Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality

Wilkes, J. Kevin; Whitehead, William E.; Wang, Yunfei; Morris, Shaine A.

doi:10.1007/s00246-021-02576-3

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…In the present study, conditions such as anencephaly, omphalocele, meningomyelocele, congenital heart disease (CHD), and congenital hernia were significantly associated with increased odds of neonatal mortality, aligning with existing literature that identifies these conditions as significant risk factors for neonatal mortality [23][24][25][26][27]. These associations underscore the necessity of early detection and intervention, particularly for CHD and meningomyelocele, where appropriate prenatal and postnatal management could improve survival rates [27][28][29]. Our results suggest that healthcare policies should prioritize prenatal screening protocols to facilitate early diagnosis and management of these conditions.…”

Section: Discussionsupporting

confidence: 83%

Determinants of Neonatal Mortality in the United States

Akinyemi,

Fasokun,

Weldeslase

et al. 2023

Cureus

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Introduction Despite a notable reduction in infant mortality over recent decades, the United States, with a rate of 5.8 deaths per 1,000 live births, still ranks unfavorably compared to other developed countries. This improvement appears inadequate when contrasted with the country's healthcare spending, the highest among developed nations. A significant proportion of this infant mortality rate can be attributed to neonatal fatalities. Objective The present study aimed to determine the risk factors associated with neonatal deaths in the United States. Method Using the United States Vital Statistics records, we conducted a retrospective study on childbirths between 2015 and 2019 to identify risk factors for neonatal mortality. Our final multivariate analysis included maternal parameters like age, insurance type, education level, cesarean section rate, pregnancy inductions and augmentations, weight gain during pregnancy, birth weight, number of prenatal visits, pre-existing conditions like chronic hypertension and prediabetes, and pregnancy complications like gestational diabetes mellitus (GDM). These variables were incorporated to enhance our model's sensitivity and specificity. Result There were 51,174 neonatal mortalities. Mothers with augmentation of labor had a 25% reduction in neonatal mortalities (NM) (OR=0.75; 95% CI 0.72-0.79), while labor induction was associated with a 31% reduction in NM (OR=0.69; 95% CI 0.66-0.72). Women above 40 years had a 29% increase in NM rate (OR=1.29;95% CI 1.15-1.44). Women without prenatal care have a 22% increase in the risk of NM (OR=1.22; 95% CI 1.14-1.30). The present model has a 60.7% sensitivity and a 99.9% specificity. Conclusion In the present study, significant interventions such as labor induction, augmentation, and prenatal care were associated with improved neonatal outcomes. These findings could serve as an algorithm for improving neonatal outcomes in the United States.

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Section: Discussionsupporting

confidence: 83%

Determinants of Neonatal Mortality in the United States

Akinyemi,

Fasokun,

Weldeslase

et al. 2023

Cureus

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“…All institutions followed the same data collection process using a survey developed by the authors. Patients with unknown shunt status ( n = 8) and syndromal conditions that included spinal dysraphism (e.g., cloaca, cloacal exstrophy, imperforate anus, VATER syndrome, caudal regression, lipo/meningocele), genetic anomalies (e.g., trisomy 13/18, mitochondrial disorder) or cardiac anomalies (e.g., tetralogy of Fallot, severe pulmonary hypertension) were excluded [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study

Szymanski,

Adams,

Alkawaldeh

et al. 2023

PRM

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PURPOSE: This study aimed to analyze organ system-based causes and non-organ system-based mechanisms of death (COD, MOD) in people with myelomeningocele (MMC), comparing urological to other COD. METHODS: A retrospective review was performed of 16 institutions in Canada/United States of non-random convenience sample of people with MMC (born > = 1972) using non-parametric statistics. RESULTS: Of 293 deaths (89% shunted hydrocephalus), 12% occurred in infancy, 35% in childhood, and 53% in adulthood (documented COD: 74%). For 261 shunted individuals, leading COD were neurological (21%) and pulmonary (17%), and leading MOD were infections (34%, including shunt infections: 4%) and non-infectious shunt malfunctions (14%). For 32 unshunted individuals, leading COD were pulmonary (34%) and cardiovascular (13%), and leading MOD were infections (38%) and non-infectious pulmonary (16%). COD and MOD varied by shunt status and age (p < = 0.04), not ambulation or birthyear (p > = 0.16). Urology-related deaths (urosepsis, renal failure, hematuria, bladder perforation/cancer: 10%) were more likely in females (p = 0.01), independent of age, shunt, or ambulatory status (p > = 0.40). COD/MOD were independent of bladder augmentation (p = >0.11). Unexplained deaths while asleep (4%) were independent of age, shunt status, and epilepsy (p >= 0.47). CONCLUSION: COD varied by shunt status. Leading MOD were infectious. Urology-related deaths (10%) were independent of shunt status; 26% of COD were unknown. Life-long multidisciplinary care and accurate mortality documentation are needed.

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“…79 A detailed assessment of the entire fetus to identify any additional malformations should be performed. 108 Given that up to 5% of live births affected by spina bifida also have a congenital heart defect, 109 a fetal echocardiogram is recommended. 102,110,111 Diagnostic genetic testing by way of amniocentesis should be offered.…”

Section: Prenatal Screening and Diagnosismentioning

confidence: 99%

Advances in Fetal Surgical Repair of Open Spina Bifida

Chmait

Monson

Chon

2023

Obstetrics &Amp; Gynecology

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Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.

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Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality

Cited by 4 publications

References 13 publications

Determinants of Neonatal Mortality in the United States

Determinants of Neonatal Mortality in the United States

Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study

Advances in Fetal Surgical Repair of Open Spina Bifida

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