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Hafezi N, Jensen AR, Saenz ZM, Collings AT, Colgate CL, Inanc Salih ZN, Geddes GC, Gray BW. Surgical history and outcomes in trisomy 13 and 18: A thirty-year review. J Pediatr Surg 2022:S0022-3468(22)00676-5. [PMID: 36402594 DOI: 10.1016/j.jpedsurg.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with Trisomy 13(T13) and 18(T18) have many comorbidities that may require surgical intervention. However, surgical care and outcomes are not well described, making patient selection and family counseling difficult. Here the surgical history and outcomes of T13/ T18 patients are explored. METHODS A retrospective review of patients with T13 or T18 born between 1990 and 2020 and cared for at a tertiary children's hospital (Riley Hospital for Children, Indianapolis IN) was conducted, excluding those with insufficient records. Primary outcomes of interest were rates of mortality overall and after surgery. Factors that could predict mortality outcomes were also assessed. RESULTS One-hundred-seventeen patients were included, with 65% T18 and 35% T13. More than half of patients(65%) had four or more comorbidities. Most deaths occurred by three months at median 42.0 days. Variants of classic trisomies (mosaicism, translocation, partial duplication; p = 0.001), higher birth weight(p = 0.002), and higher gestational age(p = 0.01) were associated with lower overall mortality, while cardiac(p = 0.002) disease was associated with higher mortality. Over half(n = 64) underwent surgery at median age 65 days at time of first procedure. The most common surgical procedures were general surgical. Median survival times were longer in surgical rather than nonsurgical patients(p<0.001). Variant trisomy genetics(p = 0.002) was associated with lower mortality after surgery, while general surgical comorbidities(p = 0.02), particularly tracheoesophageal fistula/esophageal atresia(p = 0.02), were associated with increased mortality after surgery. CONCLUSIONS Trisomy 13 and 18 patients have vast surgical needs. Variant trisomy was associated with lower mortality after surgery while general surgical comorbidities were associated with increased mortality after surgery. Those who survived to undergo surgery survived longer overall. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, United States
| | - Amanda R Jensen
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, United States
| | - Zoe M Saenz
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, United States
| | - Amelia T Collings
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, United States
| | - Cameron L Colgate
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Indianapolis, IN 46202, United States
| | - Zeynep N Inanc Salih
- Fetal Center at Riley Children's Health, Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States; Department of Pediatrics, Division of Neonatal Perinatal Medicine, Indiana University School of Medicine, 705 Riley Hospital Drive, RT 4600, Indianapolis, IN 46202, United States
| | - Gabrielle C Geddes
- Fetal Center at Riley Children's Health, Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States; Department of Molecular Genetics, Indiana University School of Medicine, 1002 Wishard Blvd, Indianapolis, IN 46202, United States
| | - Brian W Gray
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, United States; Fetal Center at Riley Children's Health, Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States.
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2
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Sandal S, Mahay SB, Dimri Gupta N, Saxena R, Lall M, Dua Puri R. Prenatal phenotypic spectrum of full trisomy 18 in an Indian cohort. Am J Med Genet A 2022; 188:1904-1908. [DOI: 10.1002/ajmg.a.62692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/04/2022] [Accepted: 01/22/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Sapna Sandal
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
| | | | | | - Renu Saxena
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
| | - Meena Lall
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
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Abstract
PURPOSE OF REVIEW The implementation of palliative care at birth has led to a significant rise in the number of couples who choose to continue with pregnancies complicated by life-limiting malformations (LLMs). Prenatal counselling and appropriate antenatal/perinatal management in these cases are poorly studied and may pose significant challenges. The purpose of this review is to outline specific obstetric risks and to suggest management for mothers who choose to continue with pregnancies with the most common LLMs. RECENT FINDINGS In pregnancies complicated by LLMs where parents opt for expectant management, clinicians should respect parental wishes, whilst openly sharing potential serious maternal medical risks specific for the identified abnormalities. The focus of both antenatal and perinatal care should be maternal wellbeing rather than foetal survival. Follow-up ultrasound examinations and maternal surveillance should be aimed at achieving timely diagnosis and effective management of obstetric complications. A clear perinatal plan, agreed with the couples by a multi-disciplinary team including a foetal medicine specialist, a neonatologist and a geneticist, is crucial to reduce maternal morbidity. SUMMARY This review provides a useful framework for clinicians who face the challenges of counselling and managing cases complicated by LLMs where parents opt for pregnancy continuation.
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Ferreira de Souza LM, Galvão E Brito Medeiros A, Júnior JPR, de Melo AN, Dias SAMM. Long Survival of a Patient with Trisomy 18 and Dandy-Walker Syndrome. ACTA ACUST UNITED AC 2019; 55:medicina55070352. [PMID: 31288482 PMCID: PMC6681329 DOI: 10.3390/medicina55070352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
Trisomy 18 is a genetic disease resulting from an extra chromosome 18, characterized by a broad clinical spectrum, poor prognosis and low rates of survival. This is the case of a 12 year-old girl diagnosed with full trisomy 18, and multiple malformations, including Dandy-Walker Syndrome and congenital heart defects on long term survival. At nine months, a new echocardiogram showed a double outlet right ventricle, significant pulmonary stenosis, patent ductus arteriosus and ventricular septal defect. Cardiac surgery was performed at one year and seven months. Early surgical intervention and multidisciplinary follow-up may change the clinical outcome of the disease. Further studies are required to evaluate the benefit of invasive procedures such as cardiac surgery on survival of patients with trisomy 18.
