Neural Tube Defects at Siriraj Hospital, Bangkok, Thailand-10 Years Review (1990-1999)
Pornswan Wasant MD*, Achara Sathienkijkanchai MD*
Affiliation : *Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objectives : Neural tube defects (NTDs), (including anencephaly, meningomyelocele and encephalocele), are
among the most common birth defects, with high associated mortality and morbidity. NTDs occur in 1-5 per
1,000 births, with marked geographic and ethnic variations. However, there are few data concerning the
incidence, associated anomalies, treatment and outcome of NTDs in Thailand. The objective of this study is to
analyze data on NTD cases from 1990-1999 at Siriraj Hospital, a hospital with 18,000-20,000 deliveries
annually.
Materials and Methods : A retrospective chart review of patients with NTDs who were born at or referred to
Siriraj Hospital 1990-1999 was performed.
Results : During the 10 year period we examined, there were 115 patients with NTDs treated in the Department
of Pediatrics as well as in other Departments at Siriraj Hospital. The incidence of NTD is 0.67 per 1,000 births.
The sex distribution was equal among NTD cases, 55 (48%) females, 59 (51%) males and one (1%) unidenti-
fied sex. Isolated NTDs accounted for 105 (91%) cases, and 10 (8.7%) had at least 1 other structural anomaly
such as cleft lip/palate, imperforate anus, amniotic band sequence, or ambiguous genitalia. Among all NTD
cases, there were 55 (48%) with myelomeningocele, 45 (39%) with anencephaly, and 14 (12%) with encepha-
locele . Seventeen (15%) cases died; among these, 7 (41% of deaths) died in utero, 8 (47% of deaths) died in
the early neonatal period, and 2 (12%) died after 1 year of age. Regarding treatment, 95 surgical corrections,
47 excisions and repairs, 45 excisions and VP shunts, 1 laminectomy and 2 club feet corrections were
performed.
Conclusions : In this hospital-based study of 115 patients with NTD, we found an incidence of 0.67/1000 births;
however, as this was a hospital-based study, the community incidence is likely higher. Most cases were isolated
NTDs, and almost half of NTDs were meningomyelocele. There was a high rate of mortality. Further studies are
warranted to better elucidate the health burden from NTDs in Thailand. Public health interventions aimed at
increasing the periconceptional consumption of folic acid should be implemented or enhanced to reduce the
incidence of NTDs in Thailand.
Keywords : Neural tube defects, Anencephaly, Encephalocele, Meningomyelocele, Folic acid supplementation
