Upload
gehanath-baral
View
529
Download
0
Embed Size (px)
Citation preview
Birth Defects Surveillance
& Zika virus in pregnancy
Dr Gehanath Baral [email protected]
Paropakar Maternity and Women’s Hospital
Thapathali, Kathmandu Nepal
Dr Gehanath Baral 1
Birth defect ?
Any
• Structural or functional abnormality
That • Exists since intrauterine life
And
• Can be identified prenatally, at birth or later in life
Dr Gehanath Baral 2
What are structural birth defects?
– Major: Significant medical or cosmetic consequence – Spina bifida, hydrocephalus, cleft lip, heart
defects, hypospadias, limb deficiency, clubfoot, hip dislocation, omphalocele, Down syndrome (trisomy 21), achondroplasia, Di George syndrome (del 22q11.2)
– Minor: Medically insignificant and suspicious of a major problem
Any anatomical abnormality of a body structure “Malformation”
Dr Gehanath Baral 3
– Inborn errors of metabolism (e.g., phenylketonuria, mucopolysaccharidosis)
– Haematologic diseases (e.g., sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase [G-6-PD]deficiency)
– Endocrine system diseases (e.g., hypothyroidism, congenital adrenal hyperplasia)
– Other molecular anomalies (e.g., cystic fibrosis, oculocutaneous albinism)
– Developmental disabilities (e.g., some types of cerebral palsy, deafness, cognitive and/or behavioral anomalies including autism)
Any altered function of a molecule or an organ
What are functional birth defects?
Dr Gehanath Baral 4
Congenital/Genetic defects
Congenital: Existing since birth or “existing since intrauterine life”
Genetic: caused by a genetic anomaly
– Genetic does not necessarily mean “hereditary”
– The majority of genetic diseases are not transmitted by parents but occur as a new event
Dr Gehanath Baral 5
– Major cause of SBs and NNDs
– Incidence =6% of births
– Birth defects may result in long-term disability
– Disability rate= 3% (1 in 33 infants)
– Annual neonatal death= 270,000
– The most common and severe birth defects are
– Heart defects (1%),
– Neural tube defects and
– Down syndrome
Birth Defects Facts
Dr Gehanath Baral 6
Birth Defects Facts
– Causes difficult to identify exactly, may be
– Idiopathic (70%),
– Genetic (Heart defect and cleft lip/palate),
– Infectious or
– Environmental in origin
– Many birth defects can be prevented
– Rubella vaccination,
– Adequate intake of folic acid and iodine, and
– Adequate preconception and antenatal care
Dr Gehanath Baral 7
Birth Defects Surveillance Project
Project Title: Expansion of strengthening
national network for newborn and birth
defects in Nepal
Duration: December 2014-November 2015
Support: WHO-SEARO
Nodal Institute: Paropakar Maternity and
Women’s Hospital
Dr Gehanath Baral 8
Hospitals in the network
1. Paropakar Maternity and Women’s Hospital, Kathmandu
2. TU Teaching Hospital, Kathmandu
3. Western Regional Hospital, Pokhara
4. BP Koirala Institute of Medical Sciences, Dharan
5. Nepal Medical College, Kathmandu
6. Kathmandu Medical College, Kathmandu
7. Koshi Zonal Hospital, Biratnagar
8. Patan Academy of Medical sciences, Lalitpur
9. Bharatpur Hospital, Chitawan
10.Dhulikhel Hospital, Dhulikhel
Dr Gehanath Baral 9
Role of National Nodal Center
1. Support capacity building of member institutions
2. Consolidate and analyze the data
3. Monitoring visits for improving quality of data
4. Providing periodic feedbacks for improvement
5. Dissemination and publication of reports
6. Co-ordinate activities of the members of network
Dr Gehanath Baral 10
Database on Newborn and Birth Defects web site
(http://apps.searo.who.int/npn)
Dr Gehanath Baral 11
Database on Newborn and Birth Defects web site
• Click on Yahoo Icon
• Provide Email ID and password
• Click on “Sign in” button
Dr Gehanath Baral 12
Database on Newborn, Still birth and Birth Defects web
site
