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Published on: May 5, 2018
Mortality in infants with cardiovascular malformations
Christopher Wren1, Claire A Irving, Josephine Amanda Griffiths
1Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK. christopher.wren@nuth.nhs.uk
Insights
Cardiovascular malformations cause significant infant mortality. While deaths decreased due to increased pregnancy terminations and better surgical outcomes, many infant deaths are still linked to these conditions or their treatments.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Cardiovascular malformations (CVMs) are a leading cause of infant mortality and the primary cause of death from congenital malformations.
- Understanding mortality trends and contributing factors is crucial for improving infant survival rates.
Purpose of the Study:
- To analyze and categorize infant deaths related to cardiovascular malformations.
- To examine mortality trends over time and identify factors influencing these outcomes.
Main Methods:
- Data on infant deaths and CVMs were collected from a single health region between 1987 and 2006.
- Deaths were categorized by cause, including cardiac and non-cardiac factors, and the presence of chromosomal, genetic, or other malformations.
- Pregnancy termination rates and surgical outcomes were also analyzed.
Main Results:
- Out of 676,927 live births, 4,437 infants had CVMs, with a 10.3% mortality rate before one year of age.
- Non-cardiac causes accounted for 33% of deaths, while cardiac causes (with or without surgery) accounted for 67%.
- Pregnancy terminations for CVMs increased significantly over the study period, and 10% of infants undergoing cardiac surgery died before one year.
Conclusions:
- Cardiovascular malformations contribute to 10.4% of all infant deaths, with two-thirds of these deaths linked to the malformation itself or its treatment.
- Mortality rates have declined, attributed to increased pregnancy terminations and improved post-operative survival rates.
Unlabelled:
Cardiovascular malformations are an important cause of infant death and the major cause of death due to malformation. Our aims were to analyse and categorise all deaths in infants with cardiovascular malformations, and to analyse trends in mortality over time and influences on mortality. We obtained details of infant deaths and cardiovascular malformations from the population of one health region for 1987-2006. We categorised deaths by cause and by presence of additional chromosomal or genetic abnormalities or non-cardiac malformations. In 676,927 live births the total infant mortality was 4,402 (6.5 per 1,000). A total of 4,437 infants had cardiovascular malformations (6.6 per 1000) of whom 458 (10.3%) died before 1 year of age. Of this number, 151 (33%) deaths had non-cardiac causes, 128 (28%) were cardiac without surgery and 179 (39%) occurred from cardiac causes after surgery. Death was unrelated to the cardiovascular malformation in 57% of infants with an additional chromosomal or genetic abnormality, in 76% of infants with a major non-cardiac malformation and in 16% of infants with an isolated cardiovascular malformation. Terminations of pregnancies affected by cardiovascular malformations increased from 20 per 100,000 registered births in the first 5 years to 78 per 100,000 in the last 5 years. A total of 2,067 infants (47%) underwent surgery and of these 216 (10%) died before 1 year of age.
Conclusions:
A total of 10.4% of infants who died had a cardiovascular malformation and two-thirds of deaths were due to the malformation or its treatment. Mortality declined due to increasing termination of pregnancy and improved survival after operation.
