Mortality and morbidity of VLBW infants with trisomy 13 or trisomy 18

Abstract

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.

Keywords: preterm infants; trisomy 13; trisomy 18; trisomy 21; very low birth weight.

FIGURE 1

Estimated proportion survived to discharge by birth defect group among VLBW infants in the NRN born 1994 through 2009. Differences in the survival distributions were significant (P < .001 by the log-rank test). No statistically significant difference was found between the survival curves for infants with T13 compared with infants with T18. Survival rates at 28 days were as follows: no major birth defect: 84%; T21: 75%; T18: 11%; T13: 11%. The last death before discharge occurred at 27 days among infants with T13; 4 infants were discharged alive after hospital stays of 36 to 110 days. Among infants with T18, the infant who remained in the hospital longest died on day 52; 11 infants were discharged alive after hospital stays of 7 to 49 days.