incidence, type of structural birth defects in live born babies in Nepal. Methods: The study was conducted at a tertiary level maternity hospital in Nepal from 14 April 2018 to 13 April 2019. Data was collected on online Newborn Birth Defect data base developed by WHO South- East-Asia Regional Office. All live born babies with external and internal birth defects confirmed by radiographic, ultrasonography and echocardiography until seven days of life were included. Ethical approval was obtained from Institutional Review Committee of hospital. Results: Total of 21,564 live babies were delivered during one-year study period. Out of these, 220 (1.02%) had one or more birth defects. Number of male babies {130 (59%)} were more than female {89 (40.9%)}. 176 (80%) babies with the malformation were born to mother within age group 20 to 35 years. Of the total 220 babies with birth defects, 197 (89.5%) had isolated malformations and remaining 23 (10.4%) had sequence malformations. The most frequent malformations involved cardiovascular system 125 (56.8%) followed by gastrointestinal system 37 (16.8%), musculoskeletal system 34 (15.4%) and central nervous system 18 (8.1%). Conclusions: Incidence of overall birth defects in this study was found to be 1.02% in which cardiovascular system anomalies was the most common followed by gastrointestinal, musculoskeletal and central nervous system anomalies.

Congenital anomalies during the 2015–2018 Zika virus epidemic: a population-based cross-sectional study

BackgroundCongenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them.MethodsThis cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories.ResultsIn total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61–11.84) and Indigenous (OR 1.32, 95% CI 1.03–1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39–3.13).ConclusionsWe estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.

The Frequency, Types and Risk Factors of Congenital Anomalies in a Tertiary Neonatal Intensive Care Unit (A hospital based study)

Background: Congenital anomalies (CA) are common causes of infant’s and childhood deaths and disability. Objectives: The aim of the study is to determine the frequency, describe the types and risk factors of congenital anomalies among newborns admitted to Neonatal Intensive Care Unit (NICU) of Assiut University Children's Hospital. Study design: It is a prospective observational study (analytic cross sectional study) was performed and screening of the newborns admitted at NICU of Assiut University Children's Hospital (for 6 months) during the period from 1st December 2017 to 31st May 2018. The sample included 346 newborns, 173 cases and 173 controls. We collected data using a record checklist and an interviewing questionnaire.Results: There were significant differences between cases and controls concerning gestational age (P=0.001), single or multiple babies (P=0.002), residence (P=0.001), consanguineous marriage (P=0.01) and family history of unfavorable outcome (P=0.001). We also found that the most common type of congenital anomalies was gastrointestinal anomalies 63 cases (36.4%) with tracheoesophageal fistula 17 cases (27%) being the most common GIT anomalies. Then the musculoskeletal anomalies being the second common anomalies 14.5% with diaphragmatic hernia 10 cases being the most common in musculoskeletal anomalies followed by other anomalies (22 multiple and 1Conjoined Twins) 23 cases (13.3%) followed by cardiovascular anomalies 22 cases (12.7%), followed by CNS anomalies 18 cases (10%). Conclusions: The frequency of congenital anomalies was 22.97%. The most common anomalies were gastrointestinal anomalies (GIT), musculoskeletal anomalies, multiple anomalies and cardiovascular system anomalies. The risk factors were consanguineous marriage, positive family history, urban areas, full-term and singleton pregnancies.

The Distribution of Congenital Malformations in Adolescent Pregnancies: A Single Tertiary Center Experience in Turkey

Objective: Adolescent pregnancies are more severe and dangerous for both mother and baby than adult pregnancies. Low birth weight, infections, intrauterine growth restriction, sudden infant death syndrome, and death risk are higher in neonates of adolescent pregnant women. Besides, anomalies of central nervous, gastrointestinal, and musculoskeletal systems are also seen frequently. The purpose of this study is to investigate congenital malformations of infants born from adolescent mothers. In this study, malformations were grouped according to the systems.
 Material and Methods: In this retrospective study, 166 pregnant women aged 18 and under who had fetal anomaly were included in the study and their charts reviewed. Descriptive information about the adolescents and information about the fetuses and anomalies were recorded. Maternal and neonatal characteristics were calculated as frequency and percentage.
 Results: The most common anomalies were the central nervous (40.5%), cardiovascular (15.8%), and urinary (10.8%) system. The anomalies related to the skin and phalanges, including the face, accounted for 8.1% of the cases. Ventricular dilatation (10,4%), neural tube defect (7,2%), and hydrocephalus (7,2%) were the most common abnormalities of the central nervous system. Ventricular septal defect (5,9%), pulmonary artery anomaly (2,7%), and tricuspid valve anomaly (2,3%) were the most common cardiovascular system anomalies. Intrauterine growth restriction (3,6%), pleural effusion/hydrothorax (3,2%), pes equinovarus (2,7%), diaphragmatic hernia (2,3%), cystic hygroma (2,3%), oligohydramnios (2,3%), polyhydramnios (2,3%), and cleft palate/lip (2,3%) were the most common anomalies among the other system and organ anomalies.
 Conclusion: Adolescent pregnancy was partially associated with an increased risk of severe neonatal anomalies especially in the central nervous, cardiovascular, and urinary systems. Pediatric health care providers should have a low threshold for suspecting pregnancy in adolescents.

