Elsevier

The Journal of Pediatrics

Volume 139, Issue 3, September 2001, Pages 366-373
The Journal of Pediatrics

Original Articles
Major birth defects in very low birth weight infants in the Vermont Oxford Network

https://doi.org/10.1067/mpd.2001.117072Get rights and content

Abstract

Objective: To study the frequency and types of major birth defects in very low birth weight (VLBW) infants and their impact on mortality and resource use. Study design: Analysis of data from the Vermont Oxford Network Database from 1994 and 1995 on infants with birth weights of 501 to 1500 g. Major birth defects were reported from a list of 40 defined major defects or if they were considered lethal or life-threatening. Mortality and length of stay were determined. Results: Major birth defects were present in 823 (4.3%) of 19,228 VLBW infants from 147 hospitals. The most common categories were chromosomal anomalies (20%); named syndromes, sequences, and associations (19%); and gastrointestinal (14%), cardiovascular (11%), and nervous system (10%) anomalies. Infants with major birth defects had a higher mortality rate (58% vs 13%, P < .001) and a higher rate of major surgery (29% vs 5%, P < .001) than infants without such defects. Infants with major birth defects accounted for 16.3% of deaths and 18.9% of major surgical procedures but only for 2.9% of total hospital days. Conclusions: Major birth defects accounted for 16% of all deaths in VLBW infants. However, they accounted for a low proportion of total hospital days. (J Pediatr 2001;139:366-73)

Section snippets

Methods

The VON comprises voluntary member neonatal intensive care units (NICUs), primarily from North America, and maintains a database on VLBW infants.3, 4 The member units submit data on all live-born infants with a birth weight of 501 to 1500 g (irrespective of gestational age), born in their hospital (inborn infants) or transported there before 28 days' postnatal age (outborn infants).

Major birth defects are defined as those that appear in a predefined list included in the Vermont Oxford Netwwork

Results

Data were reported from 147 NICUs for 19,254 infants born in 1994 and 1995. The median number of infants reported from each hospital was 107, with an interquartile range of 54 to 186. We analyzed data from the 19,228 (99.9%) infants for whom data on birth defects were available. Major birth defects were reported in 823 (4.3%).

Table I describes the general demographic characteristics of all the infants and compares infants with and without birth defects; the data for the variables were available

Discussion

In this study we have described the frequency, types, and impact of major birth defects in a large sample of live-born VLBW infants treated in NICUs in the VON. We found that 4.3% of live-born VLBW infants had major birth defects as defined in the VON Database. In population-based studies of infants of all birth weights, approximately 3% to 4% of infants were given a diagnosis of a major birth defect in the first year of life.8, 9 In other studies of infants with birth weights <1500 g,

Acknowledgements

We are grateful to Alan Guttmacher, MD, for his review of the defects chosen for reporting and the classification we used in this article.

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  • Cited by (15)

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    Reprint requests: Gautham K. Suresh, MD, Department of Pediatrics, University of Vermont College of Medicine, A121 Given Building, Burlington, VT 05405.

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