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C M Druschel

Publications and source records attributed to C M Druschel.

11 recordsLinked to original sources
PubMed1996

First year-of-life mortality among infants with oral clefts: New York State, 1983-1990.

This study examined the mortality experience of children with oral clefts using the New York State Congenital Malformations Registry. Infants born in the years 1983 to 1990 to New York residents, diagnosed with an oral cleft and matched to their birth certificate were included in the analysis. Children with oral clefts were compared to a sample of live births from the years 1983 to 1990 without malformations. Children with cleft palate without additional malformations had a statistically nonsignificant adjusted risk of 1.2 when compared to children with no malformations. Children with cleft lip with or without cleft palate had a 1.1 adjusted risk. However, 35% of children with oral clefts had associated malformations and experienced much higher mortality. Children with oral clefts should be carefully evaluated for additional malformations; if none are found, their mortality appears not to be elevated.

Abnormalities, Multiple↗
PubMed1995

A descriptive study of prune belly in New York State, 1983 to 1989.

OBJECTIVE: To determine the prevalence and spectrum of prune belly in a defined population. DESIGN: Population-based descriptive study using New York State's Congenital Malformations Registry. SETTING: The Congenital Malformations Registry is a statewide registry of children diagnosed as having congenital anomalies before the age of 2 years. PATIENTS: Infants with the diagnosis of prune-belly syndrome born during the years 1983 to 1989 to women who were New York State residents and verified by medical record review. MAIN OUTCOME MEASURES: The live birth prevalence of prune belly for the total population and for population subgroups, such as race, sex, plurality, and maternal age. The occurrence of other malformations with prune belly. RESULTS: Sixty cases of prune belly were ascertained (50 male and 10 female). The live birth prevalence was 3.2 per 100,000 and declined over the time period. The prevalence was higher in males, 5.1 per 100,000, than females, 1.1; and higher in blacks, 5.8, than whites, 2.6. The live birth prevalence of prune belly in twins, 12.2 per 100,000, was four times higher than that found in singletons, 3.0. More than 36 (60%) of patients died, most in the first week. Forty-two (70%) of patients had one of the commonly described associated defects; pulmonary hypoplasia was the most common. Almost one third of patients had defects other than those typically associated with prune belly. CONCLUSIONS: Twins, blacks, and children born to younger mothers appear to be at higher risk. Mortality remains high, especially early with many deaths due to pulmonary hypoplasia. Further studies should include stillborns and terminated pregnancies.

Diseases in Twins↗
PubMed1995

The epidemiology of infantile hypertrophic pyloric stenosis in New York State, 1983 to 1990.

OBJECTIVES: To investigate an apparent decline in the rate of infantile hypertrophic pyloric stenosis (IHPS) and to examine the characteristics of children with IHPS and any associated malformations. DESIGN: Cohort study in which children with IHPS were compared with the population of live births. Trends of IHPS were compared in two data sets: a population-based birth defects registry and hospital discharge data. PARTICIPANTS: Children with IHPS identified from a birth defects registry and the population of live-born infants born to residents of New York State from 1983 to 1990. MAIN OUTCOME MEASURE: Trends in the incidence of IHPS in the two data sets, and demographic characteristics and malformations associated with IHPS. RESULTS: The rate of IHPS declined from 2.4 per 1000 live births in 1984 to 1.7 in 1990. White race and male gender were associated with a higher occurrence of IHPS; high birth order, older maternal age, higher maternal education, and low birth weight were associated with lower occurrence. Seven percent of children with IHPS had a major malformation compared with 3.7% of the general population. Three major malformations occurred more frequently in children with IHPS: intestinal malrotation, obstructive defects of the urinary tract, and esophageal atresia. Fewer cases were found in the birth defects registry than in the hospital discharge data. CONCLUSIONS: Underreporting of IHPS to the birth defects registry accounts for some of the decline. Children with IHPS have more major malformations than the general population, although some of the excess could be attributed to increased detection. Further investigation is needed into the environmental factors, especially socioeconomic, associated with IHPS.

