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Background: Preterm birth and young maternal age are known risk factors for infant and childhood mortality. There is limited knowledge of the impact of these risk factors in children born with major congenital anomalies (CAs), who have inherently higher risks of death compared with other children. Objectives: To investigate the risk factors for mortality up to age 10 years in children born with specific major CAs. Methods: This population-based cohort study involved 150,198 livebirths from 1995 to 2014 in 13 European CA registries linked to mortality data. Cox proportional hazards models estimated the association of gestational age, maternal age and child's sex with death <1 year and 1-9 years for the whole cohort and by CA subgroup. Hazard ratios (HR) from each registry were pooled using multivariate meta-analysis. Results: Preterm birth had a dose-response association with mortality; compared with infants born at 37+ weeks gestation, those born at <28, 28-31 and 32-36 weeks had 14.88 (95% CI 12.57, 17.62), 8.39 (95% CI 7.16, 9.85) and 3.88 (95% CI 3.40, 4.43) times higher risk of death <1 year, respectively. The corresponding risks at 1-9 years were 4.99 (95% CI 2.94, 8.48), 3.09 (95% CI 2.28, 4.18) and 2.04 (95% CI 1.69, 2.46) times higher, respectively. Maternal age <20 years (versus 20-34 years) was a risk factor for death <1 year (HR 1.30, 95% CI 1.09, 1.54) and 1-9 years (HR 1.58, 95% CI 1.19, 2.10). Females had 1.22 (95% CI 1.07, 1.39) times higher risk of death between 1 and 9 years than males. Conclusion: Preterm birth was associated with considerably higher infant and childhood mortality in children with CAs, comparable to estimates reported elsewhere for the background population. Additional risk factors included young maternal age and female sex. Information on risk factors could benefit clinical care and guide counselling of parents following CA diagnoses. [ABSTRACT FROM AUTHOR]

Background: Congenital anomalies are a major cause of perinatal, neonatal and infant mortality. Objectives: The aim was to investigate temporal changes and geographical variation in survival of children with major congenital anomalies (CA) in different European areas. Methods: In this population‐based linkage cohort study, 17 CA registries members of EUROCAT, the European network for the surveillance of CAs, successfully linked data on 115,219 live births with CAs to mortality records. Registries estimated Kaplan–Meier survival at 28 days and 5 years of age and fitted Cox's proportional hazards models comparing mortality at 1 year and 1–9 years of age for children born during 2005–2014 with those born during 1995–2004. The hazard ratios (HR) from each registry were combined centrally using a random‐effects model. The 5‐year survival conditional on having survived to 28 days of age was calculated. Results: The overall risk of death by 1 year of age for children born with any major CA in 2005–2014 decreased compared to 1995–2004 (HR 0.68, 95% confidence interval [CI] 0.53, 0.89). Survival at 5 years of age ranged between registries from 97.6% to 87.0%. The lowest survival was observed for the registry of OMNI‐Net (Ukraine) (87.0%, 95% CI 86.1, 87.9). Conclusions: Survival of children with CAs improved for births in 2005–2014 compared with 1995–2004. The use of CA registry data linked to mortality data enables investigation of survival of children with CAs. Factors such as defining major CAs, proportion of terminations of pregnancy for foetal anomaly, source of mortality data and linkage methods are important to consider in the design of future studies and in the interpretation of the results on survival of children with CAs. [ABSTRACT FROM AUTHOR]

Background: Public health organisations use public health indicators to guide health policy. Joint analysis of multiple public health indicators can provide a more comprehensive understanding of what they are intended to evaluate.Objective: To analyse variaitons in the prevalence of congenital anomaly-related perinatal mortality attributable to termination of pregnancy for foetal anomaly (TOPFA) and prenatal diagnosis of congenital anomaly prevalence.Methods: We included 55 363 cases of congenital anomalies notified to 18 EUROCAT registers in 10 countries during 2008-12. Incidence rate ratios (IRR) representing the risk of congenital anomaly-related perinatal mortality according to TOPFA and prenatal diagnosis prevalence were estimated using multilevel Poisson regression with country as a random effect. Between-country variation in congenital anomaly-related perinatal mortality was measured using random effects and compared between the null and adjusted models to estimate the percentage of variation in congenital anomaly-related perinatal mortality accounted for by TOPFA and prenatal diagnosis.Results: The risk of congenital anomaly-related perinatal mortality decreased as TOPFA and prenatal diagnosis prevalence increased (IRR 0.79, 95% confidence interval [CI] 0.72, 0.86; and IRR 0.88, 95% CI 0.79, 0.97). Modelling TOPFA and prenatal diagnosis together, the association between congenital anomaly-related perinatal mortality and TOPFA prevalence became stronger (RR 0.70, 95% CI 0.61, 0.81). The prevalence of TOPFA and prenatal diagnosis accounted for 75.5% and 37.7% of the between-country variation in perinatal mortality, respectively.Conclusion: We demonstrated an approach for analysing inter-linked public health indicators. In this example, as TOPFA and prenatal diagnosis of congenital anomaly prevalence decreased, the risk of congenital anomaly-related perinatal mortality increased. Much of the between-country variation in congenital anomaly-related perinatal mortality was accounted for by TOPFA, with a smaller proportion accounted for by prenatal diagnosis. [ABSTRACT FROM AUTHOR]

