Mortality and morbidity of VLBW infants with trisomy 13 or trisomy 18.
OBJECTIVE
Little is known about how very low birth weight (VLBW) affects survival and morbidities among infants with trisomy 13 (T13) or trisomy 18 (T18). We examined the care plans for VLBW infants with T13 or T18 and compared their risks of mortality and neonatal morbidities with VLBW infants with trisomy 21 and VLBW infants without birth defects.


METHODS
Infants with birth weight 401 to 1500 g born or cared for at a participating center of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network during the period 1994-2009 were studied. Poisson regression models were used to examine risk of death and neonatal morbidities among infants with T13 or T18.


RESULTS
Of 52,262 VLBW infants, 38 (0.07%) had T13 and 128 (0.24%) had T18. Intensity of care in the delivery room varied depending on whether the trisomy was diagnosed before or after birth. The plan for subsequent care for the majority of the infants was to withdraw care or to provide comfort care. Eleven percent of infants with T13 and 9% of infants with T18 survived to hospital discharge. Survivors with T13 or T18 had significantly increased risk of patent ductus arteriosus and respiratory distress syndrome compared with infants without birth defects. No infant with T13 or T18 developed necrotizing enterocolitis.


CONCLUSIONS
In this cohort of liveborn VLBW infants with T13 or T18, the timing of trisomy diagnosis affected the plan for care, survival was poor, and death usually occurred early.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland;
Nansi S
NS
Boghossian
Nellie I
NI
Hansen
Edward F
EF
Bell
Barbara J
BJ
Stoll
Jeffrey C
JC
Murray
John C
JC
Carey
Ira
I
Adams-Chapman
Seetha
S
Shankaran
Michele C
MC
Walsh
Abbot R
AR
Laptook
Roger G
RG
Faix
Nancy S
NS
Newman
Ellen C
EC
Hale
Abhik
A
Das
Leslie D
LD
Wilson
Angelita M
AM
Hensman
Cathy
C
Grisby
Monica V
MV
Collins
Diana M
DM
Vasil
Joanne
J
Finkle
Deanna
D
Maffett
M Bethany
MB
Ball
Conra B
CB
Lacy
Rebecca
R
Bara
Rosemary D
RD
Higgins
D025063:Chromosome Disorders / Q000150:complications* / Q000401:mortality*; D002882:Chromosomes, Human, Pair 13; D002887:Chromosomes, Human, Pair 18; D004314:Down Syndrome / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D014314:Trisomy; D000073839:Trisomy 13 Syndrome; D000073842:Trisomy 18 Syndrome
preterm infants; trisomy 13; trisomy 18; trisomy 21; very low birth weight