Incidence, types and outcomes of congenital anomalies in babies born at a public, tertiary hospital in South Africa

Background. Limited information is available on the incidence of major congenital abnormalities (MCAs) in low- and middle-income countries (LMICs). Objective. To determine the incidence and types of MCA and associated all-cause mortality from a facility with a large delivery service in an LMIC. Methods. Births and neonatal admission registers of live inborn births between 1 January 2012 and 31 December 2013 at the Chris Hani Baragwanath Academic Hospital, South Africa, were reviewed for diagnosis of MCA. Results. A total of 201 infants were admitted with a diagnosis of MCA, of which 114 were inborn. This translated to an incidence of 2.60 per 1 000 live births. The cardiovascular (43.9%), gastrointestinal (21%), musculoskeletal (13.2%) and central nervous system (12.3%) were commonly affected systems. Most MCAs were single defects (75.4%), followed by trisomies (19.3%). A significant number of infants with trisomies were born to multigravid women older than 35 years (p<0.001). A significant number of infants with single defects were preterm (p<0.002) and of low birth weight (p<0.002). One third (34%) required surgical intervention before hospital discharge. All-cause mortality at hospital discharge was 20.2%, with more deaths among patients with trisomy 13 (50%) and trisomy 18 (40%) compared with patients with single defects (19.8%) or trisomy 21 (7.8%) (p<0.05). Conclusion. The incidence of MCAs found in this study is much lower than what has been reported from HICs but similar to findings from other LMICs. MCAs in LMIC settings are associated with high mortality rates.