Case-Control Studies↗
PubMed1993

Evaluation of congenital limb reduction defects in upstate New York.

Limb reduction defects (LRD), reported to the Congenital Malformations Registry in upstate New York between 1983-1987, were investigated in terms of LRD classification, parental demographics, and LRD characteristics. After excluding LRD with chromosome abnormalities, we followed guidelines developed by the European Congenital Anomaly Surveillance Consortium (EUROCAT) to classify 271 LRD into six groups based on similar patterns of embryological failure. The descriptive analysis indicated a prevalence of 0.45 per 1,000 births (stable over 5 years) for LRD diagnosed during the first 2 years of life. Among 271 LRD cases, 95 were classified as terminal transverse (35.1%), 71 as split limbs (26.2%), 36 as preaxial (13.3%), 32 as postaxial (11.8%), 26 as intercalary (9.6%), and 11 as multiple types (4.1%). In cases with multiple limb involvement (28.4%), two thirds had the same type of LRD in each limb. The multiple types and preaxial groups showed the most distinctive characteristics: they had the highest frequency of suspected syndromes, other birth defects, and syndactyly compared to the other LRD. There were no significant differences in the distribution of demographic variables among different LRD types. Consideration of the incidence and characteristics of LRD by classifying them into these distinct subgroups may be useful for evaluating possible mechanisms of malformation.

Abnormalities, Multiple↗
PubMed1993

Examining potential demographic risk factors for congenital cardiovascular malformations on a time-developmental model.

A descriptive epidemiological study of congenital cardiovascular malformations (CCM) was performed to evaluate the use of a model which groups selected cardiac lesions according to time of embryonic origin. Infants born from 1983-1986 to residents of New York State excluding New York City and reported to the Congenital Malformation Registry (CMR) were first grouped into those with (n = 299) and without (n = 4424) chromosomes anomalies. Infants were then categorised according to the time of gestation of their earliest occurring CCM into one of the seven cardiac groups of the model. The categories were analysed by infant race, gender, birthweight, gestation, maternal age and education, and the presence of additional malformations. The group without chromosomal anomalies showed an increasing proportion of non-whites, females, and preterm births and a decreasing proportion of infants with other malformations in the embryonically later categories. The group with chromosomal anomalies was too small to exhibit any significant demographic patterns. The findings suggest associations between characteristics of the infant and the embryonic period in which the CCM occurred, thus demonstrating the usefulness of a time-based model. Further research should concentrate on confirming these associations with more complete data and on investigating their biological bases.

Abnormalities, Multiple↗
PubMed1989

Neonatal mortality in normal birth weight babies: does the level of hospital care make a difference?

Although neonatal intensive care for low birth weight infants has been extensively studied, few researchers have looked at the impact of the level of care at the delivery hospital for infants weighing greater than 2500 gm. Using linked birth-death records from Georgia for 1979 to 1982, we examined the effect that the level of care available at the hospital of delivery had on neonatal mortality in infants weighing 2500 gm and above. We used a risk scoring system designed for use with vital records to determine prepartum risk and the presence or absence of a complication of labor as indicated on the birth certificate to determine intrapartum risk. We found that women with a high prepartum risk score had increased neonatal mortality at level 1 hospitals. Women who developed a complication of labor, regardless of their prepartum risk status, had the highest neonatal mortality rates when they delivered at level 1 hospitals. We suggest prenatal risk assessment for all women and referral of high risk women to level 2 or 3 hospitals for delivery even at term.

Birth Weight↗
PubMed1989

Infant mortality among moderately low birth weight infants in Alabama, 1980 to 1983.

