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. 2025 Dec;45(12):1751-1757.
doi: 10.1038/s41372-025-02384-0. Epub 2025 Aug 12.

Gestational age-based outcomes of neonates with Down syndrome in the neonatal intensive care unit (NICU): review of pediatric health information system (PHIS) database

Emily A Messick  1   2 , Stephen A Hart  3   4 , Julie Strominger  5 , Sara Conroy  5   6 , Carl H Backes  3   7   4   5 , Clifford L Cua  3   4
Affiliations

Gestational age-based outcomes of neonates with Down syndrome in the neonatal intensive care unit (NICU): review of pediatric health information system (PHIS) database

Emily A Messick et al. J Perinatol. 2025 Dec.

Abstract

Objective: To examine differences in neonatal intensive care unit (NICU) outcomes in neonates with Down syndrome (DS) by gestational age (GA) using a large national database STUDY DESIGN: Retrospective analysis of Pediatric Health Information System database, including neonates with DS admitted to the NICU <30 days old from 1/1/2008-12/31/2022. Neonates were stratified by GA (extremely preterm, very preterm, moderate/late preterm, term). GA-based risk differences were examined for NICU outcomes using term neonates as reference.

Results: Overall mortality rate was 7% with increasing mortality as GA decreased (RD 6.1 [95% CI 4.8, 7.5], RD 25.4 [95% CI 20.5, 30.6], RD 36.8 [95% CI 27.3, 46.8] for moderate/late preterm, very preterm, extremely preterm). The overall rate of pulmonary hypertension was 23% and 14% of the cohort required a gastrostomy tube.

Conclusion: Prematurity significantly increases risk of NICU mortality for neonates with DS. Rates of pulmonary hypertension and gastrostomy were high throughout all groups.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Risk differences of selected diagnoses for neonates with Down syndrome in the NICU by gestational age group (N = 7037; reference group: 37+ weeks).
Shading of the point estimate represents a given gestational age group (e.g., <28 weeks) with darker shading corresponding to a younger gestational age group. Risk differences and 95% confidence intervals are presented as a percentage. NICU neonatal intensive care unit, SGA small for gestational age, AVSD atrioventricular septal defect, ASD atrial septal defect, VSD ventricular septal defect, PDA patent ductus arteriosus.
Fig. 2
Fig. 2. Risk differences of in-hospital medical utilization for neonates with down syndrome in the NICU by gestational age group (N = 7037; reference group: 37+ weeks).
Shading of the point estimate represents a given gestational age group (e.g., <28 weeks) with darker shading corresponding to a younger gestational age group. Risk differences and 95% confidence intervals are presented as a percentage. NICU neonatal intensive care unit, TPN total parental nutrition, NIPPV noninvasive positive-pressure ventilation, HFNC high flow nasal cannula.
Fig. 3
Fig. 3. Risk differences of in-hospital complications for neonates with Down syndrome in the NICU by gestational age group (N = 7037; reference group: 37+ weeks).
Shading of the point estimate represents a given gestational age group (e.g., <28 weeks) with darker shading corresponding to a younger gestational age group. Risk differences and 95% confidence intervals are presented as a percentage. NICU neonatal intensive care unit, NEC necrotizing enterocolitis, PVL periventricular leukomalacia, IVH interventricular hemorrhage, ICH intracranial hemorrhage, ROP retinopathy of prematurity, CLABSI central line-associated bloodstream infection.
Fig. 4
Fig. 4. Risk differences of in-hospital mortality or readmission for neonates with Down syndrome in the NICU by gestational age group (N = 7037; reference group: 37+ weeks).
Shading of the point estimate represents a given gestational age group (e.g., <28 weeks) with darker shading corresponding to a younger gestational age group. Risk differences and 95% confidence intervals are presented as a percentage. NICU, neonatal intensive care unit.
See this image and copyright information in PMC

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