Survival of infants with spina bifida: a population study, 1979-94

This study aimed to investigate the survival of infants born with spina bif ida between 1979 and 1994 from the population-based Metropolitan Atlanta Co ngenital Defects Program (MACDP) and to identify clinical and demographic f actors associated with survival. Survival status was obtained from MACDP re cords and the National Death Index. Survival rates were calculated using th e Kaplan-Meier method. Risk factors potentially associated with survival we re examined by the log-rank test. We assessed the independent effect of ris k factors using the Cox proportional hazards model. Overall, 78.4% of child ren with spina bifida survived during the study period. Of the 235 infants born with spina bifida, 87.2% survived the first year of life. Survival to age 1 for the 1979-83, 1984-88 and 1989-94 birth cohorts was 82.7%, 88.5% a nd 91.0% respectively. In multivariable analysis, factors associated with i ncreased mortality were low birthweight (<2500g) (vs. <greater than or equa l to>2500g, relative risk (RR) 2.3 [95% CI 1.1, 4.9]) and high lesions (vs. low lesions, RR 3.4 [95% CI 1.6, 7.1]). This study suggests a continuous i mprovement in survival among children born with spina bifida in Atlanta. De mographic and clinical factors are associated with length of survival. Thus information is useful for both clinicians and families who need to plan fo r the long-term care of these children.