Prenatal Diagnosis of Congenital Heart Defects: Impact on 1-year Survival in the Metropolitan Atlanta Congenital Defects Program Cohort 公开

Kim, Christopher H. (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/bz60cw871?locale=zh
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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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