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Determinants of survival in children with congenital abnormalities: a long-term population-based cohort study
Mohammad M Agha1, Jack I Williams, Loraine Marrett
1Pediatric Oncology Group of Ontario, Toronto, Canada. mohammad@ices.on.ca
Insights
Children with birth defects face significantly higher long-term mortality risks. Other birth characteristics, like low gestational age and birth weight, independently increase this risk, aiding in identifying high-risk infants.
Area of Science:
- Pediatric Health
- Birth Defects Research
- Long-term Mortality Studies
Background:
- Improved medical care has increased survival for children with birth defects.
- Long-term mortality patterns and survival rates for this population remain understudied.
- The influence of non-defect birth characteristics on mortality is unclear.
Purpose of the Study:
- To investigate long-term mortality and survival patterns in children with birth defects.
- To compare mortality risks between children with and without birth defects.
- To examine the impact of additional birth characteristics on mortality risk.
Main Methods:
- Followed two large cohorts (over 45,000 each) of children with and without birth defects for up to 17 years.
- Compared long-term survival rates and mortality risk between the cohorts.
- Analyzed birth characteristics to assess their effect on mortality risk.
Main Results:
- Children with birth defects had a 13-fold higher mortality rate (RR 12.9).
- Elevated mortality persisted for 10-15 years post-birth.
- Low gestational age, low birth weight, and the number of defects independently increased mortality risk.
Conclusions:
- Children with birth defects face substantially higher mortality risks throughout life.
- Beyond birth defects, other birth characteristics independently influence mortality.
- Identifying these characteristics can help pinpoint high-risk children for targeted interventions.
Background:
Today more children with birth defects survive early childhood because of improved medical care; however, little information is available about patterns of long-term mortality and survival in this population. In particular, it is not clear whether other birth characteristics, apart from birth defects, have any role in their mortality.
Methods:
Two large cohorts of children with and without birth defects were followed for up to 17 years. More than 45,000 children with birth defects, and 45,000 matched children without birth defects born in Ontario between 1979 and 1986 were followed. Throughout the study period long-term survival rates and the risk of death were compared between the 2 cohorts. Birth characteristics were also examined to determine their effect on the risk of death.
Results:
During the study the deaths of 3620 and 301 children with and without birth defects, respectively, were recorded, indicating that those with birth defects had a 13 times higher rate of mortality (relative risk [RR], 12.9, 95% confidence interval [CI], 12.1-13.7). Mortality rates in the birth-defects cohort remained higher even after 10-15 years. In both groups children of low gestational age and low birth weight had a higher risk of death. There was a strong dose-response relationship between the number of defects and the risk of death.
Conclusions:
Children born with abnormalities face many challenges throughout their lifetimes. If they survive the high mortality risk of the first year of life, they still have to face the considerably higher risk of death in the years to come. In addition to birth defects, other birth characteristics play an independent role in their mortality. These indicators could be used to identify high-risk children.
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