Incidence Of Spina Bifida Research Articles

Risk Factors and Prevalence of Spina Bifida in Children Reported at Children Hospital (Lahore): A Mix Method Analysis

Pakistan is the country with more than 100 million children and spina bifida is a neural tube defect that commonly affects children. Folic acid deficiency during the initial three weeks of pregnancy has been identified as a significant causative factor. However, other factors and their effects vary based on geographic location, maternal pregnancy history, child sex, and race. This cross sectional study aimed to investigate the factors contributing to the incidence rate of spina bifida in Lahore, Pakistan. A total of 200 cases of neural tube defects, including spina bifida, were studied and reported from October 2012 to August 2013 at Children's Hospital Lahore. Various factors were examined, such as the age of mothers, with 50% of babies with neural tube defects born to mothers aged between 26 and 36 years. The incidence of spina bifida was found to be higher in boys (59%) compared to girls (41%). Hydrocephalus, a common complication of spina bifida, was more prevalent in boys (51%) than in girls (14%). Spina bifida cystica, another form of the condition, occurred more frequently in girls (38%) than in boys (33%). In this study group, 161 out of 200 women did not use or properly use folic acid during pregnancy, indicating a lack of awareness regarding its importance. The study also revealed that 119 cases of spina bifida occurred during winter, suggesting a seasonal influence on the condition. In addition to other identified risk factors, this study underscores the critical need for raising awareness about the use of folic acid before conception and during the initial three weeks of pregnancy.

Identification and Incidence of Spina Bifida during Gestation and its Pregnancy Outcomes

Aim: To identify the incidence of spina bifida during gestation and its pregnancy outcomes. Study design: Cohort study Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st October 2020 to 30th September 2022 Methodology: One thousand pregnant women who were screened for the identification of spina bifida. Doppler based ultrasonography was performed in each patient. The fetus body was examined during sonography Doppler between 18-24 weeks. The body of the fetus was focused and visualized longitudinally in midsagittal section. Spinal cord was traced from neck to sacral, cervical vertebra and thorax. A tram track appearance was observed. Spinal nerve positioning was also observed. In spina bifida nerve tethering was seen. The primary outcomes in reference to baby weight and maturity were recorded while secondary outcomes of the fetuses in terms of any disability were followed up to 12 months of age. Results: The mean age of the women was 25.6±5.6 years. The incidence of spina bifida was 1.1%. Within the primary outcomes observed birth weight ranged within 3.1-3.5kg. Around 81.81% cases were born full term while 18.18 were premature. On 06 months’ follow-up of the spina bifida cases it was observed that 45.45% of new born suffered from skin problems as sores, calluses or and blisters while 36.36% had hydrocephalus with excessive CSF which needed monitoring. Mobility issue and disability was observed in 27.27% cases. Conclusion: Spina bifida cases are identified successfully within gestational period. Prematurity can be significantly noticed in spina bifida cases. The lumbosacral and lumbar lesions are most common as well as skin conditions and hydrocephalus. Key words: Incidence, Spina bifida, Gestation, Outcome

Percutaneous Nephrolithotomy and Spina Bifida: Complex Major Stone Surgery?

The incidence of spina bifida (SB) is ∼1:1000, and risk of stone disease is substantially raised in SB. This is the unique published study of the outcome of patients with SB undergoing percutaneous nephrolithotomy (PCNL) compared to a neurologically intact historically matched control group at the same institution. A series of 96 PCNLs in 13 SB and 50 non-SB patients was analyzed. The following measurements were recorded: (1) Comorbidities; (2) Preoperative: (renal function, American Society of Anesthesiologists [ASA] score); (3) Intraoperative: (anesthesia time, number of tracks, stone-free rate); and (4) Postoperative: (sepsis, intensive therapy unit and total length of stay, transfusion rate, stone composition, rate of stone disease-related nephrectomy). Retrograde access to the ureter was impossible in all cases of SB. The median ASA grade (OR 10.5, 95% confidence interval [CI] 2.6-42.7) and operative time (median difference 30 minutes, 95% CI 20-40) were both higher in the SB cohort. Surgeon's estimate of stone-free rate was significantly lower in the SB cohort (46% vs 82%). Intensive care requirement (0.29 days/PCNL vs 0.1 days/PCNL); total hospital stay (7 days vs 4 days); postoperative transfusion rate (11.8% vs 1.6%); and sepsis rate (38% vs 1.6%) were all significantly higher in the SB group. Repeat PCNL and nephrectomy for recurrent stone disease were both significantly increased in SB cohort compared to control group. PCNL in patients with SB is associated with multiple parameters of poor outcome. Patients with SB should be counseled about increased peri-operative risk and likelihood of stone recurrence. In an era where hospitals are judged according to comparative outcomes, a case may be made for comparing PCNL in this cohort of patients separately because of the significantly increased peri- and postoperative morbidity.