Background: The impact of socio-economic status (SES) on congenital heart disease (CHD)-related mortality in children is not well established.Objectives: We aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD.Data Sources: Seven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched.Study Selection and Data Extraction: We included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area-based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate.Synthesis: Meta-analyses were performed to estimate pooled ORs for in-hospital mortality according to health insurance status.Results: Of 1388 identified articles, 28 met the inclusion criteria. Increased area-based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post-discharge (n = 1), infant (n = 1), and long-term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long-term mortality (n = 1). A meta-analysis of four US articles showed increased unadjusted odds of in-hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area-based income and CHD-related mortality was conflicting, with three of eight articles reporting significant associations.Conclusion: This systematic review provides evidence that children of lower SES are at increased risk of CHD-related mortality. As these children are over-represented in the CHD population, interventions targeting socio-economic inequalities could have a large impact on improving CHD survival. [ABSTRACT FROM AUTHOR]

Glinianaia SV, Rankin J, Pearce MS, Parker L, Pless-Mulloli T. Stillbirth and infant mortality in singletons by cause of death, birthweight, gestational age and birthweight-for-gestation, Newcastle upon Tyne 1961–2000. Paediatric and Perinatal Epidemiology 2010. The dramatic reduction observed in stillbirth and infant mortality over the last few decades has not been assessed by both birthweight and gestation. We have explored temporal changes in stillbirth and infant mortality in Newcastle upon Tyne, UK, by cause of death, birthweight, gestational age, birthweight standardised for gestation and infant sex during 1961–2000. We included 131 044 singleton births to mothers resident in Newcastle, including 1342 stillbirths and 1620 infant deaths. Cause-, birthweight-, gestational age- and birthweight-for-gestation-specific stillbirth (per 1000 total births) and infant mortality (per 1000 livebirths) rates were compared between 1961–80 and 1981–2000 and between individual consecutive decades. Between 1961 and 2000, total stillbirth and infant mortality rates declined dramatically from 23.4 to 4.7 per 1000 total births and from 25.7 to 5.9 per 1000 livebirths, respectively. Rates fell continuously during the first two study decades; however, from 1981–90 to 1991–2000 the decline was not statistically significant. Between 1961–80 and 1981–2000, both stillbirth and infant mortality significantly declined in all birthweight and gestational age categories and for most leading causes of death. Although the population mean birthweight during 1981–2000 [3304 g (SD ± 569)] was significantly higher than during 1961–80 [3255 g (SD ± 572)] ( P < 0.0001), the lowest stillbirth and infant mortality rates in 1981–2000 were consistently at about 1 SD above the mean birthweight, with mortality rates increasing for babies with lower or higher weight-for-gestation. Declines in stillbirth and infant mortality in Newcastle were associated with reductions in birthweight- and gestational age-specific mortality rates and occurred in most cause-specific groups of death. [ABSTRACT FROM AUTHOR]

Congenital heart disease (CHD) is the most prevalent group of congenital anomalies. There is considerable variation in the reported epidemiology of CHD, mainly attributable to methodological differences. Using register-based data, the current study describes the epidemiology of CHD in a geographically well-defined population of the North of England during 1985–2003. The total prevalence of CHD was 85.9 per 10 000 births and terminations of pregnancy for fetal anomaly. Livebirth prevalence was 79.7 per 10 000 livebirths. Both total and livebirth prevalence increased during the study period. Ninety-two per cent of affected pregnancies resulted in a livebirth, 5% were terminated, 2% resulted in a stillbirth, and 1% in a late miscarriage. Almost a quarter (23%) of cases had one or more coincident anomalies of other organs, with chromosomal abnormalities the most frequent group. A total of 89.2% of cases survived to 1 year and the survival improved during the study period. This population-based study has demonstrated an increasing trend in both prevalence and survival among children with CHD. [ABSTRACT FROM AUTHOR]

This study reports changes in the prevalence and outcome of Down's syndrome pregnancies within a 15-year period in a defined geographical population in the north of England. Cases of Down's syndrome in births and terminations of pregnancy occurring between 1985 and 1999, were identified from the Northern Congenital Abnormality Survey. The total prevalence for the 15 years was 15.2 per 10 000 births and terminations of pregnancy [95% CI 14.2, 16.2]. Total prevalence showed an upward trend over time, due largely to increasing maternal age. Sixty-seven per cent of cases resulted in live births, and the overall live birth prevalence was 10.3 per 10 000 live births [95% CI 9.4, 11.1]. The proportion of cases resulting in termination of pregnancy rose from 15% in 1985-89 to 38% in 1995-99; the rate of increase was greater in women aged < 35 years. Forty-five per cent of live born infants had an additional anomaly recorded. Survival at 1 year was 78% for those with an additional anomaly recorded, and 96% for those without. There was a non-significant trend towards improved survival in all infants with Down's syndrome, from 87% in 1985-94 to 92% in 1995-99. Despite increasing termination of Down's syndrome pregnancies resulting from the greater availability of antenatal screening and diagnosis, there has been no significant reduction in live birth prevalence. These infants have high rates of co-existing structural anomalies and are at high risk of death in the first year of life. There is a continuing need to address the reasons for poor survival for Down's syndrome infants, and to plan for their complex health and social care needs. These findings are useful for parents deciding on prenatal screening, as well as for clinicians and health service managers. [ABSTRACT FROM AUTHOR]

