UCL Great Ormond Street Institute of Child Health, London, UK.
UCL Centre for Longitudinal Studies, London, UK.
Paediatr Perinat Epidemiol. 2023 Jul;37(5):390-400. doi: 10.1111/ppe.12959. Epub 2023 Feb 6.
Children with congenital heart defects (CHD) are twice as likely as their peers to be born preterm (<37 weeks' gestation), yet descriptions of recent trends in long-term survival by gestational age at birth (GA) are lacking.
To quantify changes in survival to age 5 years of children in England with severe CHD by GA.
We estimated changes in survival to age five of children with severe CHD and all other children born in England between April 2004 and March 2016, overall and by GA-group using linked hospital and mortality records.
Of 5,953,598 livebirths, 5.7% (339,080 of 5,953,598) were born preterm, 0.35% (20,648 of 5,953,598) died before age five and 3.6 per 1000 (21,291 of 5,953,598) had severe CHD. Adjusting for GA, under-five mortality rates fell at a similar rate between 2004-2008 and 2012-2016 for children with severe CHD (adjusted hazard ratio [HR] 0.79, 95% CI 0.71, 0.88) and all other children (HR 0.78, 95% CI 0.76, 0.81). For children with severe CHD, overall survival to age five increased from 87.5% (95% CI 86.6, 88.4) in 2004-2008 to 89.6% (95% CI 88.9, 90.3) in 2012-2016. There was strong evidence for better survival in the ≥39-week group (90.2%, 95% CI 89.1, 91.2 to 93%, 95% CI 92.4, 93.9), weaker evidence at 24-31 and 37-38 weeks and no evidence at 32-36 weeks. We estimate that 51 deaths (95% CI 24, 77) per year in children with severe CHD were averted in 2012-2016 compared to what would have been the case had 2004-2008 mortality rates persisted.
Nine out of 10 children with severe CHD in 2012-2016 survived to age five. The small improvement in survival over the study period was driven by increased survival in term children. Most children with severe CHD are reaching school age and may require additional support by schools and healthcare services.
患有先天性心脏病（CHD）的儿童早产（<37 周妊娠）的可能性是同龄人的两倍，但缺乏按出生时胎龄（GA）描述最近严重 CHD 长期生存率的趋势。
通过 GA 量化英格兰严重 CHD 儿童 5 岁时生存率的变化。
我们使用链接的医院和死亡率记录，估计了 2004 年 4 月至 2016 年 3 月期间英格兰严重 CHD 儿童和所有其他儿童在 5 岁时的生存率变化。
在 5953598 例活产中，5.7%（339080/5953598）为早产儿，0.35%（20648/5953598）在 5 岁前死亡，3.6/1000（21291/5953598）患有严重 CHD。调整 GA 后，2004-2008 年和 2012-2016 年严重 CHD 儿童（调整后的危险比[HR]0.79，95%CI0.71，0.88）和所有其他儿童（HR0.78，95%CI0.76，0.81）的五岁以下死亡率以相似的速度下降。对于患有严重 CHD 的儿童，整体 5 岁生存率从 2004-2008 年的 87.5%（95%CI86.6，88.4）上升到 2012-2016 年的 89.6%（95%CI88.9，90.3）。≥39 周组有明显的生存优势（90.2%，95%CI91.1，92.3%至 93%，95%CI92.4，93.9%），24-31 周和 37-38 周有较弱的证据，32-36 周没有证据。我们估计，2012-2016 年每年有 51 例（95%CI24，77）严重 CHD 儿童死亡得以避免，而如果继续保持 2004-2008 年的死亡率，则会有这些死亡发生。
2012-2016 年，每 10 名严重 CHD 儿童中有 9 名存活至 5 岁。研究期间生存的微小改善是由足月儿童生存率的提高所驱动的。大多数患有严重 CHD 的儿童都已达到学龄，可能需要学校和医疗服务部门提供额外的支持。