Continuous Efforts of the Vitamin Society of Japan to Increase Folate Intake in Japan

Successful implementation of Folate Fortification Program in 1998 led significant reduction in incidence of neural tube defects in the USA. Currently more than 70 countries have employed this fortification program. However, the Government of Japan (GOJ) has not mandated folate fortification at this moment, while Ministry of Health, Labor and Welfare (MHLW) of GOJ recommends expecting mother taking 400 μg of folate daily. In reality, average folate intake in Japanese expecting mother does not meet recommendation made by MHLW; it is even lower than 300 μg per day. The incidence of spina bifida, one of neural tube defects, in Japan has been gradually increasing, ranging from 2.2 per 10,000 births in 1980, 3.6 in 1990, 4.6 in 2000, to 5.9 in 2010. In another aspect, it has been suggested in many reports that supplementing folate, vitamin B6 and B12 reduces stroke incidence in the elderlies. Based upon these aspects, the Vitamin Society of Japan has proposed GOJ the following in 2015: To enlighten child‐bearing age of women as to importance of taking recommended amount of folate to prevent a congenital disease. To promote and support research to examine impact of vitamins and bio‐factors for health maintenance and disease prevention.

Awareness of folic acid use increases its consumption, and reduces the risk of spina bifida.

The majority of neural tube defects were believed to be folic acid (FA)-preventable in the 1990s. The Japanese government recommended women planning pregnancy to take FA supplements of 400 μg/d in 2000, but the incidence of spina bifida has not decreased. We aimed to evaluate the OR of having an infant with spina bifida for women who periconceptionally took FA supplements and the association between an increase in supplement use and possible promoters for the increase. This is a case-control study which used 360 case women who gave birth to newborns afflicted with spina bifida, and 2333 control women who gave birth to healthy newborns during the first 12 years of this century. They were divided into two 6-year periods; from 2001 to 2006 and from 2007 to 2012. Logistic regression analyses were conducted to compute OR between cases and controls. The adjusted OR of having an infant with spina bifida for supplement users was 0.48 in the first period, and 0.53 in the second period. The proportion of women who periconceptionally consumed supplements significantly increased from 10 % in the first period to 30 % in the second period. Awareness of the preventive role of FA was a promoter for an increase in supplement use, and thus an FA campaign in high school seems rational and effective. The failure of the current public health policy is responsible for an epidemic of spina bifida. Mandatory food fortification with FA is urgent and long overdue in Japan.

Ethnic Pattern of Origin of Children with Spina Bifida Managed at the University Teaching Hospital and Beit Cure Hospital, Lusaka, Zambia 2001-2010

The incidence of spina bifida (SB) is known to differ among regions. Very little has been reported about the relationship between the incidence of SB and ethnic patterns of origin in Zambia except for the general impression that it is prevalent. The aim of the study was to establish the ethnic pattern of origin of children with SB in Zambia. It was a retrospective cross sectional study. Using a checklist, data was collected from clinical files of children with SB from the University Teaching Hospital (UTH) and Beit Cure Hospital (BCH) from 2001-2010. Descriptive statistical analysis was done in SPSS version 17. A total of 253 children with SB were identified of whom 88 (35%) of them originally came from the Southern Province of the country while the lowest province was the North-Western Province with 7 (3%). Further, a total of 77 (30%) children were referred from the Southern Province of the country and the lowest province that was represented was the North-Western Province with 5 (2%). Observed is the evidence that SB is very prevalent in the Southern Province of the country. With the presence of Uranium in the Southern Province of Zambia, a serious study ought to be done to investigate the possible link of the pollutant with the prevalence of SB in the region. It is essential that the government looks seriously at Uranium Mines being operated in the Province.

