title: Neonatal Hospital Course and Outcomes of Live-born Infants with Trisomy 18 at Two Tertiary Care Centers in the United States.
abstract: ObjectivesTrisomy 18 is presumed to be a lethal chromosomal abnormality; medical management of infants with this aneuploidy is controversial. Our objective was to describe our approach and experience with trisomy 18 infants.Study DesignWe reviewed the initial hospital course, management, and factors predicting discharge from the hospital from two large tertiary care neonatal intensive care units in the southern United States over 26 years.ResultsOf the 29 infants with trisomy 18, 21 (72%) died in the hospital and 8 (28%) were discharged home. 19 (66%) infants received mechanical ventilation and 10 (34%) received inotropic medications. Eight infants had critical congenital heart defects; only one survived to discharge. Three infants underwent major surgeries; one cardiac surgery, one tracheoesophageal fistula repair, and one myelomeningocele repair. Median length of hospital stay was 14 days (range, 0-78) for all the infants and 31 days (range, 18-66) for those that were discharged home. Factors associated with discharge from the hospital were female sex, higher gestational age, and absence of critical congenital heart defects. Median survival time was 13 days and was significantly longer for females compared with males. Our 1-month and 1-year survival rates were 31% and 3.9% respectively.ConclusionA significant proportion of infants with trisomy 18 were discharged home. These data are helpful in counseling parents of infants with trisomy 18.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee.
authors.forename: Narendra R
authors.initials: NR
authors.lastname: Dereddy
authors.affiliation: Division of Clinical Genetics, Department of Pediatrics, Department of Ophthalmology, University of Tennessee Health Sciences Center, Memphis, Tennessee.
authors.forename: Eniko K
authors.initials: EK
authors.lastname: Pivnick
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee.
authors.forename: Kirtikumar
authors.initials: K
authors.lastname: Upadhyay
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee.
authors.forename: Ramasubbareddy
authors.initials: R
authors.lastname: Dhanireddy
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Talati
mesh_terms: D001724:Birth Weight; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000209:etiology; D006801:Humans; D007223:Infant; D066088:Infant Death; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D050498:Live Birth; D008297:Male; D010351:Patient Discharge; D066087:Perinatal Death; D012121:Respiration, Artificial; D012737:Sex Factors; D015996:Survival Rate; D062606:Tertiary Care Centers; D000073842:Trisomy 18 Syndrome / Q000150:complications / Q000628:therapy*; D014481:United States
chemical_list: D002316:Cardiotonic Agents