Incidence of birth defects during different surveillance ranges in Shanghai from 2016 to 2018
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摘要:
目的 比较上海市18岁以下儿童在不同监测时段的出生缺陷发病率和构成情况，探索适宜的出生缺陷监测时段。 方法 利用2016―2018年上海市《出生缺陷儿、残疾儿童报告卡》，分析孕＜28周、孕28周~＜产后8 d、产后8~＜43 d、产后43 d~＜出生后1年、出生后1~＜2年、出生后2~＜3年和出生后3~＜18年的出生缺陷累积发病率和构成比。 结果 2016―2018年，上海市18岁以下儿童出生缺陷累积发病率分别为16.31‰、15.34‰和22.05‰，先天性心脏病在不同年度出生缺陷顺位中均为首位。孕28周前和围产期出生缺陷累积发病率分别为4.49‰和14.44‰，延长至产后42 d、出生后1年、出生后2年、出生后3年、出生后18年的累积发病率分别为15.18‰、16.90‰、17.05‰、17.11‰和17.35‰。将孕28周前纳入监测时段，并同时延长至出生后1年，出生缺陷患儿数分别占全部病例的83.21%和97.38%，出生缺陷发病率分别为常规围产期监测的1.45倍和1.70倍。 结论 建议以医院为基础的出生缺陷监测模式将孕28周前纳入监测时段，并同时延长至出生后1年。 Abstract:Objective To compare the incidence and composition of birth defects in children under 18 years old in Shanghai during prenatal and postpartum monitoring periods, in order to explore more appropriate time period of birth defects surveillance. Methods The hospital-based monitoring data from 2016 to 2018 were retrived from Shanghai birth defects surveillance network, in which all defects cases were reported from any gestational week to age of 18. The cumulative incidencece and proportion were respectively analyzed before 28 gestational weeks, 28 gestational weeks to postpartum 7 days, postpartum 8 to 42 days, postpartum 43 days to 1 years old, 1 to 2 years after birth, 2 to 3 years after birth, and 3 to 18 years old. Results The incidences were respectively 16.31, 15.34 and 22.05 per 1000 births below 18 years of age in Shanghai, 2016-2018. Congenital heart disease was the top kind of birth defects within all years. The cumulative incidences were 4.49 and 14.44 per 1000 births before 28 gestational weeks and perinatal period. The cumulative incidences turned respectively 15.18, 16.90, 17.05, 17.11 and 17.35 per 1000 births when the monitoring range was prolonged to postpartum 42 days, 1, 2, 3 and 18 years after birth. A total of 83.21% and 97.38% of birth defects were diagnosed, and the cumulative incidences increased to 1.45 and 1.7 times high, when defects identified at any gestational weeks and before 1 years of age were included. Conclusions It is suggested that the surveillance period of birth defects should be extended from any gestational weeks to 1 year after birth within hospital-based monitoring mode. -
Key words:
- Birth defects /
- Hospital based monitoring /
- Surveillance /
- Incidence rate
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表 1 2016―2018年上海市18岁以下儿童出生缺陷发病率
Table 1. Incidence of birth defects in children under 18 years old in Shanghai from 2016 to 2018
年份(年) 同期出生队列人数 18岁以下出生缺陷发病率[n(‰)] 合计 上海户籍 非上海户籍 合计 上海户籍 非上海户籍 2016 211 418 89 432 121 986 3 448(16.31) 1 743(19.49) 1 705(13.98) 2017 213 947 89 771 124 176 3 283(15.34) 1 656(18.45) 1 627(13.10) 2018 174 140 69 734 104 406 3 840(22.05) 2 070(29.68) 1 770(16.95) 合计 599 505 248 937 350 568 10 571(17.63) 248 937(21.97) 350 568(14.55) 
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表 2 2016―2018年上海市18岁以下儿童出生缺陷疾病顺位前10位[n(%)]
Table 2. Top 10 birth defects among children under 18 years old in Shanghai from 2016 to 2018 [n(%)]
顺位 2016年 2017年 2018年 1 先天性心脏病：1 177(34.14) 先天性心脏病：1 070(32.59) 先天性心脏病：1 305(33.98) 2 多指(趾)：373(10.82) 多指(趾)：398(12.12) 多指(趾)：365(9.51) 3 外耳其他畸形：163(4.73) 外耳其他畸形：160(4.87) 外耳其他畸形：159(4.14) 4 并指(趾)：135(3.92) 尿道下裂：126(3.84) 尿道下裂：138(3.59) 5 尿道下裂：129(3.74) 并指(趾)：118(3.59) 并指(趾)：127(3.31) 6 21-三体综合征：123(3.57) 21-三体综合征：102(3.11) 21-三体综合征：115(2.99) 7 腭裂：89(2.58) 腭裂：90(2.74) 腭裂：81(2.11) 8 小耳(包括无耳)：78(2.26) 唇裂合并腭裂：88(2.68) 唇裂合并腭裂：72(1.88) 9 唇裂：77(2.23) 小耳(包括无耳)：77(2.35) 小耳(包括无耳)：66(1.72) 10 唇裂合并腭裂：75(2.18) 唇裂：66(2.01) 马蹄内翻足：65(1.69) 合计 2 419(70.16) 2 295(69.91) 2 493(58.87)
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表 3 2016―2018年上海市不同监测时段的出生缺陷发生情况
Table 3. Occurrence of birth defects during different surveillance ranges in Shanghai from 2016 to 2018
监测时段 出生缺陷诊断数 累计占比(%) 累积发病率(‰) 先天性心脏病[n(%)] 孕＜28周 2 690 25.86 4.49 528(19.63) 孕28周~＜产后8 d 5 966 83.21 14.44 1 994(33.42) 产后8 ~＜43 d 447 87.50 15.18 362(80.98) 产后43 d~＜出生后1年 1 027 97.38 16.90 577(56.18) 出生后1~＜2年 93 98.27 17.05 19(20.43) 出生后2~＜3年 34 98.60 17.11 4(11.76) 出生后3~＜18年 146 100.00 17.35 14(9.59)
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