title: Length of life and treatment intensity in infants diagnosed prenatally or postnatally with congenital anomalies considered to be lethal.
abstract: OBJECTIVE
  The objectives of this study were (1) to compare age at death and the intensity and cost of medical treatment for infants diagnosed prenatally or postnatally with congenital anomalies considered to be lethal. (2) To determine whether greater treatment intensity is associated with longer life.
  
  
  METHODS
  This is a retrospective cohort study of all fetuses and neonates with congenital anomalies classified as lethal who were diagnosed or treated at the University of North Carolina Hospitals from January 1998 to December 2003.
  
  
  RESULTS
  The cohort consisted of 192 fetuses and infants: 160 were diagnosed prenatally, 2 were diagnosed perinatally, and 30 were diagnosed postnatally. In all, 115 (72%) pregnancies were terminated. Of the liveborn infants, 75% died before 10 days of age and 90% before 4 months of age. Compared with postnatally diagnosed infants, prenatally diagnosed infants received less intense treatment (median average daily Neonatal Therapeutic Intervention Scoring System score 8.3 versus 14.0; P=0.02), at less cost (median direct cost of hospitalization $1550 versus $8474; P=0.03) and died sooner (median age at death <1 day versus 4 days; P=0.01). Greater treatment intensity did not correlate with longer survival (r=-0.04; P=0.66).
  
  
  CONCLUSIONS
  Although some kinds of medical therapy may be appropriate for newborns with lethal congenital anomalies, highly aggressive interventions did not prolong survival and should not be offered. Even when pregnancy termination is not elected, infants diagnosed prenatally receive less intense care.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Courtwright
authors.forename: M M
authors.initials: MM
authors.lastname: Laughon
authors.forename: M W
authors.initials: MW
authors.lastname: Doron
mesh_terms: D000025:Abortion, Eugenic / Q000191:economics; D002585:Cesarean Section / Q000191:economics; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008136:Longevity; D008297:Male; D009657:North Carolina; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics; D011379:Prognosis; D012189:Retrospective Studies