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Published on: July 18, 2014
Epidemiology and Outcome of Major Congenital Malformations in a Large German County
Boris Wittekindt1, Rolf Schloesser1, Nora Doberschuetz1
1Department of Neonatology, Universitätsklinikum Frankfurt, Frankfurt, Hesse, Germany.
Insights
Major congenital malformations in neonates, including duodenal stenosis/atresia and gastroschisis, show outcomes comparable to prior studies. However, treatment at high-volume centers may reduce hospital stay length for these surgical conditions.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital malformations
Background:
- Congenital malformations significantly impact neonatal morbidity and mortality.
- Limited data exist on care and outcomes for neonates with surgical malformations.
- This study examines five key neonatal surgical conditions: duodenal stenosis/atresia (DA), gastroschisis (GA), omphalocele (OM), congenital diaphragmatic herniation (CDH), and esophageal atresia (EA).
Purpose of the Study:
- To analyze the epidemiology and clinical outcomes of five major congenital malformations requiring neonatal surgery.
- To identify risk factors associated with mortality and prolonged hospital stays in affected neonates.
- To investigate the relationship between treatment center volume and patient outcomes.
Main Methods:
- Retrospective review of the Hessian neonatal registry (2010-2015).
- Inclusion of 283 neonates diagnosed with DA, GA, OM, CDH, or EA using ICD-10 codes.
- Application of multiple regression analyses to determine mortality and length of stay predictors.
Main Results:
- Incidence and mortality rates varied by condition: DA (1.79/10k, 3.6%), GA (1.79/10k, 1.8%), OM (1.60/10k, 24%), CDH (1.32/10k, 27.5%), EA (2.67/10k, 11.1%).
- Thirty-three percent of neonates were not treated in a surgical perinatal center.
- Risk factors for mortality included trisomy 13/18, heart defects, prematurity, OM, and CDH. Predictors for length of stay were gestational age, additional malformations, and treatment at high-volume centers.
Conclusions:
- Epidemiology and outcomes for major congenital malformations in Hesse, Germany, align with existing literature.
- A significant volume-outcome association was observed, particularly concerning the length of hospital stay.
- Findings highlight the importance of specialized care in high-volume centers for improving neonatal surgical outcomes.
Introduction:
Congenital malformations are associated with substantial neonatal morbidity and mortality. Furthermore, only sparse data are available on the modalities of care provided to and the associated clinical outcomes in affected neonates. In this study, we focused on five malformations that require surgery during the neonatal period: duodenal stenosis and atresia (DA), gastroschisis (GA), omphalocele (OM), congenital diaphragmatic herniation (CDH), and esophageal atresia (EA).
Materials And Methods:
We reviewed the Hessian neonatal registry (2010-2015) to identify records including the ICD-10 (International Classification of Diseases, Tenth Edition) codes for the aforementioned diagnoses and identified 283 patients who were affected by at least one of these conditions. Multiple regression analyses were performed to further identify risk factors for mortality and extended length of hospital stay.
Results:
The incidence rates per 10,000 live births and inhospital mortality rates were as follows: DA: 1.79 and 3.6%; GA: 1.79 and 1.8%; OM: 1.60 and 24%; CDH: 1.32 and 27.5%; and EA: 2.67 and 11.1%, respectively. Thirty-three percent of the patients had not been born in a perinatal center in which corrective surgeries were performed. The following risk factors were significantly associated with early mortality: trisomy 13 and 18, congenital heart defects, prematurity, and high-risk malformations (OM and CDH). The predictors of length of stay were as follows: gestational age, number of additional malformations, and treatment in the center with the highest patient volume.
Conclusion:
Epidemiology and outcome of major congenital malformations in Hesse, Germany, are comparable to previously published data. In addition, our data revealed a volume-outcome association with regard to the length of hospital stay.
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