Prenatal diagnosis and further clinical characteristics of spina bifida

Abstract Objective To evaluate the major clinical features of pregnancies with spina bifida as well as to examine the diagnostic efficiency of ultrasonography based on autopsy. Methods The investigations were made into the sample of 352 spina bifida diagnosed between 1990–2010 in the Semmelweis University. Results The male: female ratio was 0.85. In 28.8% of all cases a positive obstetric, genetic or medical history was verified. The sensitivity of the maternal serum-AFP screening test was 52.1%. The majority of the cases were diagnosed before the 24th gestational week. Among the associated malformations out of the central nervous system special mentioning should be made of fetal pyelectasia, gastroschisis and pes equinovarus. The risk of recurrence was decreasing during the examined 29 years. Sonography proved to be a reliable method in diagnosing spina bifida. Conclusion The malformation is more common among girls. Positive history is of great importance in the incidence of spina bifida. MSAFP tests are considered to be useful and necessary in screening, while sonography is the gold standard method in the diagnostics. We can confirm based on a big sample that the periconceptional administration of folic acid reduces the incidence and risk of recurrence of spina bifida.

Prophylactic Effects of Levamisole and Vitamin E on Phenobarbital-induced Cleft Palate and Spina Bifida in Rat Embryos.

There are many reports that show the teratogenic effects of phenobarbital can be decreased by stimulation of maternal immune system. Therefore, in this study, the prophylactic effects of levamisole and vitamin E on teratogenic effects of phenobarbital were compared. This study was performed on 20 pregnant rats that were divided into four groups. Control group received normal saline and test groups received phenobarbital (120 mg/kg), phenobarbital (120 mg/kg) plus levamisole (10 mg/kg) and phenobarbital (120 mg/kg) plus vitamin E (100 mg/kg) intraperitoneally at 9-11th days of gestation, respectively. Fetuses were collected at 20th day of gestation and after determination of weight and length; they were stained by Alizarin red - Alcian blue method. Cleft palate and spina bifida incidence were 66.66% and 69.44% in fetuses of rats that had received only phenobarbital. Cleft palate and spina bifida incidence were 65.45% and 38.18% had in the group which had received phenobarbital plus levamisole. However, Cleft palate and spina bifida incidence were 54.54% and 27.27% in the group which had received phenobarbital plus vitamin E. The arithmetic means of the weight and length of fetuses the rats that had received levamisole and vitamin E were significantly greater than that of those that had received only phenobarbital. Vitamin E had a greater prophylactic effect than levamisole on the incidence of phenobarbital-induced cleft palate and spina bifida. However, the difference was not significant.

Seasonality of spina bifida in Northern Germany

To verify a seasonal variation in the incidence of spina bifida and thus to identify possible environmental triggers leading to its developement. An interdisciplinary approach has been taken to develop a better understanding of spina bifida through collaborative efforts from investigators specializing in genetics, fetal pathology, paediatrics, neuro-surgery and prenatal ultrasonographic diagnosis. All pregnancies with fetal spina bifida were retrospectively analyzed from May 1 1993 through May 1 2010 at Luebeck University Fetal Health Center. Results were used to construct a model to predict the occurrence of fetal spina bifida based on seasonal variation and environmental influence reflected by climatic changes and environmental pollution. Furthermore, data were categorized in respect to the date of conception and subdivided into date of conception during summer (April-September) and winter months (October-March). Neither a seasonal distribution of conception for fetuses with spina bifida in the defined time frame could be verified nor a relevant influence of the analyzed environmental factors on the prevalence of spina bifida could be proved. The incidence of spina bifida has remained relatively stable within the last 17 years at 2.5 per 1,000 screened pregnancies. Since we were unable to demonstrate a relationship between seasonal variation and certain environmental factors on the incidence of fetal spina bifida, other factors should be investigated for a possible association with the onset of fetal spina bifida.

