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Published on: July 18, 2014
Temporal trends in survival among infants with critical congenital heart defects
Matthew E Oster1, Kyung A Lee, Margaret A Honein
1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. osterm@kidsheart.com
Insights
Survival for infants with critical congenital heart defects (CCHDs) is improving, but still high. Later diagnosis is linked to better one-year survival, offering insights for screening strategies.
Area of Science:
- Pediatric Cardiology
- Public Health
- Neonatal Medicine
Background:
- Critical congenital heart defects (CCHDs) represent a significant cause of infant mortality.
- Understanding survival trends and prognostic factors is crucial for improving outcomes.
Purpose of the Study:
- To evaluate survival trends in infants with CCHDs.
- To examine the impact of diagnosis timing and other factors on CCHD survival.
Main Methods:
- Retrospective population-based cohort study of infants born between 1979-2005.
- Kaplan-Meier survival analysis and Cox proportional hazards models were used.
- Data from the Metropolitan Atlanta Congenital Defects Program were analyzed.
Main Results:
- One-year survival for CCHDs improved from 67.4% (1979-1993) to 82.5% (1994-2005).
- Later diagnosis (>1 day of age) was associated with improved one-year survival (82.5% vs 71.7%).
- Earlier birth era, earlier diagnosis, low birth weight, and maternal age <30 years were linked to higher mortality risk.
Conclusions:
- One-year survival for infants with CCHDs has improved but remains a concern.
- Delayed diagnosis correlates with better short-term survival, warranting further investigation.
- Identified prognostic factors can inform future evaluations, including pulse oximetry screening effectiveness.
Objective:
To evaluate the trends in survival for infants with critical congenital heart defects (CCHDs) and to examine the potential impact of timing of diagnosis and other prognostic factors on survival.
Methods:
We performed a retrospective population-based cohort study in infants born with structural congenital heart defects (CHDs) between 1979 and 2005 and ascertained by the Metropolitan Atlanta Congenital Defects Program. We estimated Kaplan-Meier survival probabilities for 12 CCHD phenotypes by birth era and timing of diagnosis among infants without noncardiac defects or chromosomal disorders and used stratified Cox proportional hazards models to assess potential prognostic factors.
Results:
Of 1 056 541 births, there were 6965 infants with CHDs (1830 with CCHDs). One-year survival was 75.2% for those with CCHDs (n = 1336) vs 97.1% for those with noncritical CHDs (n = 3530; P < .001). One-year survival for infants with CCHDs improved from 67.4% for the 1979-1993 birth era to 82.5% for the 1994-2005 era (P < .001). One-year survival was 71.7% for infants with CCHDs diagnosed at ≤1 day of age (n = 890) vs 82.5% for those with CCHDs diagnosed at >1 day of age (n = 405; P < .001). There was a significantly higher risk of 1-year mortality for infants with an earlier birth era, earlier diagnosis, and low birth weight and whose mothers were <30 years old.
Conclusions:
One-year survival for infants with CCHDs has been improving over time, yet mortality remains high. Later diagnosis is associated with improved 1-year survival. These benchmark data and identified prognostic factors may aid future evaluations of the impact of pulse oximetry screening on survival from CCHDs.
