Abstract 18716: Survival for Infants with Critical Congenital Heart Defects in Atlanta, Georgia, 1979-2005: Temporal Trends and Prognostic Factors
Introduction: Pulse oximetry screening for critical congenital heart defects (CCHD) was added to the Recommended Uniform Screening Panel for newborns in 2011. However, benchmark population-based data on trends in survival and prognostic factors for infants born with CCHD in the United States are limited.
Methods: We performed a retrospective cohort study of infants born with structural congenital heart defects (CHD) between 1979 and 2005 and ascertained by the Metropolitan Atlanta Congenital Defects Program. Infants with non-cardiac defects or chromosomal disorders were excluded. After determining survival through 2006 via linkage with state vital records and the National Death Index, we estimated Kaplan-Meier survival probabilities for 12 CCHD phenotypes (7 primary and 5 secondary targets of screening) by birth era and timing of diagnosis. We then used stratified Cox proportional hazards models to assess potential prognostic factors, including birth era, timing of diagnosis, maternal age, birth weight, race/ethnicity, sex, and socioeconomic status.
Results: One-year survival was 75.2% for those with CCHD (n=1336) vs. 97.1% for those with other CHD (n=3530; p<0.0001), with a survival to 18 years of age of 68.8% for those with CCHD vs. 95.4% for those with other CHD (p<0.0001). One-year survival for infants with CCHD improved from 67.4% for the 1979-1993 birth era to 82.5% for the 1994-2005 era (p<0.0001). One-year survival was 71.7% for infants with CCHD diagnosed at ≤1 day of age (n=890) vs. 82.5% for those diagnosed at >1 day of age (n=405; p<0.0001). There was a significantly higher risk of one-year mortality for infants with earlier birth era, earlier diagnosis, maternal age <30, and low birth weight (Table).
Conclusions: One-year survival for infants with CCHD has been improving over time, yet mortality remains high. These benchmark data and identified prognostic factors may aid future evaluations of the impact of pulse oximetry screening on survival from CCHD.
- © 2012 by American Heart Association, Inc.