CANADA

Taking no chance of thalidomide II

PETER CARLYLE-GORDGE December 7 1981
CANADA

Taking no chance of thalidomide II

PETER CARLYLE-GORDGE December 7 1981

Taking no chance of thalidomide II

MANITOBA

In his cramped office at Winnipeg’s St. Boniface General Hospital last week, pediatric pathologist Dr. Albert De Pape ran his hands through his greying brush cut and admitted he was baffled. “I’ve been in this field 25 years and you develop a sense about when things will occur,” he says, peering through his horn-rims. “If you haven’t seen a certain abnormality for a while you know by the law of averages that one is due and it usually shows up.” And that is precisely what has happened at St. Boniface. In the past year, a worrying total of seven babies has been born with a rare and often fatal affliction known as omphaloceles.

Babies born with omphaloceles have their intestines protruding through the abdomen. In Canada, over the past eight years, about one child in 4,100 has been born with it, though medical literature rates its frequency at one in 6,600 births. In simple cases, immediate surgery can save the child’s life. Less hopeful are the rarer cases of omphaloceles—those in which limbs, skeleton, bladder or kidneys are deformed or missing.

September saw the first—and one of the rarer—of the seven cases at St. Boniface. It was a child who, in addition to the protruding intestinal sac, had no right arm. The child died. The hospital, founded on the banks of the Red River by Gray Nuns in 1771, annually delivers just over 3,000 babies and statistically, the September birth seemed like the bad penny De Pape might have expected. He could relax until the next one, perhaps in a year. But in October the second child was born with omphaloceles and severe left-side deformities. A little surprised, De Pape alerted Manitoba’s health department. He had been on a committee that helped set up a national reporting system following the thalidomide tragedy of the early ’60s, and he asked that group to check the congenital abnormalities register to see if other Canadian centres were reporting more cases. None were.

Then in January of this year the third of the malformed babies was born at St. Boniface, followed by a fourth in June. De Pape was disturbed, but worse was to come. “Between Aug. 28 and Sept. 15 this year we had three more cases, two of them within 24 hours of each other,” he says. “This hospital simply shouldn’t be seeing that many.”

All seven infants were stillborn or died within an hour. The mothers ranged in age from 14 to 32 and none were neighbors. One was from Dauphin, 250 km northwest of Winnipeg, one

from 50 km east and the other five were from different areas of the city. So far there is no evidence of neighboring hospitals suffering unusual numbers of omphaloceles births.

At St. Boniface, doctors are now intensively studying the seven rarities born there. Says Dr. Nigel Bruist: “We’ll be checking diet, lifestyle, family medical history and the use of prescription and nonprescription drugs. We will look at exposure to pesticides, pollutants, paints and many other things.” The investigators are particularly concerned with the first 10 weeks of pregnancy and will even ask where the child was conceived; whether the family home has insulation and, if so, what type; and what kind of pets, houseplants and liquor they favor. “If we don’t find a common factor it does not mean that there isn’t one. It would be statistically astounding for such a high number of cases to be reported in one hospital merely as a fluke of nature.”

Adds De Pape: “The phenomenon may just go away, but I don’t want it ever said that we didn’t act fast enough. Thalidomide began this way and if the signs had been picked up faster we might not have had 7,000 children born deformed.” —PETER CARLYLE-GORDGE