ПЕРСПЕКТИВЫ РАЗВИТИЯ ДЕТСКОЙ КАРДИОХИРУРГИЧЕСКОЙ ПОМОЩИ В РЕСПУБЛИКЕ БУРЯТИЯ

The article describes the demographic situation, the status of neonatal, children cardiological and cardiosurgery cares in the Buryat Republic. The information gathered by main non-staff experts of appropriate specializations proves the necessity of cardiosurgical care to the children population, identifies the structure of heart defects, the volume of cardiosurgical care provided to patients with congenital heart diseases in the region and outside of the region during from 2013 to 2015, preoperative and postoperative mortality. In addition, the article represents diagnostic capabilities of one of the largest medical institutions of the Buryat Republic as a potential station for delivery of cardiosurgical care for patients with congenital anomalies of cardiovascular system and suggests ways to optimize the care of children with congenital heart disease.

Diagnosis Of Cardiovascular Anomalies Using Electrical Bioimpedance Method

Electrical Bioimpedance method is used to explore the cardiovascular system. The objective of this work is to perform automatic diagnosis by processing the ICG signal which represents the aorta impedance variation during the heart cycle activity. ICG is detected by mean of two electrodes located at the level of the ascendant aorta. Automatic diagnosis method consists on preparing, first, a data base with a set of N cepstral parameters of 140 different normal cardiovasculars diseases. This data base corresponds to 14 classes Yk with 13 different cardiovascular diseases and 10 normal class. The classification of anonymous individuals is based on the determination of Fisher and Mahalanobis distance between anonymous disease and class Yk. Our method permits to calculate seven relevant cepstral parameters. The application of the discrimant analysis method has allows us to perform the diagnosis of 30 anonymous cases. The results found in this work indicate that 7 cepstral parameters are sufficient to perform the automatic diagnosis of the cardiovascular system abnormalities with 96.45% of percentage of correctly classified The major interest of this method is its especially useful for the exploration of cardiovascular system anomalies for emergency cases, children, elderly and pregnant women who can't support surgical operations especially at the level of the heart.

Diagnosis Of Cardiovascular Anomalies Using Electrical Bioimpedance Method

Electrical Bioimpedance method is used to explore the cardiovascular system. The objective of this work is to perform automatic diagnosis by processing the ICG signal which represents the aorta impedance variation during the heart cycle activity. ICG is detected by mean of two electrodes located at the level of the ascendant aorta. Automatic diagnosis method consists on preparing, first, a data base with a set of N cepstral parameters of 140 different normal cardiovasculars diseases. This data base corresponds to 14 classes Yk with 13 different cardiovascular diseases and 10 normal class. The classification of anonymous individuals is based on the determination of Fisher and Mahalanobis distance between anonymous disease and class Yk. Our method permits to calculate seven relevant cepstral parameters. The application of the discrimant analysis method has allows us to perform the diagnosis of 30 anonymous cases. The results found in this work indicate that 7 cepstral parameters are sufficient to perform the automatic diagnosis of the cardiovascular system abnormalities with 96.45% of percentage of correctly classified The major interest of this method is its especially useful for the exploration of cardiovascular system anomalies for emergency cases, children, elderly and pregnant women who can't support surgical operations especially at the level of the heart.