Incidencia de los defectos del tubo neural en el Instituto Nacional Materno Perinatal de Lima

Objective: Determine the hospital incidence rate trends for neural tube defects (NTDs) and their types during the pre-fortification period (2001-2005) at the National Maternal-Perinatal Institute of Lima (INMP). Material and method: An observational, descriptive, retrospective, cross sectional study was carried out. Medical histories of newborns and their mothers between 2001-2005 were reviewed. The sampling universe was 93.863 newborns, of which 128 had NTDs. The univariate analysis included the average, standard deviation, and absolute and relevant frequency determination. The comparison between the data for different years was carried out through a Prais Winsten test. The CI of 95% for the global incidence and the types of NTD was calculated through the Poisson Test. Results: NTDs fluctuated between 18 and 32 cases per year, which corresponds to the global hospital rate of 13.6 per 10,000 newborns (CI 95%: 11.38;16.21) between 2000-2005. The incidence of spina bifida was 8.3 x 10,000 (CI 95%: 6.57;10.37), followed by anencephaly with 5.1 x 10,000 (CI 95%: 3.77;6.78) and 0.2 x 10,000 (CI 95%: 0.03; 0.77) for encephalocele. Finally, the tendency of NTDs between 2001 to 2005 showed a not significant increase (p=0.951). Conclusion: The average NTD global incidence rate in the period of 2001- 2005 was 13.6 per 10,000 newborns (CI: 11.38;16.21), showing a not significant rising trend. Myelomeningocele had the highest incidence rate in relation to the other types of NTD.

Palliative care: recognition of changing need in a children's spina bifida service in Northern Ireland

Background The regional Spina Bifida (SB) service for Northern Ireland is organised through two multi-professional teams based in Belfast, one for children and the other for those of older teenage years and beyond who transfer to an adult service. Although the incidence of SB is lower in comparison to earlier decades, more children are living longer with complex problems requiring support and remediation. This study examines the palliative care needs of children and young people with SB attending the children's service that were recognised as having a life-limiting dimension; required symptom control; and there was an expectation of early death.

The Swedish Birth Defects Registry: Ascertainment and incidence of spina bifida and cleft lip/palate

To assess the ascertainment of spina bifida and cleft lip/palate (CLP) in newborns and in fetuses from terminated pregnancies (ToPs) in the Swedish Birth Defects Registry (BDR) and to estimate the true incidences of these two anomalies. Retrospective register study. Center for Epidemiology at the Swedish National Board of Health and Welfare, and Uppsala University Hospital. Newborns and fetuses from ToPs with spina bifida (1999-2004) and CLP (1999-2002) in Sweden. Data from four registries/sources were used to estimate ascertainment in BDR and incidences of spina bifida and CLP. Ascertainment, under-ascertainment, and true incidence. For newborns, under-ascertainment of spina bifida and CLP were 6 and 13%, respectively, in BDR after record linkage with the Medical Birth Registry. Ascertainment of cleft palate increased when accompanied by cleft lip. The under-ascertainment of spina bifida in ToPs after 18 gestational weeks was 27%. Ascertainment of CLP in all ToPs and of spina bifida in ToPs before the 18th gestational week could not be estimated. The majority (109/155, 70%) of ToPs with spina bifida occurred before the 18th week. The estimated incidence of spina bifida per 10,000 births was 6.1 (2.4 newborns and 3.7 ToPs) and of CLP 20.1 (18.9 newborns and 1.2 ToPs). The ascertainments are relatively high for newborns in BDR, but lower or unknown for ToPs, which has an impact on the surveillance of spina bifida in view of the high proportion of ToPs.

Gender, head size and disease: A hypothesis related to posterior fossa growth

This hypothesis proposes that the difference in head size between the genders has a bearing on disease incidence. Smaller head size predisposes to spina bifida and larger head size predisposes to autism. In the fetus, the posterior fossa has a regulatory influence on maximum intracerebral cerebrospinal fluid (CSF) pressure. CSF pressure pulsations are generated by movements in the chest and abdomen and transmitted to the intracranial CSF spaces via the posterior fossa. The efficiency of transmission of pressure to the head is influenced by the size of posterior fossa CSF spaces. The larger posterior fossa in the male fetus allows higher peaks of pressure in the lateral ventricles than the female, resulting in larger head size. Restriction of posterior fossa growth has a greater influence on females than males. This leads to a greater incidence of spina bifida in females, where reduced head size is characteristic in the fetal stages. Fetal surgery for spina bifida expands posterior fossa CSF spaces and improves transmission of pressure waves generated in the fetal abdomen and thorax into the head. This results in an increase in head circumference following surgery. Males are susceptible to autism where head growth is accelerated in early childhood. This is because they have a larger average head size.