A previous study of postneonatal deaths among normal birth weight infants in Alabama indicated that rural residence increased the risk of postneonatal death, the magnitude of the excess risk in the black population, and the risk of death from preventable causes. To determine whether this pattern persisted in a group presumably at higher than usual risk of infant death, patterns of mortality among infants weighing 1500 to 2499 g at birth and born in Alabama between 1980 and 1983 were examined by race, residence, and cause of death. Neonatal and infant mortality rates were higher for black infants; postneonatal mortality rates were higher for black infants. Neonatal mortality was highest for white infants from the rural part of the state; post-neonatal mortality was highest for black infants from the rural part of the state. There was little variation in the proportion of preventable postneonatal deaths by race or residence (17.6% for all) but almost twice as many white deaths were not preventable as black ones (39.0 vs 21.9%). It is posited that rural residence may actually be a surrogate measure for lack of access to health services.

Black or African American↗
PubMed1989

Trends in cause-specific infant mortality in Georgia.

We previously reported that almost one third of the potential for reduction (PFR) in infant mortality in Georgia would result from reduction in mortality of normal birthweight infants. To determine where reductions were made in the past and where gaps remain, we examined trends from 1960 to 1980-82 in cause-specific mortality for normal birthweight infants by race. In the neonatal period, mortality was reduced by 66% for white infants, 76% for black infants. In the postneonatal period, overall reductions were smaller than in the neonatal period, 50% for white and 71% for black infants. The majority of the remaining gap resulted from excess mortality in the infection, injury, and Sudden Infant Death categories. The widest gaps in infant mortality exists in the postneonatal period. There is a 12% potential for reduction in the black infant mortality rate if interventions directed at the normal birthweight infant in the postneonatal period are emphasized.

Cause of Death↗
PubMed1987

Postneonatal mortality among normal birth weight infants in Alabama, 1980 to 1983.

To identify reasons for the racial differential in postneonatal deaths and possible intervention strategies, Alabama's linked birth-death file was used to evaluate causes of postneonatal mortality for the 1980 to 1983 cohorts of normal birth weight infants. Causes were aggregated into six categories, and cause-specific rates were compared by race and by urban-rural residence. Both total and cause-specific postneonatal mortality rates among black infants were two or more times higher than for white infants, except for congenital anomalies. The greatest differential was for infection-related deaths. Rural residence increased both the risk of postneonatal death and the magnitude of the racial differential. The risks were especially elevated for deaths due to infection and "systemic causes" (including those in the perinatal category). Only 26% of postneonatal deaths were probably not preventable, and nearly one third were clearly preventable. Potential prevention strategies include injury control, prevention of infectious diseases, and prompt treatment of infectious diseases.

Alabama↗
PubMedDate not supplied

An evaluation of congenital malformations surveillance in New York State: an application of Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems.

Established in 1982, the New York State Congenital Malformations Registry (NYCMR) is one of the largest statewide, population-based birth defects registries in the nation. In this article, we evaluate the surveillance of congenital malformations in New York State using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. In addition to the evaluation of selected qualitative and quantitative system attributes, we assess the public health significance and usefulness of the surveillance system and how well it is meeting its stated objectives. The NYCMR uses passive case ascertainment, relying on reports from hospitals and physicians. A congenital malformation is defined as any structural, functional, or biochemical abnormality determined genetically or induced during gestation and not due to birthing events. In addition to being the primary source of congenital malformations surveillance data in New York State, the NYCMR also provides cases for traditional epidemiological studies to determine risk factors for specific congenital malformations. The NYCMR has been working to meet its stated objectives while striving to improve its qualitative and quantitative attributes. Registry personnel have implemented several measures designed to enhance the simplicity of the data collection and data entry processes, as well as to maintain the acceptability of the surveillance system to the reporting sources. Because it is a statewide, population-based surveillance system, by far the strongest quantitative attribute of the NYCMR is representativeness. The sensitivity of the NYCMR is difficult to evaluate. Available estimates suggest, however, that the NYCMR identifies a large proportion of children born with congenital malformations in New York State and diagnosed from birth through two years of life. Finally, the NYCMR has in recent years been able to publish and disseminate annual reports describing the distribution of specific malformations in New York State on a timely basis.

Centers for Disease Control and Prevention, U.S.↗