Congenital anomalies: an increasingly important cause of mortality and workload in a neonatal intensive care unit.

With improvement in perinatal management and advances in neonatal intensive care, congenital anomalies have emerged as a major cause of neonatal mortality and morbidity. A 1 year review (1985) of all the admissions to our neonatal intensive care unit (NICU) showed that 78 of 790 (10%) had one or more congenital anomalies. Of these, 26% died in the NICU; another 10% died during the first year; therefore the total mortality of infants with congenital anomalies in the first year of life was 36%. Even though they accounted for only 10% of the total admissions, the infants with congenital anomalies were responsible for 13% of the total NICU patient-days, 26% of the total NICU mortality, 32% of all deaths within the first year, and 35% of all NICU infants with intrauterine growth retardation (IUGR). Of interest, 67% of the infants with anomalies were suspected or diagnosed prenatally. Of these, 54% were delivered by cesarean section, done for fetal reasons in the majority of cases. The highest mortality was associated with (1) multiple abnormal prenatal ultrasound findings; (2) extreme prematurity (less than 30 weeks gestation); and (3) the presence of IUGR. These findings raise concerns about the use of resources in the management of the pregnancy and the delivery of infants with congenital anomalies, particularly when diagnosed prenatally.