The incidence of spina bifida in Sweden 1973–2003: the effect of prenatal diagnosis

Many studies have been conducted on the accuracy of prenatal ultrasound diagnosis of foetal CNS-malformations. These studies were mostly hospital-based or, sometimes, multicentre studies. We present here a population-based study of the prenatal diagnosis of spina bifida in Sweden over a period of 31 years. We compared the number of newborns with spina bifida and the elective terminations because of the prenatal diagnosis of spina bifida for different periods. The rate of spina bifida among newborns diminished gradually from 0.55 per 1000 to 0.29 per 1000 during the study period. In M county the rate of spina bifida at birth decreased very rapidly and from 1993 onwards was about half of that in the rest of the country. There has been a decline in the rate of spina bifida at birth. This decline can be seen earlier in the southern part of the country, M county. The decline is probably, to a great extent, a consequence of prenatal ultrasound screening.

P14.20: The incidence of spina bifida in Sweden 1973–2001: the effect of prenatal diagnosis

P14.20: The incidence of spina bifida in Sweden 1973–2001: the effect of prenatal diagnosis

Anthropological study on spina bifida in the Community of Madrid

The incidence of spina bifida in the Community of Madrid (Spain) has been assessed during an eleven-year period, since 1970 to 1980: 0.37 per 1,000 newborns over a total of 272,332 newborns, dead and alive, of simple births. The sex ratio at birth was 94. Maternal variables have been studied (maternal age, menarche, parity, etc.), obstetric variables (number of abortions, medication during pregnancy, etc.) and also neonatal variables (weight, gestational age, state at birth, etc.). Seasonal variations were observed.

Spina Bifida Incidence at Birth—United States

Spina bifida, a birth defect of the spinal column that can cause varying degrees of paralysis, is a major contributor to serious developmental disabilities in the United States. To determine the incidence and descriptive epidemiology of spina bifida, CDC analyzed reports from 16 states with population-based birth defects surveillance systems (Table 1). This report summarizes findings from this analysis for 1983-1990.(ABSTRACT TRUNCATED AT 250 WORDS)

From the Centers for Disease Control. Spina bifida incidence at birth--United States

From the Centers for Disease Control. Spina bifida incidence at birth--United States

A survey of serious congenital morphological abnormalities in Abu Dhabi

The overall incidence of severe congenital abnormalities diagnosed within the first week of life was 12.9/1000, which is similar to other surveys (1,2), although the distribution and type of abnormalities encountered varied considerably. The incidence of spina bifida and encephaloceles was lower than elsewhere (0.54/1000).

DECREASING INCIDENCE OF SPINA BIFIDA AND ANENCEPHALY

The notification of congenital malformations in England and Wales is voluntary, and from time to time some malformations become foci of attention because, for example, a preventive programme shows promises of success, surgeons begin to offer a treatment not previously available, or diagnosis improves. The notification rate was 220.8 per 10,000 in total births in 1983, almost 5% up on the previous year and the highest in the decade 1974 to 1983. The cause may be disputed but there is no doubting the decline in incidence of spina bifida, down to 6.7 per 10,000 last year from 18.3 in 1974, while the rate for anencephalus fell from 13.1 to 1.8 per 10,000 over the decade. Age-specific rates for individual malformations year by year are not provided but an impact of screening for Down syndrome is not discernible. The U-shaped graph of maternal age against malformation rate is defied by Down syndrome and the rate for women aged 45 or more is ten times that for women aged 30-34—but there were only 7 Down syndrome births in the oldest groups compared with 130 in the younger women. A preventive programme restricted to but 100% effective in women aged 35 or more would have prevented the births of only 27% of Down syndrome babies.