Using data from the Northern Congenital Abnormality Survey, we describe trends in the prevalence of neural tube defects (NTDs), maternal age-specific prevalence, outcome of pregnancy and the sensitivity of antenatal diagnosis of NTD-affected pregnancies in the Northern Region during 1984-96. This population-based sample consisted of 934 NTDs: there were 403 (43.1%) with anencephaly, 472 (50.5%) with spina bifida and 59 (6.3%) with encephalocele. The total prevalence at birth was 17.9 per 10,000 births and terminations (95% confidence interval [CI] = 16.7, 19.0) with a significant reduction over time (chi(2) for trend = 7.2; P = 0.007). The overall birth prevalence was 5.6 per 10,000 births [95% CI = 5.0, 6.3]; there was also a significant reduction in birth prevalence with time (chi(2) for trend = 68.3; P < 0.0001). Maternal age-specific prevalence rates decreased with increasing age. The proportion of NTD pregnancies terminated increased from 60.3% (325 cases) during 1984-90 to 78.6% (293 cases) during 1991-96, whereas the proportion of livebirths declined from 31.7% (171 cases) to 15.0% (56 cases) (P < 0.001). The sensitivity of antenatal diagnosis was consistently high for anencephaly (98%) and increased significantly for spina bifida from 60% during 1984-90 to 85% during 1991-96 (P < 0.05). Ascertainment of all cases of NTD in the Northern Region revealed a twofold reduction in birth prevalence between 1984-90 and 1991-96. This has resulted from improvements in the accuracy of antenatal detection of NTD-affected pregnancies with an increase in terminations of pregnancy. [ABSTRACT FROM AUTHOR]

The article presents author's comments on the rate of tobacco smoking in several countries. It mentions that smoking in men decreased to 46 percent. It focuses on the association between maternal smoking in pregnancy and adverse outcomes including miscarriage, fetal growth restriction and preterm births. It focuses on the impact of exposure to second-hand smoke (SHS), exhaled smoke and the smoke from the lit end of the cigarette.

Perinatal mortality has long been used as a comparative measure of health and health care across regions, countries and over time. Recently, the validity of the measure has been questioned. Using data from a population-based survey of late fetal losses, stillbirths and infant deaths, the Northern Perinatal Mortality Survey, we demonstrate the potential for inaccuracy of crude measures of perinatal mortality. Such measures are generally not adjusted for characteristics of the population (e.g. birthweight, maternal age, plurality, gender) which are known to affect risk of adverse pregnancy outcome when comparing temporal or geographical trends. We also show the effect of standardising for these factors on the most frequent causes of perinatal death. We recommend the construction of a‘standard birth population’ for calculating standardised perinatal mortality rates that would improve direct comparisons between populations. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Children born with major congenital anomalies (CAs) have lower academic achievement compared with their peers, but the existing evidence is restricted to a number of specific CAs.To investigate academic outcomes at ages 11 and 16 in children with major isolated structural CAs and children with Down or Turner syndromes.This population‐based cohort study linked data on approximately 11,000 school‐aged children born with major CAs in 1994–2004 registered by four regional CA registries in England with education data from the National Pupil Database (NPD). The comparison group was a random sample of children without major CAs from the background population recorded in the NPD that were frequency matched (5:1) to children with CAs by birth year, sex and geographical area.Overall, 71.9%, 73.0% and 80.9% of children with isolated structural CAs achieved the expected attainment level at age 11 compared to 78.3%, 80.6% and 86.7% of the comparison group in English language, Mathematics and Science, respectively. Children with nervous system CAs as a whole had the lowest proportion who achieved the expected attainment at age 11. At age 16, 46.9% of children with CAs achieved the expected level compared to 52.5% of their peers. Major CAs were associated with being up to 9% (95% confidence interval [CI] 8%, 11%) and 12% (95% CI 9%, 14%) less likely to achieve expected levels at ages 11 and 16, respectively, after adjustment for socioeconomic deprivation.Although many children with isolated CAs achieved the expected academic level at ages 11 and 16, they were at higher risk of underachievement compared to their peers. These stark yet cautiously encouraging results are important for counselling parents of children with specific CAs and also highlight the possible need for special education support to reduce potential academic difficulties. [ABSTRACT FROM AUTHOR]