title: Perspectives on the care and management of infants with trisomy 18 and trisomy 13:  striving for balance.
abstract: OBJECTIVE
  At the time of diagnosis of the trisomy 18 and trisomy 13, parents and care providers face difficult and challenging decisions regarding management. Because of the increased infant mortality and developmental outcome associated with both conditions, the conventional approach to management has been to withhold technological support. In recent years, an active dialogue on this topic has emerged. The purpose of this review is to summarize the literature on the outcome of infants with trisomy 18 and 13 and to discuss the key themes in this emerging dialogue.
  
  
  RESULTS
  In recent years, several important studies have appeared that have analyzed the issues relevant to this topic, including parental autonomy, best interest of the child standard, and quality of life. Some authorities state that in areas of ambiguity it is best to defer to parents' views, whereas others indicate concern that the best interest standard has given way to parental autonomy. Information on the actual experience of parents of children with trisomy 18 and 13 has been limited until recently.
  
  
  CONCLUSIONS
  The author recommends a balanced approach to counseling families of the newborn with trisomy 18 and 13 at the time of diagnosis. The counseling process should include presentation of accurate survival figures, avoidance of language that assumes outcome, communication of developmental outcome that does not presuppose perception of quality of life, and respect for the family's choice, whether it be comfort care or intervention.
authors.affiliation: Division of Medical Genetics, Department of Pediatrics, University of Utah Health Sciences Center, Utah 84108, USA. john.carey@hsc.utah.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Carey
mesh_terms: D000015:Abnormalities, Multiple / Q000628:therapy*; D001294:Attitude to Health; D025063:Chromosome Disorders / Q000628:therapy*; D002882:Chromosomes, Human, Pair 13; D002887:Chromosomes, Human, Pair 18; D017281:Cost of Illness; D003376:Counseling / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010290:Parents / Q000523:psychology*; D014314:Trisomy; D000073839:Trisomy 13 Syndrome