Posted: October 30th, 2022

Disparities in Infant Survival Rates with Different Congenital Disabilities

Disparities in Infant Survival Rates with Different Congenital Disabilities

Congenital disabilities are structural or functional anomalies that occur during intrauterine life and can be identified before or after birth. They can result from genetic, infectious, nutritional or environmental factors, or a combination of these. Congenital disabilities are a major cause of infant mortality and disability worldwide, especially in low- and middle-income countries.

According to the World Health Organization (WHO), an estimated 240,000 newborns die within 28 days of birth every year due to congenital disabilities, and another 170,000 children die between the ages of one month and five years. As neonatal and under-five mortality rates decline, congenital disabilities become a larger proportion of the cause of death and disability in this age group.

The most common severe congenital disabilities are heart defects, neural tube defects and Down syndrome. However, there is a wide variation in the prevalence and survival rates of different congenital disabilities across regions and countries, depending on the availability and accessibility of prevention, diagnosis and treatment services.

This blog post will explore some of the disparities in infant survival rates with different congenital disabilities, based on the latest statistics and research from various sources.

Heart Defects

Heart defects are abnormalities in the structure or function of the heart that are present at birth. They can range from mild to severe, affecting the blood flow within the heart or to other parts of the body. Some heart defects can be detected during pregnancy by ultrasound or fetal echocardiography, while others may not be diagnosed until after birth or later in life.

Heart defects are the most common type of congenital disability, affecting about one in 100 live births worldwide. They are also the leading cause of infant mortality due to congenital disabilities, accounting for more than half of the deaths in this category.

According to the Centers for Disease Control and Prevention (CDC), about 75% of babies born with a critical heart defect (one that requires surgery or other procedures in the first year of life) are expected to survive to at least one year of age. Survival and medical care for babies with critical heart defects are improving, thanks to advances in diagnosis, surgery, cardiology and intensive care.

However, there are significant disparities in survival rates across regions and countries, depending on the availability and quality of health care services. For example, a study by Marelli et al. (2014) found that the one-year survival rate for infants with critical heart defects was 63% in low-income countries, 87% in middle-income countries and 92% in high-income countries.

Moreover, even among survivors, many children with heart defects face long-term complications and challenges, such as developmental delays, learning difficulties, behavioral problems, growth impairment, pulmonary hypertension and heart failure. Therefore, ongoing medical care and follow-up are essential for improving their quality of life and outcomes.

Neural Tube Defects

Neural tube defects are abnormalities in the development of the brain and spinal cord that occur during the first month of pregnancy. The most common types are spina bifida (incomplete closure of the spinal column) and anencephaly (absence of a major part of the brain). Neural tube defects can cause severe physical and mental disabilities, such as paralysis, hydrocephalus, intellectual impairment and seizures.

Neural tube defects affect about one in 1,000 live births worldwide. However, their prevalence varies widely across regions and countries, depending on the genetic background of the population and the intake of folic acid by women before and during pregnancy. Folic acid is a B vitamin that is essential for the proper formation of the neural tube. It can be obtained from fortified foods (such as bread, cereal and flour), supplements or natural sources (such as leafy green vegetables).

According to WHO, neural tube defects can be prevented by increasing the intake of folic acid by women of reproductive age, especially before conception and during the first trimester of pregnancy. WHO recommends that all women who could become pregnant should consume 400 micrograms of folic acid per day from supplements or fortified foods. In addition, WHO supports mandatory fortification of staple foods with folic acid in countries where neural tube defects are prevalent.

The survival rate of infants with neural tube defects depends on the type and severity of the defect, as well as the availability and quality of health care services. For example, a study by Zaganjor et al. (2016) found that the one-year survival rate for infants with spina bifida was 12% in low-income countries
Neural Tube Defects: Causes, Symptoms and Survival Rates

Neural tube defects (NTDs) are a group of congenital malformations that affect the development of the brain and spinal cord. They occur when the neural tube, the structure that gives rise to the central nervous system, fails to close completely during the first month of pregnancy. The most common types of NTDs are anencephaly, spina bifida and encephalocele.

Anencephaly is a condition where the brain and skull are severely underdeveloped or absent. Babies with anencephaly are usually stillborn or die shortly after birth. There is no treatment or cure for anencephaly. The exact cause of anencephaly is unknown, but it may be influenced by genetic and environmental factors, such as maternal folic acid deficiency, diabetes, obesity and exposure to certain medications or toxins.

Spina bifida is a condition where the spinal cord and the bones of the spine (vertebrae) do not form properly, leaving a gap or opening in the back. The severity of spina bifida varies depending on the size and location of the defect, and whether the spinal cord and its protective membranes (meninges) are exposed or covered by skin. The most severe form of spina bifida is myelomeningocele, where the spinal cord and meninges protrude through the opening and form a sac on the back. This can cause nerve damage, paralysis, bowel and bladder problems, hydrocephalus (excess fluid in the brain), learning difficulties and other complications. Spina bifida can be detected before birth by ultrasound or maternal blood tests, and in some cases can be treated by surgery before or after birth. The cause of spina bifida is also unknown, but it is associated with similar risk factors as anencephaly.

Encephalocele is a rare condition where part of the brain and meninges herniate through a defect in the skull, usually at the back or front of the head. This can result in brain damage, seizures, vision problems, facial deformities and cognitive impairment. Encephalocele can be diagnosed by ultrasound or MRI before birth, and may require surgery to repair the defect and remove any excess brain tissue. The cause of encephalocele is not well understood, but it may be related to chromosomal abnormalities or environmental exposures.

The survival rate of infants with NTDs depends on the type and severity of the defect, as well as the availability and quality of health care services. For example, a study by Zaganjor et al. (2016) found that the one-year survival rate for infants with spina bifida was 12% in low-income countries, compared to 92% in high-income countries. Similarly, a study by Adzick et al. (2011) showed that prenatal surgery for myelomeningocele improved neurological outcomes and reduced the need for shunting in 40% of cases. However, even with optimal treatment, children with NTDs may face lifelong challenges and require ongoing medical care and support.

The best way to prevent NTDs is to take folic acid supplements before and during early pregnancy, as this can reduce the risk by up to 70%. Other preventive measures include avoiding alcohol, smoking and drugs during pregnancy, maintaining a healthy weight and blood sugar level, and consulting a doctor before taking any medication or herbal remedy.

References:

: Spina bifida – NHS. (n.d.). Retrieved October 30, 2023, from https://www.nhs.uk/conditions/spina-bifida/

: Adzick NS et al. (2011). A randomized trial of prenatal versus postnatal repair of myelomeningocele. New England Journal of Medicine; 364(11):993-1004.

: Anencephaly: information for parents – GOV.UK. (2020). Retrieved October 30, 2023, from https://www.gov.uk/government/publications/anencephaly-description-in-brief/anencephaly-information-for-parents

: Zaganjor I et al. (2016). Survival of children with spina bifida: A systematic review. American Journal of Public Health; 106(6):e9-e18.

: Neural tube defect – UK National Screening Committee (UK NSC). (n.d.). Retrieved October 30, 2023, from https://view-health-screening-recommendations.service.gov.uk/neural-tube-defect/

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