NICU management and outcomes of infants with trisomy 21 without major anomalies

McAndrew, Sarah; Acharya, Krishna; Nghiem-Rao, T. Hang; Leuthner, Steven R.; Clark, Reese H.; Lagatta, Joanne

doi:10.1038/s41372-018-0136-5

Cited by 13 publications

(7 citation statements)

References 16 publications

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“…Full‐term infants with Trisomy 21 were more likely to develop CLD. This is likely due to the higher incidence of pulmonary hypoplasia, pulmonary hypertension, hypotonia, and other anomalies in these infants 23–27 . However, the majority of these infants had a milder CLD with a lower incidence of adverse hospital outcomes, as 87% of infants with Trisomy 21 syndrome hospitalized at 28 days survived without tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Chronic lung disease in full‐term infants: Characteristics and neonatal intensive care outcomes in infants referred to children's hospitals

Mikhael

Cleary

Zaniletti

et al. 2022

Pediatric Pulmonology

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Objective To describe characteristics, outcomes, and risk factors for death or tracheostomy with home mechanical ventilation in full‐term infants with chronic lung disease (CLD) admitted to regional neonatal intensive care units. Study Design This was a multicenter, retrospective cohort study of infants born ≥37 weeks of gestation in the Children's Hospitals Neonatal Consortium. Results Out of 67,367 full‐term infants admitted in 2010–2016, 4886 (7%) had CLD based on receiving respiratory support at either 28 days of life or discharge. 3286 (67%) were still hospitalized at 28 days receiving respiratory support, with higher mortality risk than those without CLD (10% vs. 2%, p < 0.001). A higher proportion received tracheostomy (13% vs. 0.3% vs. 0.4%, p < 0.001) and gastrostomy (30% vs. 1.7% vs. 3.7%, p < 0.001) compared to infants with CLD discharged home before 28 days and infants without CLD, respectively. The diagnoses and surgical procedures differed significantly between the two CLD subgroups. Small for gestational age, congenital pulmonary, airway, and cardiac anomalies and bloodstream infections were more common among infants with CLD who died or required tracheostomy with home ventilation (p < 0.001). Invasive ventilation at 28 days was independently associated with death or tracheostomy and home mechanical ventilation (odds ratio 7.6, 95% confidence interval 5.9–9.6, p < 0.0001). Conclusion Full‐term infants with CLD are at increased risk for morbidity and mortality. We propose a severity‐based classification for CLD in full‐term infants. Future work to validate this classification and its association with early childhood outcomes is necessary.

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Section: Discussionmentioning

confidence: 99%

Chronic lung disease in full‐term infants: Characteristics and neonatal intensive care outcomes in infants referred to children's hospitals

Mikhael

Cleary

Zaniletti

et al. 2022

Pediatric Pulmonology

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“…Others have reported lower birth weights in infants with hypoplastic left heart syndrome and major genetic syndromes. [7][8][9][10][11] The female preponderance is likely due to the association between Turner syndrome and hypoplastic left heart syndrome and the increased incidence of CHD in females with Trisomy 21. 12,13 Finally, the diagnosis of unbalanced atrioventricular canal defect is known to be more common in patients with Trisomy 21 and heterotaxy syndrome than in non-syndromic patients.…”

Section: Patient Demographics and Characteristicsmentioning

confidence: 99%

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities

Pierick

Scholz

et al. 2022

Cardiol Young

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Background: Hypoplastic left heart syndrome and single ventricle variants with aortic hypoplasia are commonly classified as severe forms of CHD. We hypothesised patients with these severe defects and reported genetic abnormalities have increased morbidity and mortality during the interstage period. Methods and Results: This was a retrospective review of the National Pediatric Cardiology Quality Improvement Collaborative Phase I registry. Three patient groups were identified: major syndromes, other genetic abnormalities, and no reported genetic abnormality. Tukey post hoc test was applied for pairwise group comparisons of length of stay, death, and combined outcome of death, not a candidate for stage 2 palliation, and heart transplant. Participating centres received a survey to establish genetic testing and reporting practices. Of the 2182 patients, 110 (5%) had major genetic syndromes, 126 (6%) had other genetic abnormalities, and 1946 (89%) had no genetic abnormality. Those with major genetic syndromes weighed less at birth and stage 1 palliation. Patients with no reported genetic abnormalities reached full oral feeds sooner and discharged earlier. The combined outcome of death, not a candidate for stage 2 palliation, and heart transplant was more common in those with major syndromes. Survey response was low (n = 23, 38%) with only 14 (61%) routinely performing and reporting genetic testing. Conclusions: Patients with genetic abnormalities experienced greater morbidity and mortality during the interstage period than those with no reported genetic abnormalities. Genetic testing and reporting practices vary significantly between participating centres.

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“…Feeding problems are described in multiple genetic syndromes associated with hypotonia in infancy. Term infants with trisomy 21, even in the absence of major anomalies (40%), have more feeding problems when compared to their term counterparts (34% vs. 15%) without trisomy 21 [ 45 ]. Infants with Prader–Willi syndrome can present with hypotonia and poor sucking even in the neonatal period and have feeding problems and failure to thrive [ 46 , 47 ].…”

Section: Feeding Problems In Preterm Infants Beyond the Nicumentioning

confidence: 99%

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

2021

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Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.

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NICU management and outcomes of infants with trisomy 21 without major anomalies

Abstract: One-third of infants with trisomy 21 admitted to the NICU are full term without major anomalies. Common diagnoses and greater respiratory needs place infants with trisomy 21 at risk for longer length of stay.

Cited by 13 publications

References 16 publications

Chronic lung disease in full‐term infants: Characteristics and neonatal intensive care outcomes in infants referred to children's hospitals

Chronic lung disease in full‐term infants: Characteristics and neonatal intensive care outcomes in infants referred to children's hospitals

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

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