Abstract
ABSTRACT
Prenatal Diagnosis of Congenital Heart Defects: Impact on
1-year Survival in the Metropolitan Atlanta Congenital Defects
Program Cohort
By Christopher H. Kim
Background: Prenatal diagnosis has been shown to
improve short-term morbidity in newborns with congenital heart
defects (CHDs), but there are conflicting data as to the impact on
1-year survival.
Methods: We performed a population-based, retrospective
cohort study of infants with prenatally vs. postnatally diagnosed
CHDs between 1994 and 2005 as ascertained by the Metropolitan
Atlanta Congenital Defects Program. Among infants with isolated
CHDs, we estimated Kaplan-Meier survival probabilities for
prenatally vs. postnatally diagnosed infants and determined Cox
proportional hazard ratios adjusted for critical CHD status,
gestational age, and maternal race/ethnicity.
Results: Of 539,519 live births, 4,366 infants had CHDs
(411 prenatally diagnosed). Compared to those with non-critical
defects, those with critical defects were more likely to be
prenatally diagnosed (57.9% vs. 19.4%, p<0.001). Among the 3,065
infants with isolated CHDs, 1-year survival was 77.1% for those
prenatally diagnosed (n=201) vs. 96.1% for those postnatally
diagnosed (n=2,864) (p<0.001). Comparing 1-year survival among
those with non-critical CHDs alone (n=2,379) showed no difference
between prenatal and postnatal diagnosis (98.0% vs. 98.4%, p=0.80)
whereas among those with critical CHDs (n=686), prenatally
diagnosed infants had significantly lower survival (70.4% vs.
86.0%, p<0.001). After adjustment, the hazard ratio for
mortality between those with prenatally vs. postnatally diagnosed
CHDs was 2.564 (95% CI: 1.78, 3.70).
Conclusion: Prenatal diagnosis is associated with lower
1-year survival for infants with isolated critical CHDs but shows
no change for those with isolated non-critical CHDs. Varying
disease severity within critical CHD subtypes for prenatal vs.
postnatal diagnosis might explain this association.
Table of Contents
TABLE OF CONTENTS
Manuscript 1
Introduction 1
Methods 2
Results 4
Discussion 5
Conclusion 10
References 11
Tables 17
Figures 20
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