Temporal Trends in Survival Among Infants With Critical Congenital Heart Defects

• Type of Material: Article
• Authors: Matthew Oster, Emory University; Kyung A. Lee, Centers for Disease Control and Prevention; Margaret A. Honein, Centers for Disease Control and Prevention; Tiffany Riehle-Colarusso, Centers for Disease Control and Prevention; Mikyong Shin, Centers for Disease Control and Prevention; Adolfo Correa, Emory University
• Language: English
• Date: 2013-05-01
• Publisher: AMER ACAD PEDIATRICS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by the American Academy of Pediatrics.
• Final Published Version (URL): http://dx.doi.org/10.1542/peds.2012-3435
• Title of Journal or Parent Work: PEDIATRICS
• Volume: 131
• Issue: 5
• Start Page: E1502
• End Page: E1508
• Grant/Funding Information: No external funding.
• Keywords: congenital heart disease/defects; survival rate; PULSE OXIMETRY; PREVALENCE; neonatal; MORTALITY; screening; Science & Technology; FAILURE; SURGERY; Life Sciences & Biomedicine; TRANSPOSITION; epidemiology; pulse oximetry; DISEASE; Pediatrics; DIAGNOSIS; METROPOLITAN ATLANTA; NEWBORNS
• Research Categories: Biology, Anatomy; Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

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.