Outcome of isolated fetal talipes: A systematic review and meta-analysis.

INTRODUCTION: The aim of this systematic review was to explore the outcome of fetuses with a prenatal diagnosis of isolated talipes. MATERIAL AND METHODS: Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched. The outcomes explored were: associated anomalies detected at follow-up ultrasound examination; fetal magnetic resonance imaging (MRI) and birth; chromosomal abnormalities detected with standard and chromosomal microarray analysis, intrauterine, neonatal, and perinatal death, and termination of pregnancy; rate of surgical and nonsurgical treatment; neurodevelopmental outcome; and false-positive rate of prenatal diagnosis. Meta-analyses of proportions were used to combine data. RESULTS: Twenty-five studies (1567 fetuses) were included. Associated anomalies were detected in 7.8% (95% CI 0.1%-29.3%) of cases at follow-up ultrasound, and in 4.0% (95% CI 0.1%-13.2%) of cases, fetal MRI identified anomalies not detected at ultrasound assessment. Similarly, 7.0% (95% CI 3.4%-11.7%) of cases labeled as isolated talipes on prenatal imaging were found to have associated anomalies at birth. Abnormal karyotype was present in 3.6% (95% CI 1.7%-6.2%) of fetuses, whereas no anomaly was found at chromosomal microarray analysis, although this outcome was reported by only 1 study. Intrauterine death occurred in 0.99% (95% CI 0.4%-1.9%) of fetuses, whereas the corresponding figures for neonatal death and termination of pregnancy were 1.5% (95% CI 0.6%-2.6%) and 2.2% (95% CI 1.2%-3.4%), respectively. Surgical management of anomalies after birth was found in 41.7% (95% CI 27.0%-57.2%) of fetuses with isolated talipes, and 54.8% (95% CI 31.5%-77.0%) had nonsurgical management of the anomalies after birth. Abnormal neurodevelopmental outcome was reported in 7.6% (95% CI 1.0%-19.4%) of children, although this analysis was affected by the small number of included cases and short time of follow up. CONCLUSIONS: Isolated talipes detected on prenatal ultrasound carries a generally good prognosis. The incidence of additional abnormalities detected on fetal MRI, aneuploidy, or neurodevelopmental disability is relatively low. However, longitudinal ultrasound assessment during pregnancy and a thorough postnatal evaluation are recommended to rule out associated anomalies that may significantly impact short- and long-term prognosis.

A national estimate of the birth prevalence of congenital anomalies in India: systematic review and meta-analysis.

BACKGROUND: A quarter of all global neonatal deaths occur in India. Congenital anomalies constitute the fifth largest cause of neonatal mortality in the country, but national estimates of the prevalence of these conditions are lacking. The objective of the study was to derive an estimate of the birth prevalence of congenital anomalies in India. METHODS: The search was carried out in PubMed and pooled prevalence was estimated using the inverse variance method. A random effects model was used due to high heterogeneity between the studies. Forest plots were generated using the Review Manager software. RESULTS: The PubMed search identified 878 articles from which 52 hospital based and three community based studies were included in the meta-analysis. The pooled prevalence of congenital anomaly affected births was 184.48 per 10,000 births (95% CI 164.74-204.21) among 802,658 births. Anomalies of the musculoskeletal system were highest among live births while the prevalence of central nervous system defects was highest when stillbirths were included in the analysis. Anencephaly and talipes were the most commonly reported anomalies. CONCLUSIONS: Data from this meta-analysis suggests that there may be as many as 472,177 (421,652 to 522,676) congenital anomaly affected births in India each year. Population based studies using standard definitions are needed to validate these estimates. The two most frequently reported anomalies were anencephaly that is potentially preventable through preconception folate supplementation, and talipes which can be corrected using relatively low cost interventions. Studies are needed to determine the impact of congenital anomalies on neonatal mortality in India.

