The Association of Prenatal Diagnoses with Mortality and Long‑TermMorbidity in Children with Specific Isolated Congenital Anomalies:A European Register‑Based Cohort Study

Objectives To compare 5-year survival rate and morbidity in children with spina bifida, transposition of great arteries (TGA),congenital diaphragmatic hernia (CDH) or gastroschisis diagnosed prenatally with those diagnosed postnatally.Methods Population-based registers’ data were linked to hospital and mortality databases.Results Children whose anomaly was diagnosed prenatally (n = 1088) had a lower mean gestational age than those diagnosedpostnatally (n = 1698) ranging from 8 days for CDH to 4 days for TGA. Children with CDH had the highest infant mortal-ity rate with a significant difference (p < 0.001) between those prenatally (359/1,000 births) and postnatally (116/1,000)diagnosed. For all four anomalies, the median length of hospital stay was significantly greater in children with a prenataldiagnosis than those postnatally diagnosed. Children with prenatally diagnosed spina bifida (79% vs 60%; p = 0.002) weremore likely to have surgery in the first week of life, with an indication that this also occurred in children with CDH (79%vs 69%; p = 0.06).Conclusions Our findings do not show improved outcomes for prenatally diagnosed infants. For conditions where prenataldiagnoses were associated with greater mortality and morbidity, the findings might be attributed to increased detection ofmore severe anomalies. The increased mortality and morbidity in those diagnosed prenatally may be related to the lower meangestational age (GA) at birth, leading to insufficient surfactant for respiratory effort. This is especially important for thesefour groups of children as they have to undergo anaesthesia and surgery shortly after birth. Appropriate prenatal counsellingabout the time and mode of delivery is needed.