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Death in infancy from unrecognised congenital heart disease
1Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne.
Insights
Many infants with congenital heart disease (CHD) die undiagnosed. Early identification of these treatable conditions, even in those who die, is crucial for improving infant mortality rates and understanding CHD.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Congenital heart disease (CHD) is a significant cause of infant mortality.
- Accurate diagnosis and understanding the full spectrum of CHD are essential for effective management.
- Previous studies may have underestimated the incidence of CHD due to undiagnosed cases, particularly in infants who died.
Purpose of the Study:
- To identify all cases of congenital heart disease in infancy, including those diagnosed posthumously.
- To assess the 'treatability' of congenital heart disease in infants who died before diagnosis.
- To provide a more accurate epidemiological picture of congenital heart disease spectrum.
Main Methods:
- A retrospective study was conducted in a single health region from 1985-1990.
- All births, infant deaths, and surviving infants with CHD were identified.
- Diagnosed CHD cases were classified as 'complex', 'significant', or 'minor'.
Main Results:
- A total of 1074 infants were diagnosed with CHD during infancy.
- 185 infants died, with 56 (30%) of these deaths occurring before a CHD diagnosis.
- Of the 56 undiagnosed deaths, 29 had severe non-cardiac malformations, while 27 were otherwise normal, with complex or significant cardiovascular abnormalities.
Conclusions:
- A substantial proportion of infant deaths attributed to congenital heart disease may be undiagnosed.
- Identifying these previously unrecognized cases improves the epidemiological evaluation of CHD.
- Earlier recognition of treatable congenital heart disease abnormalities holds the potential to reduce infant mortality.
Abstract:
This study was undertaken to identify all congenital heart disease in infancy, including deaths before diagnosis, to provide a truer picture of the spectrum of congenital heart disease and to assess the 'treatability' of those dying before diagnosis. All births, infant deaths, and surviving babies with congenital heart disease in one health region in 1985-90 were identified and were classified as 'complex', 'significant', or 'minor'. Of the 1074 infants diagnosed in infancy, 185 died and 56 of these (30%) died undiagnosed. Severe non-cardiac malformations were present in 29 of the 56 while 27 were otherwise normal. Cardiovascular abnormalities in the latter group were complex in 13/27 and significant in 14/27. Identification of undiagnosed cardiovascular anomalies will improve epidemiological evaluation of congenital heart disease and, more importantly, earlier recognition of treatable abnormalities may reduce mortality.