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Survival of infants with spina bifida--Atlanta, 1972-1979
Insights
Survival rates for infants with spina bifida varied significantly based on clinical factors. Early diagnosis and treatment of associated conditions like hydrocephalus improved outcomes for this spina bifida cohort.
Area of Science:
- Pediatric Neurology
- Birth Defects Research
- Public Health Epidemiology
Background:
- Spina bifida is a complex birth defect impacting infant survival.
- Understanding survival trends and influencing factors is crucial for clinical management and public health initiatives.
Purpose of the Study:
- To analyze the survival experience of a population-based cohort of 154 infants with spina bifida born between 1972-1979.
- To identify clinical characteristics associated with survival differences within this cohort.
Main Methods:
- Population-based cohort study design.
- Univariate analyses to assess survival based on clinical variables.
- Data collected on birth year, birth weight, defect status (open/closed), defect level, multiple defects, and hydrocephalus.
Main Results:
- Overall, 57% of infants survived one year or more.
- Significant survival differences were observed based on year of birth (later years better), defect status (closed defects better survival), defect level (lower defects better survival), birth weight, multiple defects, and hydrocephalus presence at birth.
- Infants born in the late 1970s demonstrated improved survival compared to those born in the early 1970s.
Conclusions:
- Overall survival rates for spina bifida can mask critical subgroup variations.
- Clinical factors such as defect type, location, presence of hydrocephalus, and birth weight significantly influence infant survival.
- Comparisons with other cohorts require careful consideration of referral biases and differing clinical characteristic distributions.
Abstract:
We studied the survival of a population-based cohort of 154 infants with spina bifida who were born during the eight-year period from 1972 through 1979 to residents of Atlanta. Our objectives were to describe the cohort's survival experience and to explore relationships between clinical characteristics and survival. Overall, 57% of the cohort survived one year or more. This figure is misleading, however, because it conceals important differences in survival among subgroups of affected infants. From univariate analyses, we observed significant differences in survival among infants categorized by year of birth, birth weight, the open-closed status of the defect, the highest level of the defect on the spine, the presence of multiple major birth defects, and the presence of hydrocephalus at birth. More infants born in the late 1970s survived their first year of life than infants born in the early 1970s; infants with open defects had lower survival than those with closed defects; and infants whose defects were low on the spine had better survival than those whose defects were higher. When comparing the survival experience of this cohort with that of other groups from other areas or from more recent years, health workers must consider referral biases and differences in the distribution of clinical characteristics.