Frequency of congenital malformations and chromosomal disorders in Bacau and Vaslui counties (Romania)

This paper presents the state of genetic health of the human populations in two Romanian counties, Bacau and Vaslui, as they are different in area, number of inhabitants, level of economic and social development, etc. The data presented in this paper is from the Public Health Directions of the two counties, reflecting the situation recorded during 2006-2013. In the 8 years study, 1894 cases of congenital and chromosomal disorders were recorded in the newborns from the populations in the two counties. The identified cases were distributed based on years, categories of disorders and sexes. The average frequency of congenital disorders in the two populations over the investigated period was about 1.65 in Bacau county and 1.83% in Vaslui counties. In the population of Bacau county, these disorders affect in the same number in both the sexes (49.62% female cases and 50.38% male cases), while in Vaslui, the male cases are more than the females (53.92 and 46.08%, respectively). The main congenital disorders observed were: cardiovascular system anomalies, musculoskeletal system, urogenital system, etc. During the investigation period, in the human population of Bacau county, 97 cases of newborns with chromosomal disorders were diagnosed (0.16% of the living newborns), while in Vaslui county there were 106 cases (0.26% of the living newborns). Among these disorders, the Down's syndrome was the most frequent one, representing 83.5 and 85.8% of cases in the population of Bacau county, and Vaslui counties.

A New Method for Cardiac Diseases Diagnosis

The objective of this work is to perform automatic diagnosis using a non invasive method which consists on the bioimpedance signal processing. Bioimpedance signal (BIS) represents the aorta impedance variation during the heart cycle activity. BIS is detected by mean of two electrodes located at the level of the ascendant aorta. Automatic diagnosis method consists on preparing, first, a data base with a set of cepstral parameters of different BIS according to normal case and different cardiac diseases. This data base is composed from n classes Yk corresponding to n diseases. The classification of anonymous individuals is based on the determination of Fisher distance between anonymous disease and class Yk using Fischer formula. Our method permits to calculate seven relevant cepstral parameters. The application of Fisher method has allowed us to perform the diagnosis of five anonymous cases. The major interest of this method is its especially useful for the exploration of cardiovascular system anomalies for emergency cases, children, elderly and pregnant women who can’t support surgical operations especially at the level of the heart.

OP05.08: First‐trimester diagnosis of fetal cardiovascular system anomalies Accuracy study for 2D and 4D ultrasound methods

<scp>OP</scp>05.08: First‐trimester diagnosis of fetal cardiovascular system anomalies Accuracy study for <scp>2D</scp> and <scp>4D</scp> ultrasound methods

Impact of maternal body mass index on the antenatal detection of congenital anomalies

To investigate the association between maternal body mass index (BMI) and antenatal ultrasound detection of congenital anomalies. Population-based register study. North of England (UK). All pregnancies (n = 3096) associated with a congenital anomaly notified to the Northern Congenital Abnormality Survey (NorCAS) during 2006-2009. Cases with chromosomal and teratogenic anomalies (n = 611) or without information on antenatal scanning (n = 4) were excluded. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for antenatal detection according to maternal BMI categories were estimated using logistic regression. For all anomalies combined, cases were defined as 'detected' if any congenital anomaly was suspected antenatally. Organ system-specific anomalies were defined as detected if an anomaly of the correct system was suspected. Antenatal detection of any anomaly occurred in 1146 of 2483 (46.2%) cases with normal karyotype. The odds of detection were significantly decreased in obese (BMI ≥ 30 kg/m(2)) women compared with women of recommended BMI (18.5-24.9 kg/m(2); aOR, 0.77; 95% CI, 0.60-0.99; P = 0.046). Cardiovascular system anomalies were suspected antenatally in 109 of 945 (11.5%) cases. The odds of detecting a cardiovascular anomaly were significantly greater in underweight women (BMI < 18.5 kg/m(2)) than in women of recommended BMI (aOR, 2.95; 95% CI, 1.13-7.70; P = 0.027). There was no association between BMI and detection in any other organ system or between BMI and termination of pregnancy for fetal anomaly. Antenatal ultrasound detection of a congenital anomaly is decreased in obese pregnant women. This has implications for the scanning and counselling of obese women.

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre

We reviewed the data of the termination of pregnancy (TOP) cases between 2002 and 2010 to evaluate the changes in fetal indications for both early and late TOPs in this period. The data of 962 TOP cases were analysed in two groups according to the periods as in 2002-2006 and 2007-2010. The women were also subdivided into two categories according to their gestational age; <23 weeks' gestation (early termination) and ≥23 weeks' gestation (late termination). Four hundred and fifty-eight (47.6%) of TOPs were performed between 2002 and 2006 (Group 1) and 504 (52.3%) were performed between 2007 and 2010 (Group 2). The number of early (<23 weeks) and late (≥23 weeks) terminations were 583 (60.6%) and 379 (39.3%), respectively. The vast majority of anomalies were central nervous sytem malformations (51.8%). They were followed by multiple anomalies (10.2%) and chromosomal anomalies (9.4%). Chromosomal and cardiovascular system anomalies were significantly higher in 2007-2010 in comparison to 2002-2006 (p<0.0001 and p=0.002, respectively). There was no statistically significant difference between the fetal indications that led to early termination compared to those that led to late termination. The distribution of indications for TOP was influenced by the development in prenatal screening policy, resulting in a significant increase in terminations due to chromosomal and cardiovascular system anomalies. Cultural, educational, religious and legal factors cause differences in the indications for TOP as well as the gestational age that TOPS are performed.

