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Survival of infants with neural tube defects in Western Australia 1966-1990
Insights
Infant survival rates for neural tube defects (NTDs) improved over time, particularly for spina bifida, due to relaxed treatment criteria and better care. Anencephaly cases decreased, with most liveborn infants not surviving the first day.
Area of Science:
- Medical research
- Pediatrics
- Public health
Background:
- Neural tube defects (NTDs) are serious congenital anomalies.
- Survival rates for infants with NTDs have varied historically.
- Changes in medical treatment and pregnancy termination practices impact outcomes.
Purpose of the Study:
- To analyze trends in infant survival for anencephaly, spina bifida, and encephalocoele in Western Australia from 1966 to 1990.
- To compare survival rates across different birth cohorts defined by evolving treatment selection criteria.
- To identify factors contributing to changes in infant survival for NTDs.
Main Methods:
- Ascertainment of NTD cases from multiple sources in Western Australia.
- Separate examination of survival for anencephaly, spina bifida, and encephalocoele.
- Comparison of four birth cohorts (1966-1972, 1973-1979, 1980-1985, 1986-1990) reflecting changes in treatment selection.
Main Results:
- A decrease in liveborn and stillborn infants with anencephaly, with most liveborn infants dying within 24 hours.
- For encephalocoele, survival was poorest in the 1973-1979 cohort, though not statistically significant across cohorts.
- For spina bifida, survival improved significantly in later cohorts, with the poorest survival in 1973-1979.
- Increased pregnancy terminations for anencephaly and spina bifida over the study period.
Conclusions:
- Improved survival for infants with spina bifida is linked to relaxed treatment selection criteria and enhanced medical care.
- While pregnancy terminations for NTDs increased, survival improvements are primarily attributed to treatment advancements.
- Anencephaly remains a condition with extremely poor survival rates for liveborn infants.
Abstract:
To investigate the survival of infants with neural tube defects in Western Australia from 1966 to 1990, cases of neural tube defects were ascertained from multiple sources. Survival of infants with anencephaly, spina bifida, and encephalocoele was examined separately, and four birth cohorts were compared: 1966-1972 (when most surviving infants were actively treated), 1973-1979 (a period of stringent application of selection criteria for treatment), 1980-1985 (some relaxation of selection criteria), and 1986-1990 (further relaxation of selection criteria). There was an increase in terminations of pregnancies affected with anencephaly over the study period, and a fall in the proportion of both liveborn and stillborn infants with anencephaly. Most liveborn infants (76.4%) died in the first 24 hours, and none survived longer than 5 days. Most infants with encephalocoele (76.4%) were liveborn, and survival was poorest in the 1973-1979 cohort, although the difference in survival across cohorts just failed to attain a formal level of significance. For spina bifida, there was an increase in terminations of affected pregnancies over the study period. Survival of liveborn infants with spina bifida was poorest in the 1973-1979 cohort, and greatest in the most recent cohort. These improvements in survival are likely to be the result of relaxation of selection criteria for treatment, improvements in treatment and, to a lesser extent, selective termination of affected pregnancies.