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Lethal Congenital Anomalies

Aubrey Milunsky, MB, BCh, DSc, FRCP, DCH
JAMA. 1983;250(4):517-518. doi:10.1001/jama.1983.03340040057034.
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The Western world has witnessed waning infant mortality rates from infectious diseases these past few decades. At the same time has come the increasing recognition of the importance of congenital anomalies as a major cause of perinatal, neonatal, and infant deaths. Today, 2% to 3% of all births are associated with a major congenital anomaly.1 Such anomalies, mental retardation, and genetic disorders together account for 25% to 30% of admissions to children's hospitals in North America. Pain and suffering of both children and family inexorably follow the birth and death of many affected infants (estimate, 109,380 in 1981 in the United States). This heavy personal and societal burden is aggravated by the realization that a recognizable cause is not found in some 60% of major congenital anomalies.2

Infants with congenital anomalies frequently have low birth weights. While the causes of these low birth weights are frequently unknown, certain


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