The incidence and distribution of the congenital anomalies in our University Hospital

With the neighboring cities, our university hospital provides service to a wide area, and in this study we aimed to expose the incidence, and distribution of the congenital anomalies of the newborns that hospitalized in the period of September 2009 and December 2011. The records of the 788 patients followed in newborn intensive care unit between September 2009 and December 2011 were investigated, One hundred and seventeen newborns were detected as having congenital anomalies. Twenty seven of the 117 babies had cardiovascular system anomalies, 21 had central nervous system anomalies, 15 had gastrointestinal, 14 had urinary, and 8 had skeletal system anomalies. In 9 patients, multiple congenital anomalies detected that affects at least three systems. Trisomies were detected in 6 patients; three of them were trisomy 13. In 4 patients, we indicated respiratory system anomalies. In case of the development of the prenatal diagnostic techniques, and the awareness of the parents, the congenital anomalies could be detected before the birth and the families prefer the advanced health centers for having healthcare for their babies with congenital anomaly. In fact, the number of advanced hospitals all over the country is inadequate, and it is too risky to transfer a newborn with cardiac anomaly from one hospital to another. So the number of experienced units should be promoted. And also, the data achieved from university hospitals do not reflects the true incidence and distribution of the population. A database should be created all over the country to have real numbers of congenital malformations of the Turkish population.

20-year survival of children born with congenital anomalies: a population-based study

Congenital anomalies are a leading cause of perinatal and infant mortality. Advances in care have improved the prognosis for some congenital anomaly groups and subtypes, but there remains a paucity of knowledge about survival for many others, especially beyond the first year of life. We estimated survival up to 20 years of age for a range of congenital anomaly groups and subtypes. Information about children with at least one congenital anomaly, delivered between 1985 and 2003, was obtained from the UK Northern Congenital Abnormality Survey (NorCAS). Anomalies were categorised by group (the system affected), subtype (the individual disorder), and syndrome according to European Surveillance of Congenital Anomalies (EUROCAT) guidelines. Local hospital and national mortality records were used to identify the survival status of liveborn children. Survival up to 20 years of age was estimated by use of Kaplan-Meier methods. Cox proportional hazards regression was used to examine factors that affected survival. 13,758 cases of congenital anomaly were notified to NorCAS between 1985 and 2003. Survival status was available for 10 850 (99.0%) of 10 964 livebirths. 20-year survival was 85.5% (95% CI 84.8-86.3) in individuals born with at least one congenital anomaly, 89.5% (88.4-90.6) for cardiovascular system anomalies, 79.1% (76.7-81.3) for chromosomal anomalies, 93.2% (91.6-94.5) for urinary system anomalies, 83.2% (79.8-86.0) for digestive system anomalies, 97.6% (95.9-98.6) for orofacial clefts, and 66.2% (61.5-70.5) for nervous system anomalies. Survival varied between subtypes within the same congenital anomaly group. The proportion of terminations for fetal anomaly increased throughout the study period (from 12.4%, 9.8-15.5, in 1985 to 18.3%, 15.6-21.2, in 2003; p<0.0001) and, together with year of birth, was an independent predictor of survival (adjusted hazard ratio [HR] for proportion of terminations 0.95, 95% CI 0.91-0.99, p=0.023; adjusted HR for year of birth 0.94, 0.92-0.96, p<0.0001). Estimates of survival for congenital anomaly groups and subtypes will be valuable for families and health professionals when a congenital anomaly is detected, and will assist in planning for the future care needs of affected individuals. BDF Newlife.

A STUDY OF CONGENITAL ANOMALIES AT A UNIVERSITY TEACHING HOSPITAL

This is a seven (7) years retrospective study of all cases of congenital anomalies that presented at the Jos University Teaching Hospital from January 1998 to December 2005. A total of 200 cases were seen at the Special Care Baby Unit (SCBU) of the Paediatrics Department of the hospital.The results were as follows: anomalies of the gastrointestinal system had the highest incidence (30.5%), central nervous system abnormalities, 24.5%, skeletal system anomalies, 8.0%, cardiovascular system anomalies, 7.5%, chromosomal anomalies, 7.5,urogenital system anomalies, 5.0%, cutaneus system anomalies, 2.0% and metabolic disorders, 1.5%. 13.5% of cases presented with multiple anomalies.

