Survival for babies born with a birth defect: a “postal code lottery”

According to scientists in 74 countries, survival for a baby born with a congenital defect (also known as a congenital anomaly) is a “postal code lottery.”

A study published today in The Lancet, led by researchers at King’s College London, examined the risk of mortality by about 4,000 babies is born with birth defects in 264 hospitals worldwide. The study found babies born with birth-related birth defects intestinal tract they have two out of five chances of dying in a low-income country compared to one in five in a middle-income country and one in twenty in a high-income country.

Gastroschisis, a birth defect in which the baby is born with the intestines protruding through a hole in the navel, has the largest difference in mortality, with 90% of infants dying in low-income countries compared to 1% in high-income countries. In high-income countries, most of these babies will be able to live a full life without a disability.

The lead researcher, Dr Naomi Wright, is a pediatric surgery registrar at King’s College London who has spent the last four years studying these disparities in outcomes. She said: “Geography should not determine outcomes for babies who have correctable surgical conditions. The goal of sustainable development will end preventable deaths in infants and children under 5 years of age by 2030 ‘is unattainable without urgent action to improve surgical care for low babies and middle-income countries. “

Andrew Leather, co-author and director of King’s College for Global Health and Health Partnerships at King’s College London, said: “We need to focus on improving surgical care for newborns in middle- and low-income countries. The last 25 years, although there has been great success in reducing deaths in children under 5 years of age through the prevention and treatment of infectious diseases, there has been little focus on improving surgical care for infants and children. and, in fact, the proportion of deaths related to surgical diseases continues to rise.

“Birth defects are now the fifth leading cause of death in children under 5 worldwide, most deaths occur in the newborn period. Birth defects affecting the intestinal tract have a particularly high mortality in low- and middle-income countries they are not compatible with life without emergency surgical care after birth. “

In high-income countries, most women receive a prenatal ultrasound to assess for birth defects. If identified, this allows the woman to give birth in a hospital with pediatric surgical care so that the baby can receive help as soon as it is born. In low- and middle-income countries, babies with these conditions often arrive late at the pediatric surgical center in poor clinical condition. The study shows that babies who present at the already septic pediatric surgical center with infection are more likely to die.

The co-author Mr. Niyi Ade-Ajayi, a pediatric surgeon at King’s College Hospital and co-chair of the International Affairs Committee of the British Association of Pediatric Surgeons, added: “The study highlights the importance of perioperative care (care received). on both sides of the operation or corrective procedure) in the pediatric surgical center.Babies treated in hospitals without access to intravenous ventilation and nutrition when needed were more likely to die.In addition, not having qualified anesthetic support and not using a list of surgical safety control at the time of the operation was associated with a higher probability of death. “

The research team found that improving the survival of these conditions in low- and middle-income countries involves three key elements:

1) improve prenatal diagnosis and childbirth in a hospital with pediatric surgical care,

2) improve surgical care for infants born in district hospitals, with a safe and fast transfer to the children’s surgical center,

3) improvement of perioperative care for infants in the pediatric surgical center.

They recognize that this requires strong teamwork and planning between midwifery and obstetrics teams, infant and pediatric teams, and children’s surgical surgical teams at the children’s surgical center, along with outreach education and networking with referral hospitals.

They also urge that, along with local initiatives, surgical care be taken for babies and children it must be integrated into national and international child health policy and must no longer be left out of global child health.