title: Ten-year review of major birth defects in VLBW infants.
abstract: OBJECTIVE
  Birth defects (BDs) are an important cause of infant mortality and disproportionately occur among low birth weight infants. We determined the prevalence of BDs in a cohort of very low birth weight (VLBW) infants cared for at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers over a 10-year period and examined the relationship between anomalies, neonatal outcomes, and surgical care.
  
  
  METHODS
  Infant and maternal data were collected prospectively for infants weighing 401 to 1500 g at NRN sites between January 1, 1998, and December 31, 2007. Poisson regression models were used to compare risk of outcomes for infants with versus without BDs while adjusting for gestational age and other characteristics.
  
  
  RESULTS
  A BD was present in 1776 (4.8%) of the 37 262 infants in our VLBW cohort. Yearly prevalence of BDs increased from 4.0% of infants born in 1998 to 5.6% in 2007, P < .001. Mean gestational age overall was 28 weeks, and mean birth weight was 1007 g. Infants with BDs were more mature but more likely to be small for gestational age compared with infants without BDs. Chromosomal and cardiovascular anomalies were most frequent with each occurring in 20% of affected infants. Mortality was higher among infants with BDs (49% vs 18%; adjusted relative risk: 3.66 [95% confidence interval: 3.41-3.92]; P < .001) and varied by diagnosis. Among those surviving >3 days, more infants with BDs underwent major surgery (48% vs 13%, P < .001).
  
  
  CONCLUSIONS
  Prevalence of BDs increased during the 10 years studied. BDs remain an important cause of neonatal morbidity and mortality among VLBW infants.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, GA, USA. iadamsc@emory.edu
authors.forename: Ira
authors.initials: I
authors.lastname: Adams-Chapman
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Nansi S
authors.initials: NS
authors.lastname: Boghossian
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Murray
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.forename: M Bethany
authors.initials: MB
authors.lastname: Ball
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
mesh_terms: D000328:Adult; D001724:Birth Weight; D002423:Cause of Death; D002869:Chromosome Aberrations; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D008297:Male; D008423:Maternal Age; D054582:National Institute of Child Health and Human Development (U.S.); D016012:Poisson Distribution; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: Neonatal Research Network; birth defects; low birth weight; prematurity