Routine ultrasound screening in diabetic pregnancies

To assess the detection rate of congenital fetal malformations and specific problems related to routine ultrasound screening in women with pre-existing diabetes. A retrospective study was carried out to assess the performance of routine ultrasound screening in women with pre-existing diabetes (Types 1 and 2) within a tertiary institution. The incidence, type and risk factors for congenital fetal malformations were determined. The detection rate of fetal anomalies for diabetic women was compared with that for the low-risk population. Factors affecting these detection rates were evaluated. During the study period, 12 169 low-risk pregnant women and 130 women with pre-existing diabetes had routine ultrasound screening performed within the institution. A total of 10 major anomalies (7.7%) and three minor anomalies (2.3%) were present in the fetuses of the diabetic women. Central nervous system and cardiovascular system anomalies accounted for 60% of the major anomalies. Periconceptional hemoglobin A1c of more than 9% was associated with a high prevalence of major anomalies (143/1000). Women who had fetuses with major anomalies had a significantly higher incidence of obesity (78% vs. 37%; P < 0.05). Ultrasound examination of these diabetic pregnancies showed high incidences of suboptimal image quality (37%), incomplete examinations, and repeat examinations (17%). Compared to the 'low-risk' non-diabetic population from the same institution, the relative risk for a major congenital anomaly among the diabetic women was 5.9-fold higher (95% confidence interval, 2.9-11.9). The detection rate for major fetal anomalies was significantly lower for diabetic women (30% vs. 73%; P < 0.01), and the mean body mass index for the diabetic group was significantly higher (29 vs. 23 kg/m2; P < 0.001). The incidence of congenital anomalies is higher in diabetic pregnancies. Unfortunately, the detection rate for fetal anomalies by antenatal ultrasound scan was significantly worse than that for the low-risk population. This is likely to be related to the maternal body habitus and unsatisfactory examinations. Methods to overcome these difficulties are discussed.

Patterns of infant mortality caused by major congenital anomalies.

We assessed the impact of recent advances in perinatal care on infant mortality due to congenital anomaly. Analysis of trends in congenital anomaly-attributed infant mortality, using the 1981-1995 Statistics Canada's birth and death records, with a total of 2,878,826 live births, 21,883 infant deaths, and 6, 908 infant deaths due to congenital anomalies. Infant mortality due to major congenital anomaly decreased from 3.11 per 1, 000 live births in 1981 to 1.89 per 1,000 live births in 1995. Cause-specific infant mortality rates for anencephaly, spina bifida, other central nervous system anomalies, cardiovascular system anomalies, respiratory system anomalies, digestive system anomalies, certain musculoskeleton anomalies, urinary system anomalies, chromosomal anomalies, and multiple congenital anomalies were 0.20, 0.23, 0.27, 1.04, 0.24, 0.08, 0.22, 0.16, 0.22, and 0.13 per 1,000 live births, respectively, in 1981-1983, whereas corresponding rates were 0.07, 0.07, 0.18, 0.73, 0.25, 0.03, 0.12, 0.12, 0.26, and 0.06 per 1,000 live births, respectively, in 1993-1995. Recent Canadian data show that infant deaths caused by major congenital anomalies have decreased significantly, but reductions varied substantially according to specific forms of anomalies.

Regional Patterns of Infant Mortality Caused by Lethal Congenital Anomalies

Purpose: To assess the regional patterns of infant mortality due to lethal congenital anomalies, and the potential reasons for the regional patterns. Method: The study analyzed 2,507 infant deaths due to lethal congenital anomalies among 1,178,452 live births in 9 of the 12 Canadian provinces and territories from 1990 to 1995 recorded in Statistics Canada’s live birth and death data bases. Results: Compared with the province of Quebec, congenital anomaly-attributed infant mortality was higher in Newfoundland, Saskatchewan, and Alberta. These differences in infant mortality were substantial for cardiovascular system anomalies and especially anen-cephaly. For infant mortality due to chromosomal anomalies, however, there was little interprovincial variation. Conclusions: Despite substantial recent reductions in lethal congenital anomaly-attributed infant mortality, there remain major regional variations in infant mortality caused by certain forms of congenital anomalies including anen-cephaly and cardiovascular system anomalies.