Estudio de prevalencia, referencia y tratamiento oportuno de recién nacidos con Talipes en Argentina / Study of prevalence, reference and opportune treatment of newborns with Talipes in Argentina

INTRODUCCIÓN Talipes es la anomalía congénita musculoesquelética más frecuente. Si no se realiza tratamiento adecuado, se asocia a secuelas. El tratamiento requiere consultas regulares con el especialista en traumatología y el uso de ortesis. OBJETIVO Describir la prevalencia de talipes en recién nacidos, estimar el número de casos anuales esperados y describir las características del acceso al tratamiento inicial. MÉTODOS Estudio observacional en dos etapas; la primera describe las características epidemiológicas. La segunda es un estudio de corte transversal acerca del acceso al tratamiento inicial en los recién nacidos a través de una encuesta semiestructurada. RESULTADOS La prevalencia de talipes fue de 8,9 por cada 10.000 nacimientos. La razón de sexos fue de 1,45; el 69% fueron casos aislados; el 88% del subtipo equinovarus. En las familias encuestadas, 97% de los niños inició tratamiento, el 68% de ellos ha completado el mismo. En 71% se colocó el primer yeso antes del mes de vida. El 69% se trasladaba a la consulta con el profesional en transporte público, costeado en el 94% por la familia. En un tercio de los casos el tiempo de traslado al hospital fue mayor a 2 horas. En aquellos niños que tenían indicación, el 61% contó con la ortesis en el momento requerido. En el 63% de los casos, la misma fue costeada por la familia. DISCUSIÓN La prevalencia de talipes en el país coincidió con la observada en otros estudios. Se observó diferencias según la jurisdicción. Se estimó el número de casos anuales esperados lo cual consideramos permitirá identificar prioridades y diseñar nuevas intervenciones de prevención en sus diferentes niveles. Se observaron obstáculos en la referencia directa y oportuna. El tratamiento implica además para las familias una carga monetaria (ortesis, traslado) y de tiempo, lo cual puede comprometer la eficacia del tratamiento. Sería importante facilitar el acceso al tratamiento así como proveer los insumos necesarios para el mismo

Association between a Maternal History of Miscarriages and Birth Defects.

BACKGROUND: Some studies, mainly in the older literature, observed a significant association between miscarriages and birth defects (BDs) occurring in the same sibship. However, few studies examined the BD/miscarriage relationship in depth. In addition nothing has been added to the underlying mechanisms possibly linking both events. The purpose of this work was to identify specific BDs associated with maternal miscarriages. In particular, it examined whether the risk depended on the number of losses, and to suggest the existence of specific factors for each BD/miscarriage association observed. METHODS: The study relied on the Latin American Collaborative Study on Congenital Malformations (ECLAMC) database registries including 26,906 live and stillborn infants with one of 19 selected isolated BDs and 93,853 normal controls. Infants born to primigravid mothers were excluded from the present study. Demographic and reproductive variables were compared between control mothers With and Without previous miscarriages. The number, frequency, and distribution of miscarriages were observed for each BD and controls. A conditional logistic regression was applied to evaluate the miscarriage risk for each BD. RESULTS: Control mothers with previous miscarriages were older, had had more pregnancies, and were less educated. Three risk patterns of miscarriages were observed: a very high risk of miscarriages associated with gastroschisis, omphalocele, and talipes; only one miscarriage associated with spina bifida, and two or more miscarriages associated with hypospadias. CONCLUSION: These three patterns suggest that different factors underly each BD/miscarriage association: infertility for hypospadias, vascular disruption for gastroschisis and talipes, while for spina bifida, the much debated trophoblastic cell residue theory could not be discarded. Birth Defects Research 109:254-261, 2017. © 2017 Wiley Periodicals, Inc.

Desarrollo de la morfología de la huella plantar en niños congoleños y su relación con el uso de calzado / Development of footprint morphology in congolese children in relation to footwear use

Se estudió la huella plantar con los índices de ChippauxSmirak, del arco de Staheli y el ángulo de Clarke, de 1.851 escolares congoleños, 906 chicas y 945 chicos, de área urbana que utilizaban calzado y rural que iban descalzos habitualmente, con edades comprendidas entre 3 y 12 años. Los niños y niñas de menor edad presentaron mayor porcentaje de pies morfológicamente planos. Este porcentaje disminuyó con el crecimiento en ambos sexos. El factor que más influyó en el desarrollo del pie y de la huella plantar fue la edad, después el calzado y, por último, el sexo. Los niños pequeños mostraron una mayor frecuencia de pies morfológicamente planos; las chicas presentaron mayor frecuencia de pies cavos y la población rural descalza estudiada presentó mayor cantidad de pies normales en el grupo de edad más joven (AU)