consaguinity and apnea of prematurity hala tamim, phd 1 khalid yunis, md 2
TRANSCRIPT
CONSAGUINITY AND APNEA OF
PREMATURITY
Hala Tamim, PhD1
Khalid Yunis, MD2
BackgroundDefinition of consanguinity
Consanguineous marriage is the
union of individuals having a
common ancestor. It is categorized
as 1st, 2nd and 3rd degree. The 1st
being the closest kinship.
It is believed that consanguineous
marriages would preserve: Family
dynamics & structure and provide:
Cultural, Social and economic
benefits.
High estimates of consanguineous marriages have been reported in various Arab countries:
54% in Kuwait1
29-50% in Egypt2
52% in Saudi Arabia3
51% in the United Arab Emirates4
50% in Jordan5 15% in Lebanon6
40% in Yemen7.
BackgroundPrevalence of Consanguinity
Consanguineous marriages are more
prevalent in rural than urban areas8,
such marriages have been positively
associated with: Low age at marriage8,
Low educational level of the mother9,
Low occupational status of husband5.
BackgroundSocio-demographic Characteristics of Consanguinity
Parental consanguinity increases the
autosomal recessive conditions
through the expression of recessive
deleterious alleles, especially in the
offspring of first degree cousins.
BackgroundHealth Impacts of Consanguinity
BackgroundHealth Impacts of Consanguinity
Parental consanguinity has been associated with increased risk of pediatric disorders including:
Stillbirths and perinatal mortality10,
Congenital birth defects, Malformations,
and mental retardation11, Blood diseases
(hemophilia, â-thalassemia)12, cystic
fibrosis13, Chronic renal failure14 and
Neonatal diabetes mellitus15.
Cont’d
Apnea of prematurity is a common
problem in the neonatal intensive care
setting that affects premature infants
(those born before 37 weeks of gestation).
It is defined as either the cessation of
breathing for longer than 20 seconds or
that of any duration if accompanied by
cyanosis and sinus bradycardia.
BackgroundApnea of Prematurity
The aim of this study was to
examine the association between
consanguinity and apnea of
prematurity among infants born in
Greater Beirut, Lebanon, a country
with a relatively high prevalence of
consanguineous marriages.
Objective
Initiated in September 1998, the National Collaborative Perinatal Neonatal Network (NCPNN) is a non-profit voluntary collaboration of health professionals.
NCPNN contains major hospitals in the city of Beirut as well as hospitals in the South, East, North and the mountains. The network is now in the process of expanding to other areas in Lebanon (Annex 1,2).
National Collaborative Perinatal Neonatal Network NCPNN
Data is collected prospectively at
the network hospitals.
Information on maternal and
neonatal characteristics is
obtained from obstetric and
nursery records and through
direct interviews with the mothers
before hospital discharge.
National Collaborative Perinatal Neonatal Network NCPNN
Between September 1, 1998, and
March 31, 2001, a total of 21,723
consecutive newborn infants were
delivered and admitted to the
NCPNN.
MethodsSubjects
Inclusion criteria were:
Infants less than 37 weeks of gestation,
admitted to the intensive care unit of
one of the NCPNN centers, and having no
congenital malformations, sepsis,
neurologic disorders, or metabolic and
electrolytic disturbances such as
hypoglycemia, hypocalcemia, or
hypomagnesemia.
MethodsSubjects
The inclusion criteria were satisfied
for 857 infants of the total of 21,723
infants, of whom 78 had apnea of
prematurity. Analysis was based on
597 infants with complete information
on consanguinity, 66 of whom had
apnea of prematurity.
MethodsSubjects
To assess the relation between neonatal
characteristics and Apnea of Prematurity,
odds ratios and 95 percent confidence
intervals were calculated. Variables
significantly associated with Apnea of
Prematurity at the bivariate level were
included in a logistic regression model to
determine the independent effect of
consanguinity on apnea of prematurity.
MethodsStatistical analysis
Results
Bivariate analysis revealed that
the variables significantly
associated with Apnea of
Prematurity were: First-degree
consanguinity, Gestational age,
Presence of complications during
pregnancy, Multiple gestation, 5-
minute Apgar score (Table 1).
VariablesOdds ratio
95% Confidence
interval
First-degree consanguinity 2.16 1.06-4.42
Gestational age (weeks)
30 9.26 4.31-19.89
31-33 4.86 2.53-9.31
34-36 1
Complication 1.68 1.01-2.82
Multiple gestation 1.70 1.01-2.84
5-minute Apgar score <7 2.29 1.04-5.04
Table 1: Association between Neonatal characteristics and Apnea of Prematurity
Results
Adjusting for Gestational age,
Presence of complications during
pregnancy, Multiple gestation and 5-
minute Apgar score, the effect of
first-degree consanguinity on Apnea
of Prematurity was OR: 2.89 CI: 1.3-
6.43 (Table 2).
Results
Results
VariablesOdd
s ratio
95% Confidence
interval
First-degree consanguinity 2.89 1.30-6.43
Gestational age (weeks)
30 6.33 2.62-15.31
31-33 4.53 2.26-9.08
34-36 1
Complication during pregnancy
1.37 0.75-2.49
Multiple gestation 1.41 0.78-2.55
5-minute Apgar score <7 0.49 0.21-1.18
Table 2: Logistic regression analysis of the main predictors of Apnea of Prematurity
ConclusionThere is an urgent need to inform the
public properly about the anticipated
deleterious effects of inbreeding in
societies where intermarriage is widely
practiced. Further etiologic studies
that look into the association of
consanguinity and apnea of
prematurity are needed to support this
finding and clarify the significance of
such an association.
References
NETWORK COORDINATING CENTER
(AUBMC)
Dania Abi Haydar, B.Sc (1999-present)Hiba Al Assaad, B.Sc (2001-2003)May Al Kassar, B.Sc (2001-present)Bassima Dergham, B.Sc (2002-present)Mary Ghanem, MPH (2003-2004)Diana Jamal,B.Sc (2004-present)May Sanyoura. B.Sc. (2004-present)
Research Assistants:
Pascale Nakad, B.Sc (1999-present) Network coordinator:
GhinaMumtaz, M.Sc (2002-present)Ban Al Sahab, M.Sc (2003-2004)Hind Beydoun, MPH (1999-2003)Choghik Boulghourjian, M.Sc (1998-2001)
Network statistician:(Epidemiology and Population Health)
Hala Tamim, PhDEpidemiology & Population Health
Mustafa Khogali, MDFamily Medicine
Co-investigators:
Khalid A. Yunis, MDPediatrics & Neonatology
Project director:
CURRENT INVESTIGATORS AT NCPNN MEMBER INSTITUTIONS (by alphabetical order)
Hospital Investigator
Ain Wa Zain Hospital Margo Ali, MD
American University Hospital
Khalid Yunis, MD
Hotel Dieu de France Hospital
Imad Melki, MD
Jbeily Hospital Niazi Jbeily,MD
Makassed General Hospital Hassan Fakhoury, MD
Najjar Hospital Mohammad Itani, MD
Notre Dame de la Paix (Akkar)
Ghayth Makhoul, MD
Rassoul al Aazam Hospital Alia Aaraj, MD
Rayak Hospital Amir Al Zahr, MD
Rizk Hospital Gerard Wakim, MD
Rahhal Hospital (Akkar) Joseph Rashkidi, MD
Sahel General Hospital Mona Alameh, MD
St. Georges Hospital Yolla Nassif, MD