RESUMEN
The spectrum of the VATER association has been debated ever since its description more than two decades ago. To assess the spectrum of congenital anomalies associated with VATER while minimizing the distortions due to small samples and referral patterns typical of clinical series, we studied infants with VATER association reported to the combined registry of infants with multiple congenital anomalies from 17 birth defects registries worldwide that are part of the International Clearinghouse for Birth Defects Monitoring Systems (ICB-DMS). Among approximately 10 million infants born from 1983 through 1991, the ICB-DMS registered 2,295 infants with 3 or more of 25 unrelated major congenital anomalies of unknown cause. Of these infants, 286 had the VATER association, defined as at least three of the five VATER anomalies (vertebral defects, anal atresia, esophageal atresia, renal defects, and radial-ray limb deficiency), when we expected 219 (P<0.001). Of these 286 infants, 51 had at least four VATER anomalies, and 8 had all five anomalies. We found that preaxial but not other limb anomalies were significantly associated with any combination of the four nonlimb VATER anomalies (P<0.001). Of the 286 infants with VATER association, 214 (74.8%) had additional defects. Genital defects, cardiovascular anomalies, and small intestinal atresias were positively associated with VATER association (P<0.001). Infants with VATER association that included both renal anomalies and anorectal atresia were significantly more likely to have genital defects. Finally, a subset of infants with VATER association also had defects described in other associations, including diaphragmatic defects, oral clefts, bladder exstrophy, omphalocele, and neural tube defects. These results offer evidence for the specificity of the VATER association, suggest the existence of distinct subsets within the association, and raise the question of a common pathway for patterns of VATER and other types of defects in at least a subset of infants with multiple congenital anomalies.
Asunto(s)
Anomalías Múltiples/epidemiología , Canal Anal/anomalías , Esófago/anomalías , Femenino , Humanos , Recién Nacido , Riñón/anomalías , Deformidades Congénitas de las Extremidades , Masculino , Sistema de Registros , Columna Vertebral/anomalías , SíndromeRESUMEN
From 1970 to 1985, the total number of hospital admissions in Finland increased by 36 per cent, the number of admissions due to musculoskeletal disorders by 121 percent, and the admissions due to trauma by 38 percent. The combined share of musculoskeletal disorders and trauma in hospitals will grow to an estimated 18 percent of all the admissions by the year 2000. Of all the early pensions granted by the Social Insurance Institution, the share of musculoskeletal disorders as the main cause increased from 16 percent in 1970 to 25 percent in 1985.