expectant parents are unsure if they have to worry about their unborn children. VIP News has spoken with a prenatal diagnostician.
Update from September 30, 2019: The Ministry of Health of North Rhine-Westphalia is now giving the all-clear. In arm and hand malformations of new-borns, the authority sees in the past years “no obvious trends and regional accumulations “. This was announced by the ministry on Monday. It had asked in all birth clinics of the state for malformations in the years 2017, 2018 and 2019.
The result: In significantly less than 0.1 percent of all new-borns, doctors have found malformations of the hands. “For the years 2017, 2018, 2019, a total of 72, 64 and 61 malformations of the upper extremities in North Rhine-Westphalia were reported as of 27 September 2019 “, it was said. The feedback from the hospitals should now be analysed in detail and compared with data from other quality assurance survey systems and other data collections.
Three cases within twelve weeks
Babies who are born without fully trained hands, the hands and fingers are missing: In Gelsenkirchen St. Mary’s Hospital Buer that’s exactly what happened in twelve weeks apparently several times. Three children were born between June and the beginning of September in the clinic, each with one malformed hand. In two babies, the left hand was affected, the third new-born was born without a right hand.
The forearm was normal in all three cases. However, the hands and fingers are no longer considered “rudimentary” in infants, the hospital said. All other body parts of the children were completely unobtrusive.
Midwife went public with cases
The cases became public last week by the Cologne midwife Sonja Liggett-Igelmund. She had called in an interview with the Cologne ” Express ” parents to also report to her if their children were born with similar birth defects. So far, a report of the ” Bild ” newspaper has done 30 families. However, some of the children are already considerably older than the babies born on the Gelsenkirchen birth ward this summer. The oldest of them is already ten years old.
Cause is so far unclear
The clinic calls the period of only twelve weeks, in which the malformations of the three babies occurred, in a statement “conspicuous”. But could also be behind a random accumulation, write the doctors on. As far as the causes are concerned, they seem to have been in the dark so far.
Accordingly, the clinic could not establish a connection between the cases: “We could not see any ethnic, cultural or social similarities between the families of origin.” All families, however, lived in the local environment of the clinic in North Rhine-Westphalia.
Doctors do not think panic is appropriate
Accordingly, many future mothers and fathers are concerned. However, Jochen Frenzel considers the fear of malformation per se to be unfounded. He is a gynaecologist, national chairman of the professional association of gynaecologists (BVF) in Saarland and prenatal diagnostician, so is mainly concerned with the investigation of the embryo in the womb.
“Such hand malformations are extremely rare,”. According to the Sankt Marien-Hospital Buer, the likelihood that a child with a malformation of whatever kind will be born is one to two percent. “The likelihood of an isolated malformation of one hand as in the three new-borns even at 1: 10,000,” adds Frenzel.
97 percent of babies are healthy
Care of many expectant parents on current cases can be understood by the doctor. Conversely, the numbers implied that more than 97 percent of babies were born physically perfectly healthy.
Three babies without hands and within twelve weeks on the same maternity ward, this local accumulation, however, make Frenzel “more than listening,” he says. “Considering how rare such malformations occur, it is all the more noticeable when the same malformation pattern appears three times in such a short time.”
“Cases must be critically questioned”
The current accumulation in Gelsenkirchen could still be within statistical limits, explains Frenzel. If no such cases occur for about ten years, malformations may happen at another time. But “in any case, the cases that have occurred now must be critically scrutinized and investigated,” says the doctor.
Possible reasons for malformations are the gynaecologist after various. In particular, Frenzel calls:
- Medicinal triggers
- Genetic causes
- environmental influences
- Viral diseases of the mother in pregnancy
- General risk factors such as smoking, alcohol or drugs during pregnancy
However, only in very few cases does the physician consider viral diseases the cause of individual malformations. After all, they usually not only relate to singular extremities, as in Gelsenkirchen but also the brain and other internal organs.
Pesticides as a cause?
As potentially harmful environmental influences, pesticides have been repeatedly discussed in the past. Especially in France, plant protection products are suspected of being responsible for similar cases of malformations. The Cologne midwife, who has made the cases in Germany now public, also mentions environmental toxins as a possible cause of malformations. Frenzel holds in particular pesticides as a trigger of not fully trained hands, however, questionable.
If plant protection products were to blame for this, in his opinion significantly more new-borns would suffer from corresponding malformations.
Limb control “under-represented” in practice
Basically, Frenzel does not consider panic for pregnant women to be appropriate at this time. However, the control of malformations of the extremities in the long catalogue of prenatal care is underrepresented in his opinion. “This is simply because such malformations occur much less frequently than others,” explains the gynaecologist. Accordingly, the heart of the embryo is usually most intensively examined. It is the organ most commonly affected by malformations or malformations.
However, anyone who wants to have the arms and legs of his unborn child controlled explicitly can demand that from the doctor, says Frenzel. If there is no indication that such a fine diagnosis by ultrasound is advisable from a medical point of view and therefore to the cash benefit, it costs about 200 euros, the parents have to pay privately.
There is no specific suspicion for a further diagnosis from a medical point of view. “Even if the doctor sees something on the ultrasound that is diffuse, but in a way conspicuous to him, he can order a closer examination,” says Frenzel.
In many cases, therapy is already possible in the womb
If a malformation of the child’s extremities is detected in the womb during such an examination, the possibilities of therapy are more limited than in the case of abnormalities of the heart or bladder, the gynaecologist explains. So not properly working heart valves can already be corrected in the mother’s stomach. Also, catheters that make the bladder work better can be used even before the birth of the baby. Even cardiac arrhythmias can be treated with medicines taken by the mother before the baby is born.
In the case of arms and legs that do not grow as they should, such therapy is even more difficult during pregnancy, explains Frenzel. They start to develop very early, from about the fifth week of pregnancy (SSW). “Things that are not planned until the twelfth week of pregnancy can hardly be increased or conjured up,” explains the prenatal physician.
Agility can be improved after birth
However, such birth defects could be treated after birth. How good, that depends heavily on the severity, says Frenzel. The first thing that doctors tried to do in such cases was tweezers. “This designates the interaction of thumb and index finger, which is elementary for humans to be able to grasp,” explains the gynaecologist.
The operative measures would usually be supported by physiotherapy and mobilizing exercises to improve the mobility of the hand. Also, prostheses are often a way to improve the functioning of the hand, says Frenzel. These can work very well depending on the severity of the deformity – and would not even stand out visually. “If you do not pay attention, you will not notice many dentures at first sight,” says Frenzel. How the therapy of the three babies from Gelsenkirchen will look in the future, is not yet known.