• Birth Defects (BD) Form
• Newborn (NB) Form
• Stillbirth (SB) Form
Dr Gehanath Baral 13
Hospital based gross prevalence in live birth
%37.0
10078766
295
100Birth Live Total
DefectsBirth with BabiesDefectBirth
Dr Gehanath Baral 14
Hospital based gross prevalence in still birth
%1.3
1001159
36
100Birth Still Total
DefectsBirth with BabiesDefectBirth
Dr Gehanath Baral 15
Hospital based gross prevalence in total birth
%41.0
10079925
331
100Birth Total
DefectsBirth with BabiesDefectBirth Total
Dr Gehanath Baral 16
Types of birth defects
Number of babies with Birth Defects
331
Types of birth defects
Neural Tube Defects 46
Orofacial Cleft 68
Hypospadias 14
Talipes Equinavarus 32
Limb Reduction Defects 17
Abdominal Wall Defects 10
Others 245
Number of Visible Birth Defects
432
Dr Gehanath Baral 17
New born admission and morbidities
Birth trauma 0.8% Respiratory Upto 7%
Hypoglycemia 4.4% CNS Upto 8%
Meconeum aspiration 8.2% Systemic infection
39%
Hypothermia 5.6% Therapeutic intervention
Upto 61%
Hyperbilirubinemia 24.1% NND 4.03‰
Rhesus isoimmunization
1.6%
LBW 33.1%
Dr Gehanath Baral 18
Microcephaly=2-12‰0
Dr Gehanath Baral 19
What is ZIKA virus?
– ssRNA/Flavi virus : 1947 (RhMonkey)/1952 (human)
– Aedes aegipti/albopictus mosquito bite,
– Vertical tansmission,
– Sexual transmission
– Symptoms
– 20% symptomatic,
– Acute fever, maculopapular rash, arthralgia and conjunctivitis
– Myalgia, headache
– Complication: GB Syndrome
Dr Gehanath Baral 20
Prevention of ZIKA virus?
– Neither a vaccine nor prophylactic medications available to prevent Zika virus infection
– Mosquito prevention strategies:
– Wearing long-sleeved shirts and long pants
– Using insect repellents
– DEET, picaridin, and IR3535 are safe for pregnant women
– Using permethrin-treated clothing
– Staying and sleeping in screened-in or air-conditioned rooms
Dr Gehanath Baral 21
ZIKA virus test In Pregnancy
– RT-PCR
– Serology: IgM + neutralizing Ab by PRNT (plaque reduction neutralization test)
– X-reactive results:
– Dengue
– Yellow fever
– JE vaccination
– NO test if NO travel history to risk area
– Do test if ≥2 symptoms during or within 2 weeks of travel
Dr Gehanath Baral 22
What to test?
– Maternal serum/plasma
– Amniotic fluid
– HPE/immunostain of Placenta/cord
– Zika test for frozen placental/cord tissue
– Serology of cord blood
Dr Gehanath Baral 23
Which specimen?
– Maternal serum/plasma
– Amniotic fluid: RT-PCR
– HPE/immunostain of Placenta/cord
– Zika test for frozen placental/cord tissue
– Serology of cord blood
Amniocentesis
• ≥15 weeks gestation
• Do test if ≥2 symptoms during or within 2 weeks of travel
• USG: microcephaly or calcification (sensitivity=57%)
What to test in pregnancy?
Dr Gehanath Baral 24
Zika Virus treatment In pregnancy
1. No specific antiviral treatment
2. Supportive
– Rest, fluids, and use of analgesics /antipyretics
– Fever should be treated with acetaminophen
– Avoid aspirin and other nonsteroidal anti-inflammatory drugs until dengue can be ruled out to reduce the risk for hemorrhage
3. If +ve Zika virus test in serum or amniotic fluid
– Serial USG for fetal anatomy and growth q 3–4 weeks
Dr Gehanath Baral 25
Neonatal screening
Measure head circumference after
24 hours of birth
Compare with standard nomogram
If microcephaly USG/CT/MRI of
brain
Dr Gehanath Baral 26
References
– World Health Organization Fact sheet N°370 Updated April 2015. http://www.who.int/mediacentre/factsheets/fs370/en/
– Questions and Answers for Obstetrical Healthcare Providers. http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html
– Interim Guidelines for Pregnant Women during a Zika Virus Outbreak. http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm
– Steps to prevent bug bites. http://wwwnc.cdc.gov/travel/page/avoid-bug-bites
Dr Gehanath Baral 27