Determining the amount, timing and causes of mortality among infants with Down syndrome

Abstract

Objective To examine the amount, timing and causes/correlates of infant mortality among newborns with Down syndrome. Methods Using the Tennessee Department of Health Birth, Hospital Discharge and Death records, infants were identified who were born with Down syndrome from 1990 to 2006. Those who died during the first year were separated into three groups (first day death, neonatal mortality, postneonatal mortality) and data from the Birth and Death records were used to compare the three death groups and the survival group on correlates of mortality. Results Of 1305 infants born in Tennessee with Down syndrome from 1990 to 2006, 97 died within the first year, for a mortality rate of 74 per 1000. Most Down syndrome infant deaths occurred during the post-neonatal period (56%), although many occurred during the first day (27%). Newborns who died during the first day had significantly lower birthweight, 5-min Apgar scores and gestational lengths, whereas those who died in the post-neonatal period had significantly more heart-related causes of death (all Ps < 0.001).No associations were found in this sample between increased infant mortality and maternal age, education, race, marital status or familial urban residence.Conclusions Infants with Down syndrome experience high rates of mortality occurring at three distinct times during the first year. These groupings are tied to specific, different causes of death.

Survival among people with Down syndrome: a nationwide population-based study in Denmark

“…Previous studies reported that persons with DS had a mortality of 5-11 times that of the general population, 9,11,20,21 and our estimates support this. Many previous studies lacked information on mortality early in life, as our study does for those born before 1968.…”

“…Cytogenetic studies reported as trisomy G in the 1960s and 1970s (before the routine use of banded karyotyping that permitted distinguishing the two G-group chromosomes) were accepted as trisomy 21. Persons who were studied with fluorescence in situ hybridization only were not included.…”

Respiratory Syncytial Virus Prophylaxis in Down Syndrome: A Prospective Cohort Study

“…[1][2][3][4][5][6][7][8] The combined attributes of a compromised innate and adaptive immune system in early infancy [9][10][11][12][13] with anatomic [14][15][16] and physiologic aberrations such as gastroesophageal reflux disease, 17 obstructive sleep apnea, 18 and hemodynamically significant heart disease 4,19 all lead to significant morbidity and mortality in DS during the first 2 years of life. [20][21][22] Palivizumab, a humanized monoclonal antibody, has been proven safe and efficacious against RSV in randomized, placebo-controlled studies involving preterm infants #35 weeks' gestational age during their first RSV season and children aged ,2 years with severe chronic lung disease (CLD) and hemodynamically significant cardiac disease. 23,24 The Canadian Paediatric Society recommends prophylaxis for children with DS only if they are likely to be exposed to RSV during their first season and are on home oxygen or have experienced prolonged hospitalization for pulmonary disease or are severely immunocompromised.…”

Trends in Survival Among Children With Down Syndrome in 10 Regions of the United States

“…Goldman et al found age variations in the contribution by specific factors to mortality, but the study was limited to the first year of life. 22 Our analysis showed that very low and low birth weight conferred the greatest risk of mortality during the neonatal period, but the associated risk lessened with increasing age. CHDs are the leading cause of death among infants with DS 8 and conferred a risk of mortality that was highest during the post-neonatal period and was associated with the greatest risk relative to the other factors from age 1 through 10.…”

“…Although some studies have suggested a survival advantage among male children, 6,18 our study confirmed findings from other studies that found no survival differences by sex 9,10,19-21 Although previous reports have found an increased risk associated with low birth weight, 6,9,21 only 1 other populationbased study was found that examined very low birth weight infants (<1500 g) as a distinct group, possibly because of relatively low study population sizes. 22 This study found that among infants with very low birth weight those with DS had 2.5 times the risk of death compared with very low birth weight infants with no birth defects. The percent of infants with DS in our study population that were born with birth weight <2500 g was 22%, a >2.5-fold increased risk compared with the general population, and these infants were twice as likely to be born <1500 g. 23 Recognition of the high risk of mortality associated with very low birth weight for infants with DS is important to increase vigilance among health care providers for this vulnerable group.…”