The Clinical Study On Relevant Factors Of Congenital Malformation Of 323 Newborns

Congenital Malformation is not only one of the momentous causes bringing on death of perinatal newborns and infants, but also induces perennial deformity and illness to defective children.It will make a severe impact on the quality of fetus and infants, also bring a painful and ponderous burden to the whole society, family and patients. With the product and the living environment are polluted, as well as people's behaviors and lifestyle changing, the rate of human congenital malformation takes on an increasing trend. Congenital malformations of China's population monitoring project began in 1986, according to Chinese Birth Defects Monitoring Centre, monitoring results showed that the mortality of infants who die of congenital malformation gradually rose to the second place in our country. With the rise in the level of medical care, some of the treatments of congenital malformation have a great development, but some prognosis is not ideal, and there is no special treatment for the majority of malformations. So the way of reducing the occurrence of congenital malformation is early intervention, which should be important. The reasons of congenital malformations are complicated, and it is recognized that congenital genetic factors, biological factors, chemical substance, and physical factors would lead to human congenital malformation. It includes genetic factors, environmental factors and interactions of them. From the 19th century to the early 20th century, many scholars focused on genetics research about the study of etiology of congenital malformation. Until the late 1950s and early 1960s, after the incident about some pregnant women's take of Thalidomide leading to "Seals children" in some countries of Europe and America. Whole world started to attach importance to congenital malformations, and the emphases of teratogenic study focused on exogenous teratogenic source of environment instead of genetic factors. For the present, it has been identified that the environmental risk fact- ors that lead to congenital malformations include human cytomegalovirus, toxoplasma, rubella virus, herpes simplex virus, Treponema pallidum, radiation, high temperature, mechanical compression injury, a lack of vitamin, certain antibiotics, anti-tumor drugs, thalidomide and so on. There are many factors that relate to teratogenic embryos, such as: maternal exposure to harmful substances during pregnancy, special jobs, adverse mental stimulus during pregnancy, nutritional status, pregnancy complications, diseases, and advanced maternal age, low level of education by parents, the lack of eugenic knowledge, and poor economic conditions. Because of the differences of regions, customs and cultural, the regional environmental risk factors are very different.In order to explore the factors relating to the neonatal congenital malformations, get quantitative realization of the influencing extent of the relevant factors to congenital malformation, and proceed to provide a reliable basis for early intervention of the neonatal congenital malformations. We selected 173 cases of congenital malformations infants diagnosed and treated in the Newborn Department of our hospital from January 2007 to December 2007, and selected 150 cases without congenital malformations to compare in the same period of hospitalization. The match conditions were: the gender of the newborns and the season of birthing were identical. In hospital, I conducted a questionnaire survey of these parents, checked these patients and recorded all results timely. After the survey, verification, and collecting, I established data files of all the information in the Excel and analyzed all the data with SAS statistical analysis software. At first, descriptive studies including general characteristics analysis and equilibria tests in subjects were conducted. Secondly, We analyzed 36 factors with the method of single-factor analysis: gestational age, birth weight, multiple births, the child-bearing age of mother, personality type, occupation, education, ethnic, past medical history, the number of pregnancy, maternal parity, nutritional status, regular prenatal exam, exposure to injurants during pregnancy, animalcule infection during pregnancy, fever, pregnancy complications, smoking, drinking, pet contact, whether adverse mental stimulation, the per capita monthly income of family, paternal exposure to injurants, education, medical history and so on, and worked out P value of each factors. At last, we put all the factors into a logistic regression model to go on multivariate analysis, and selected the effecting factor with stepwise regression methods by the standard test set (α=0.05). The study finded that the common types of congenital malformation are congenital heart disease, multiple malformations, intestinal atresia or stenosis, diaphragmatic hernia, esophageal atresia (and tracheoesophageal fistula), during which 115 cases suffering from congenital heart disease, accounting for 66.47%, ranking first of all types of malformations. In the 173 cases of congenital malformations, the 157 cases suffered from single malformation, accounting for 90.75%, the 16 cases of deformity accounting for 9.25%. After a single factor analysis of the 36 related factors, it showed there were 15 factors having a significant difference. They were gestational age of newborns, BW, maternal child-bearing age, education, maternal parity, pregnancy complica- tions, past medical history, maternal exposure to noise, pesticides and pets during pregnancy, taking drugs to avoid abortion antibiotics, the reach of oral contraceptives, upper respiratory infection during pregnancy, smoking of father. All 36 factors were analyzed with the method of multi-regression analysis. The result manifested that low birth weight, pregnancy complications, maternal past medical history, taking antibiotics during pregnancy, the reach of oral contraceptives during pregnancy, upper respiratory infection, smoking of father and mother who was a farmer were risk factors for congenital malformations. OR values were 2.767, 3.400, 3.891, 4.408, 6.060, 3.013, 1.731, 2.834. Regular prenatal testing was protective factor (β<0, OR=0.453). Overall, the conclusion was that low birth weight, pregnancy complications, maternal past medical history, taking antibiotics during pregnancy, the reach of oral contraceptives during pregnancy, upper respiratory infections, father smoking, mother who was a farmer and regular prenatal exams were closely related to the newborn CM. So before and during pregnancy, pregnant women should try to avoid contacting risk factors. If the pregnant women are likely to be exposed to the higher risk factors, regular prenatal testing can help to reduce the rate of the congenital malformations. In addition, although other relevant factors in the statistical analysis have no statistical significance, there were relevant researches showing that they were related to newborns with congenital deformities. We have to pay attentions to them as well.