Association of birth defects during the perinatal period with child mortality under 5 years

TL;DR

Children born with birth defects have significantly higher mortality rates under 5 years of age, especially in the first 28 days.

Contribution

This study quantifies the association between perinatally diagnosed birth defects and child mortality in Hunan Province using a large-scale cohort analysis.

Findings

Children with birth defects had an 11.6 times higher mortality risk compared to those without defects.

Congenital anomalies were the leading cause of death among children with birth defects.

Mortality risks were particularly elevated for muscular, chromosomal, genetic, and nervous system abnormalities.

Abstract

To calculate the impact of birth defects (BDs) diagnosed during the perinatal period on the mortality of children under 5 years of age.

This was a retrospective cohort analysis. From the monitoring system, we collected all hospital delivery, BD monitoring, and death information for children under 5 years in Hunan Province from 2017–2022. These data were linked by ID number. Mortality rates and Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the impact of BDs on mortality in children under 5 years of age.

Among 3,807,340 live-born children, 29,879 (0.8%) had at least one type of BDs during the perinatal period, with a total of 12,215,033 person-years of follow-up. The mortality rate of the BDs group was 14.5% (95% CI: 13.7–15.3) per 1,000 person-years, which was 11.6 times (HR = 11.6, 95% CI: 10.5–12.8) greater than that of the nondefect group. The mortality rate per 1,000 person-years of girls with BDs was higher than that of boys (15.4% vs. 13.5%). For the BDs group, congenital anomalies (CAs) were the most common cause of death (57.2%). Compared with children without BDs, those with BDs had elevated mortality risks for CAs (HR, 58.1; 95% CI, 42.7–79.0), digestive (HR = 16.5, 95% CI: 6.1–45.0) and respiratory system malformations (HR, 11.9; 95% CI, 7.9–17.8), and cancer (HR = 11.1 95% CI: 4.7–26.2).

This study revealed that BDs were strongly associated with mortality under 5 years of age, especially in the first 28 days, for muscular, chromosomal, genetic, and nervous system abnormalities.

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