The Association of Prenatal Diagnoses with Mortality and Long-Term Morbidity in Children with Specific Isolated Congenital Anomalies: A European Register-Based Cohort Study

Autores de FISABIO

• 

  Clara Cavero Carbonell

  Autor

• Laura Garcia Villodre

  Autor

Autores ajenos a FISABIO

• Heino, A
• Morris, JK
• Garne, E
• Baldacci, S
• Barisic, I
• Given, J
• Jordan, S
• Loane, M
• Lutke, LR
• Neville, AJ
• Santoro, M
• Scanlon, I
• Tan, JC
• de Walle, HEK
• Kiuru-Kuhlefelt, S
• Gissler, M

Grupos de Investigación

• GRUPO 021. INVESTIGACIÓN EPIDEMIOLÓGICA DE LAS ENFERMEDADES RARAS Y DE LAS ANOMALÍAS CONGÉNITAS

  

  Investigador/a Principal

  Clara Cavero Carbonell

Abstract

Objectives To compare 5-year survival rate and morbidity in children with spina bifida, transposition of great arteries (TGA), congenital diaphragmatic hernia (CDH) or gastroschisis diagnosed prenatally with those diagnosed postnatally. Methods Population-based registers' data were linked to hospital and mortality databases. Results Children whose anomaly was diagnosed prenatally (n = 1088) had a lower mean gestational age than those diagnosed postnatally (n = 1698) ranging from 8 days for CDH to 4 days for TGA. Children with CDH had the highest infant mortality rate with a significant difference (p < 0.001) between those prenatally (359/1,000 births) and postnatally (116/1,000) diagnosed. For all four anomalies, the median length of hospital stay was significantly greater in children with a prenatal diagnosis than those postnatally diagnosed. Children with prenatally diagnosed spina bifida (79% vs 60%; p = 0.002) were more likely to have surgery in the first week of life, with an indication that this also occurred in children with CDH (79% vs 69%; p = 0.06). Conclusions Our findings do not show improved outcomes for prenatally diagnosed infants. For conditions where prenatal diagnoses were associated with greater mortality and morbidity, the findings might be attributed to increased detection of more severe anomalies. The increased mortality and morbidity in those diagnosed prenatally may be related to the lower mean gestational age (GA) at birth, leading to insufficient surfactant for respiratory effort. This is especially important for these four groups of children as they have to undergo anaesthesia and surgery shortly after birth. Appropriate prenatal counselling about the time and mode of delivery is needed.

Keywords

• Congenital diaphragmatic hernia; Gastroschisis; Prenatal diagnosis; Spina bifida; Transposition of great arteries