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a Department of
Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne NE7
7DN, UK, b Neonatal Unit, Sunderland
Royal Hospital, Sunderland, UK, c Department of Epidemiology and Public Health,
University of Newcastle upon Tyne, UK
Correspondence to: Dr Wren email: Christopher.Wren{at}tfh.nuth.northy.nhs.uk
Accepted 6 January
2000
OBJECTIVE
To investigate changes over
time in the prevalence at live birth of cardiovascular malformations
and to compare "anatomical" and "physiological" diagnostic
hierarchies within a population.
DESIGNRetrospective and prospective
ascertainment of all congenital cardiovascular malformations diagnosed
in infancy.
SETTINGThe resident population of
one health region.
PATIENTSAll infants live born from
1985 to 1997 with cardiovascular malformations confirmed by
echocardiography, cardiac catheterisation, surgery or autopsy.
MAIN OUTCOME MEASURESYear to year
variation in prevalence of individual malformations and of
"complex", "significant", and "minor" groups.
RESULTS2671 babies with
cardiovascular malformations were confirmed in a denominator population
of 477 960 live births (5.6 per 1000). There was no change over 13 years in the birth prevalence of "complex" or "significant"
defects, but a highly significant increase in "minor" defects
(p < 0.0001), mainly small ventricular septal defects. Termination
of pregnancy increased from no cases in 1985 to 16 in 1997 with no
demonstrable effect on live born babies with heart defects. A one
dimensional "anatomical" diagnostic hierarchy led to under
ascertainment of pulmonary atresia by 27%, coarctation of the aorta by
39%, and interruption of the aorta by 100%.
CONCLUSIONSThe apparent increase in
live born cardiovascular malformations results mainly from improved
diagnosis of minor defects. There has been no change over time in birth
prevalence of more serious defects. Spontaneous year to year variation
in numbers will make it difficult to ascribe any short term changes to
any particular intervention. A two dimensional diagnostic hierarchy is
offered as a standard.
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