Saldarriaga-Gil Wilmar, Ruiz-Murcia Fabián Andrés, Fandiño-Losada Andrés, Cruz-Perea Manuel Enrique, Isaza de Lourido Carolina
Department of Morphology Faculty of Health, Universidad del Valle. Cali, Valle, Colombia .
Group on Congenital Malformations and Dysmorphology, Faculty of Health. Universidad del Valle (MACOS). Cali, Valle Colombia .
Colomb Med (Cali). 2014 Mar 30;45(1):32-8. eCollection 2014 Jan-Mar.
The study aim was to determine the frequency of prenatal ultrasound diagnosis of congenital anomalies in Newborns (NB) with birth defects hospitalized in two Neonatal Intensive Care Units (NICU) of Cali (Colombia) and to identify socio-demographic factors associated with lack of such diagnosis.
It was an observational cross-sectional study. NB with congenital defects diagnosable by prenatal ultrasound (CDDPU), who were hospitalized in two neonatal intensive care units (NICU), were included in this study. A format of data collection for mothers, about prenatal ultra-sonographies, socio-demographic data and information on prenatal and definitive diagnosis of their conditions was applied. Multiple logistic and Cox regressions analyses were done.
173 NB were included, 42.8% of cases had no prenatal diagnosis of CDDPU; among them, 59.5% had no prenatal ultrasound (PNUS). Lack of PNUS was associated with maternal age, 25 to 34 years (Odds Ratio [OR]: 4.41) and 35 to 47 years (OR: 5.24), with low levels of maternal education (OR: 8.70) and with only a PNUS compared to having two or more PNUS (OR: 4.00). Mothers without health insurance tend to be delayed twice the time to access the first PNUS in comparison to mothers with payment health insurance (Hazard Ratio [HR]: 0.51). Among mothers who had PNUS, screening sensitivity of CDDPU after the 19(th) gestational week was 79.2%.
The frequency of prenatal diagnosis is low and is explained by lack of PNUS, or by lack of diagnostic in the PNUS. An association between lack of PNUS and late age pregnancy and low level of maternal education was found. In addition, uninsured mothers tend to delay twice in accessing to the first PNUS in comparison to mothers with health insurance. It is necessary to establish national policies which ensure access to appropriate, timely and good quality prenatal care for all pregnant women in Colombia.
本研究旨在确定在哥伦比亚卡利市两家新生儿重症监护病房（NICU）住院的患有出生缺陷的新生儿（NB）中，先天性异常的产前超声诊断频率，并确定与未进行此类诊断相关的社会人口学因素。
这是一项观察性横断面研究。本研究纳入了在两家新生儿重症监护病房住院、可通过产前超声诊断的先天性缺陷（CDDPU）的新生儿。应用了一份针对母亲的关于产前超声检查、社会人口学数据以及其病情产前和最终诊断信息的数据收集表格。进行了多项逻辑回归和Cox回归分析。
共纳入173例新生儿，42.8%的病例未进行CDDPU的产前诊断；其中，59.5%未进行产前超声检查（PNUS）。未进行PNUS与母亲年龄25至34岁（优势比[OR]：4.41）和35至47岁（OR：5.24）、母亲教育水平低（OR：8.70）以及与进行两次或更多次PNUS相比仅进行一次PNUS（OR：4.00）有关。与有付费医疗保险的母亲相比，没有医疗保险的母亲获得首次PNUS的时间往往延迟两倍（风险比[HR]：0.51）。在进行了PNUS的母亲中，孕19周后CDDPU的筛查敏感性为79.2%。
产前诊断的频率较低，原因是未进行PNUS或PNUS中缺乏诊断。发现未进行PNUS与高龄妊娠和母亲教育水平低之间存在关联。此外，与有医疗保险的母亲相比，未参保母亲获得首次PNUS的时间往往延迟两倍。有必要制定国家政策，确保哥伦比亚所有孕妇都能获得适当、及时且高质量的产前护理。
