Congenital malformations, which are according to Schwalbe’s definition: the morphological alterations which came into being during fetal life and are without the variability of the species, are responsible for 6.4% of the total number of deaths among infants, mentioned in tables VII-7 and VII-8.
The occurrence of congenital malformations among the newborn infants in Jogjakarta can be estimated from the figures, which are available from the maternity-ward of Bethesda-hospital. During the period July 1, 1954 – July 1, 1958 2,094 infants were born alive in this maternity-ward. Among these 2,094 infants were born alive in this maternity-ward. Among these 2,094 Javanese infants 16 babies showed congenital malformations, which in 4 cases were also the cause of death. The frequency of congenital malformations was among these Javanese newborn infants during this period 7.6 per 1,000. This concerns of course only the congenital malformations which can be discovered through inspection and physical examination or cause symptoms in the course of the first week of life.
The congenital malformations were the following: pes equinovarus 2, harelip 2, harelip with palatoschizis 1, atresia ani 2, and five other newborn-infants with vitium cordis, microcephalus, hypospadias, atresia of the nasal duct, and syndactilism respectively. The newborn with congenital haemangioma is classified in the section about tumours. The four newborns who died of congenital malformation were the patients suffering from atresia duodeni, atresia intestinae, malformation of the heart and hydrocephalus respectively.
The still-births which occurred in these 4-year period was left out of consideration in the review above. Among the still-births were quite a number of hydrocephalus. Out of the 20 cases of still-births with a congenital malformation which occurred in this hospital 14 were cases of hydrocephalus. Because hydrocephalus is often an impediment for the normal course of the delivery, many pregnant women are therefore taken to hospital during delivery for special obstetric treatment. The two cases of hydrocephalus among the infants born alive is one newborn, who survived the puncture of the skull by which 270 cc cerebrospinal fluid was discharged gradually while the other newborn-infant was delivered by caesarean section. This was a medical mistake.
In the course of the period July 1, 1954 – July 1, 1958 119 infants with a congenital malformation were admitted in Bethesda hospital, while during the period May 1, 1955 – July 1, 1958 33 infants with congenital malformations were admitted in the University’s children’s ward. A review of the congenital malformations observed is given in table VIII-5.
Table VIII – 5.
Review of the congenital malformations of the patients admitted in the University’s Children’s ward and the Bethesda children’s ward during the period July 1, 1954 till July 1, 1958.
The children who died of congenital malformations were all infants. In many cases a request for surgical treatment brought these infants to the hospital. This explains the great difference in number of patients admitted with congenital malformation in the two hospitals. In this period there was in Bethesda-hospital a surgical department with a capacity of 200 beds (Surgeon in this period Dr.G.J.Renes) while in Gadjah Mada university the surgical department was in an early stage of development in these years. The new surgical department of the University was opened in 1959. The infants with atresia ani were mostly admitted within the first three days of life. Out of the 28 cases 21 were admitted within three days. Two infants were admitted on the 15th day of life and one even survived. The four infants who died of congenital hernia were admitted at the moment when the hernia had already been incarcerated for some days.
Congenital malformations as cause of death among infants in the D.I. Jogjakarta are not so important as they are in European countries. Congenital malformations, which are in many cases difficult to treat and because only few possibilities to prevent these malformations are known, became in European countries relatively more important as a cause of death in infancy. After the success in combating infectious diseases, diseases of the respiratory tract and prematurity the congenital malformations and birthtrauma became gradually more important causes of death.
In the Netherlands e.g. During the period 1930-1932 infant-mortality was 50 per 1,000 live-births and 10% of all deaths of infants was caused by congenital malformations. In the period 1950-1952 infant mortality decreased to 25 per 1,000 live births, but 20% of all deaths among infants were caused by congenital malformations.