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Objective To evaluate the respiratory outcome in children with congenital heart disease (CHD), considering recent management procedures and the CHD pathophysiology. Design and Setting Clinical and functional respiratory outcome were evaluated in 8-year-old children with isolated CHD followed up from birth in the prospective population-based EPICARD cohort. Patients Children were assigned to two groups, based on the pathophysiology of the CHD: CHDs with left-to-right shunt (n = 212) and CHDs with right outflow tract obstruction (n = 113). Results Current wheezing episodes were observed in 15% of the children with isolated CHD and left-to-right shunt, and 11% of the children with isolated CHD and right outflow tract obstruction (not significant). Total lung capacity (TLC) was the only respiratory function parameter that significantly differed between the two groups. It was lower in children with left-to-right shunt (88.72 ± 0.65% predicted) than in those with right outflow tract obstruction (91.84 ± 0.96, p = 0.006). In multivariate analysis, CHD with left-to-right shunt (coeff. [95% CI]: -3.17 [-5.45; -0.89]) and surgery before the age of 2 months (-6.52 [-10.90; -2.15]) were identified as independent factors associated with significantly lower TLC values. Conclusion Lower TLC remains a long-term complication in CHD, particularly in cases with left-to-right shunt and in patients requiring early repair. These findings suggest that an increase in pulmonary blood flow may directly impair lung development.

To assess overall and malformation-specific trends in the prevalence and prenatal diagnosis of congenital anomalies in the Parisian population.The Paris Registry of Congenital Malformations is population-based and since 1981 has registered all cases with structural birth defects or chromosomal anomalies in the Parisian population. The total and livebirth prevalence and the proportion of cases with prenatal diagnosis were calculated for all anomalies and 20 malformations selected based on their higher frequency and their impact on health outcomes.The overall prevalence was 3.30% (95% CI 3.27-3.33), and the livebirth prevalence 2.42% (95% CI 2.39-2.45). The proportion of cases diagnosed prenatally increased from 16.5% (95% CI 14.1-19.1) in 1983 to 70.7% (95% CI 68.3-73.1) in 2007. Terminations of pregnancy for fetal anomaly (TOPFA) increased from 8.8% (95% CI 7.0-10.8) in 1983 to 35.6% (95% CI 33.1-38.1) in 2007. These results varied substantially for the 20 congenital anomalies studied.We found an increase in the overall prevalence of all anomalies, especially for chromosomal abnormalities. The observed increase is at least to a large extent due to trends in delayed childbearing and an increase in both pre- and postnatal diagnosis of congenital anomalies in our population.

In all industrialized countries, injuries constitute the primary public health problem during adolescence; study of long-term outcome of injuries to adolescents remains poor.A longitudinal epidemiological study performed on 8,140 students in 17 secondary schools in Paris and the Department of the Côte-d'Or followed the development over one year of 777 adolescents who had injuries in 1990. All injuries, both within and outside school, were included if they fulfilled the following criteria: school absence or excused from vocational training exceeding or equal to 2 days, or excused from physical education classes for at least 14 days.One year after the injury, 13% of the adolescents were still bothered by their injury, especially those who were older and the girls. Among described impairments, musculo-skeletal problems (88% of cases) were the major difficulty. These impairments were primarily in the lower limbs (53%). Unaesthetic scars were found in 17% of cases, and a psychological impact was found in 16.5% of the adolescents. The presence of sequelae was related to the type of initial lesion (present in 24% of head injuries and in 16% of cases affecting the lower limbs). The most serious difficulties were caused by dislocations, serious sprains and fractures. One year after the injury, sequelae were serious in 10% of those adolescents still experiencing problems; they had some impact on the daily life of the adolescents in 36% of cases, that is, 5% of all adolescents experiencing an injury. These sequelae were responsible for a high level of consumption of medical services.Although observed sequelae were relatively minor, the high frequency of injuries during adolescence, as well as their high economic costs, justify the most appropriate care available for victims of injuries, even those which appear benign. In addition, longitudinal studies should be prepared using adapted tools (scales for the evaluation of the gravity of injury sequelae).