Patterns and risk factors of birth defects in Bangladesh: evidence from a neonatal intensive care unit

Birth defects constitute substantial contributor to neonatal mortality and morbidity particularly in low and middle income countries. In Bangladesh, limited screening and low awareness contribute to delayed diagnoses and inadequate care. This study aimed to delineate the patterns of birth defects and identify associated risk factors to provide baseline data in a tertiary care neonatal intensive care unit in Bangladesh to support future surveillance, inform policy development, and guide preventive strategies.

This hospital based prospective observational study was conducted in the Department of Neonatology at Chittagong Medical College Hospital, Bangladesh, from August to December 2020. Neonates with birth defects were identified through detailed clinical examination and classified according to the International Classification of Diseases, 10th Revision, Clinical Modification. Relevant data were collected using a predesigned questionnaire. Data were analyzed in SPSS version 28. Logistic regression was done to identify perinatal risk factors. A p-value < 0.05 was considered statistically significant.

Among 5,223 admitted neonates, 183 (3.5%) had birth defects. Musculoskeletal anomalies were most common (67 cases), followed by cleft lip/palate (30), circulatory (29), chromosomal (24), eye, ear, face and neck (23) anomalies. Among these neonates, 56 (30.6%) died, with a 1.59 fold higher mortality risk compared to those without defects (95% CI: 1.15-2.18; p = 0.005). Maternal hypertension (AOR: 3.92; 95% CI: 2.56-5.99; p < 0.001), diabetes mellitus (AOR: 4.15; 95% CI: 2.37-7.27; p < 0.001), polyhydramnios (AOR: 7.33; 95% CI: 2.63-20.41; p < 0.001), and oligohydramnios (AOR: 10.19; 95% CI: 3.68-28.23; p < 0.001) were strongly associated with birth defects.

The study highlights the significant burden of birth defects and associated neonatal mortality. Musculoskeletal anomalies were the most frequently observed defects. Maternal hypertension and diabetes mellitus were identified as strong predictors, warranting targeted antenatal screening and timely intervention. Routine neonatal examination at community level as well as in hospital is recommended to facilitate early detection and proper referral of birth defects.