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Survival of infants with spina bifida: a population study, 1979-94
1National Center for Birth Defects and Developmental disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA. Lyw8@cdc.gov
Insights
Infant survival rates for spina bifida improved significantly between 1979 and 1994. Low birthweight and high spinal lesions were linked to increased mortality risk in children with spina bifida.
Area of Science:
- Pediatric Neurology
- Public Health Surveillance
- Clinical Epidemiology
Background:
- Spina bifida is a complex birth defect impacting infant survival.
- Understanding survival trends and risk factors is crucial for clinical management and family planning.
Purpose of the Study:
- To investigate survival rates of infants with spina bifida.
- To identify demographic and clinical factors influencing survival.
Main Methods:
- Utilized population-based data from the Metropolitan Atlanta Congenital Defects Program (MACDP).
- Employed Kaplan-Meier method for survival rate calculation.
- Applied log-rank test and Cox proportional hazards model for risk factor analysis.
Main Results:
- Overall survival for children with spina bifida was 78.4% during the study period.
- First-year survival improved across birth cohorts from 82.7% (1979-83) to 91.0% (1989-94).
- Increased mortality risk was associated with low birthweight (RR 2.3) and high spinal lesions (RR 3.4).
Conclusions:
- Survival rates for infants with spina bifida show continuous improvement.
- Demographic and clinical factors significantly impact long-term survival.
- Findings aid clinicians and families in planning long-term care for affected children.
Abstract:
This study aimed to investigate the survival of infants born with spina bifida between 1979 and 1994 from the population-based Metropolitan Atlanta Congenital Defects Program (MACDP) and to identify clinical and demographic factors associated with survival. Survival status was obtained from MACDP records and the National Death Index. Survival rates were calculated using the Kaplan-Meier method. Risk factors potentially associated with survival were examined by the log-rank test. We assessed the independent effect of risk factors using the Cox proportional hazards model. Overall, 78.4% of children with spina bifida survived during the study period. Of the 235 infants born with spina bifida, 87.2% survived the first year of life. Survival to age 1 for the 1979-83, 1984-88 and 1989-94 birth cohorts was 82.7%, 88.5% and 91.0% respectively. In multivariable analysis, factors associated with increased mortality were low birthweight (<2500 g) (vs. > or =2500g, relative risk (RR) 2.3 [95% CI 1.1, 4.9]) and high lesions (vs. low lesions, RR 3.4 [95% CI 1.6, 7.1]). This study suggests a continuous improvement in survival among children born with spina bifida in Atlanta. Demographic and clinical factors are associated with length of survival. This information is useful for both clinicians and families who need to plan for the long-term care of these children.