THE IMPORTANCE OF CONGENITAL MALFORMATIONS AT BIRTH

Resumo

Introduction: Countries that have overcome high infant mortality rates show, nowadays, concentration of deaths in the neonatal period and, within it, mainly in the first week of life (early neonatal deaths). Regarding causes of death, as some diseases have started to be controlled, a significant proportional increase in the participation of congenital malformations has been verified. Objective: To describe the prevalence of congenital malformations (CM) at birth in conceptuses (stillbirths and live births) of women hospitalized in institutions located in the city of São Paulo, Brazil. Methods: Descriptive, cross-sectional study carried out at 4 hospitals in the city of São Paulo during 3 months in the 2 and semester of 2011. Data were collected by means of interviews with the women and examinations of hospital records. The CM were studied according to variables of epidemiological and socio-demographic interest. The deaths were analyzed according to underlying and associated causes. Results: The results showed the occurrence of 9.1% of CM registered among stillbirths and 4.3% among live births. Among the latter – 238 newborns – 284 CM were registered, totaling 1.2 CM per live birth with CM registered. Among the 238 newborns that had a CM register, there were 10 deaths by CM (4.2%). This value differs from the one verified among the live births without CM register that died (19 out of 5,341 or 0.4%). Aiming to identify possible  occurrences of death after hospital discharge, a linkage was performed between the official mortality database of the city of São Paulo and the study’s database. The occurrence of 18 deaths was found in this way, 4 of which were caused by CM. Thus, the total of deaths in the 1 st year of life was 47, and 14 of them had CM as the underlying cause, which leads to a proportional infant mortality by CM equal to 29.8% and an infant mortality coefficient by CM of 2.5%o live births. The data show a high undercount of CM in the registers of the official information systems (regarding SINASC, the prevalence of CM in the study was three times the prevalence for the city of São Paulo and 5.4 times the prevalence for Brazil). Conclusion: It is necessary to implement measures to improve the register of CM in the information systems, such as: raising doctors’ awareness concerning the importance of diagnosing CM and registering it in the newborn’s hospital records, creating a specific space to register the CM in the newborn’s hospital records, and qualifying and monitoring the personnel in charge of filling in the Certificate of Live Birth and transcribing it to the information systems.