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Affiliation(s)
| | | | | | - Aurea Nogueira de Melo
- Department of Pediatric of Federal, University of Rio Grande do Norte, Natal 58051-900, Brazil.
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He M, Du L, Xie H, Lei T, Zheng Q, Wu L. The ratio of cavum septi pellucidi width to anteroposterior cerebellar diameter: A novel index as a diagnostic adjunct for prenatal diagnosis of trisomy 18. J Obstet Gynaecol Res 2019; 45:1245-1250. [PMID: 30932268 DOI: 10.1111/jog.13960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/02/2019] [Indexed: 11/30/2022]
Abstract
AIM To explore the effectiveness of cavum septi pellucidi (CSP) width to anteroposterior cerebellar diameter (APCD) ratio as a diagnostic adjunct for prenatal diagnosis of trisomy 18. METHODS Images of normal fetal brain within 15 and 35 weeks were stored in our center from 2016 to 2017. Images of aneuploid fetuses were retrospectively collected from 2004 to 2017. The transverse cerebellar diameter, APCD and CSP width were measured. CSP/APCD and APCD/transverse cerebellar diameter ratios were calculated and compared between euploid and aneuploid fetuses. RESULTS One thousand and forty one fetuses were analyzed, including 817 euploid fetuses and 224 aneuploid fetuses (trisomy 21 117 cases, trisomy 18 82 cases, trisomy 13 9 cases, sex-linked 16 cases). No correlation had been found between both ratios and gestational weeks (P > 0.05). In aneuploid groups, means of ratios were both significantly different just between trisomy 18 group and euploid group (P < 0.05). The best area under the curve was shown by the CSP/APCD ratio. The cutoff value of CSP/APCD was 0.46 (sensitivity 87.0%, specificity 85.0%). CONCLUSION A wide CSP or cerebellar hypoplasia warrants a more detailed ultrasound screening and genetic counseling. A larger CSP/APCD ratio alerts us to trisomy 18 syndrome, especially in cases with subtle anomalies.
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Affiliation(s)
- Miao He
- Department of Obstetrics and Gynecology Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liu Du
- Department of Obstetrics and Gynecology Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongning Xie
- Department of Obstetrics and Gynecology Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting Lei
- Department of Obstetrics and Gynecology Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiao Zheng
- Department of Obstetrics and Gynecology Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lihong Wu
- Department of Obstetrics and Gynecology Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Rosa RFM, Correia EPE, Bastos CS, da Silva GS, Correia JD, da Rosa EB, Silveira DB, Targa LV, da Cunha AC, Zen PRG. Trisomy 18 and holoprosencephaly. Am J Med Genet A 2017; 173:1985-1987. [DOI: 10.1002/ajmg.a.38129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/07/2016] [Accepted: 12/24/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Rafael F. M. Rosa
- Clinical Genetics; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA); Porto Alegre RS Brazil
- Graduate Program in Pathology; UFCSPA; Porto Alegre RS Brazil
- Graduate Program in Biosciences; UFCSPA; Porto Alegre RS Brazil
| | | | | | | | | | | | | | - Luciano V. Targa
- Pediatric Radiology; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
| | | | - Paulo R. G. Zen
- Clinical Genetics; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA); Porto Alegre RS Brazil
- Graduate Program in Pathology; UFCSPA; Porto Alegre RS Brazil
- Graduate Program in Biosciences; UFCSPA; Porto Alegre RS Brazil
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7
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Trevisan P, Rosa RFM, Koshiyama DB, Zen TD, Paskulin GA, Zen PRG. Congenital heart disease and chromossomopathies detected by the karyotype. ACTA ACUST UNITED AC 2016; 32:262-71. [PMID: 25119760 PMCID: PMC4183026 DOI: 10.1590/0103-0582201432213213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/17/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE: To review the relationship between congenital heart defects and chromosomal
abnormalities detected by the karyotype. DATA SOURCES: Scientific articles were searched in MEDLINE database, using the descriptors
"karyotype" OR "chromosomal" OR "chromosome" AND "heart defects, congenital". The
research was limited to articles published in English from 1980 on. DATA SYNTHESIS: Congenital heart disease is characterized by an etiologically heterogeneous and
not well understood group of lesions. Several researchers have evaluated the
presence of chromosomal abnormalities detected by the karyotype in patients with
congenital heart disease. However, most of the articles were retrospective studies
developed in Europe and only some of the studied patients had a karyotype exam. In
this review, only one study was conducted in Latin America, in Brazil. It is known
that chromosomal abnormalities are frequent, being present in about one in every
ten patients with congenital heart disease. Among the karyotype alterations in
these patients, the most important is the trisomy 21 (Down syndrome). These
patients often have associated extra-cardiac malformations, with a higher risk of
morbidity and mortality, which makes heart surgery even more risky. CONCLUSIONS: Despite all the progress made in recent decades in the field of cytogenetic, the
karyotype remains an essential tool in order to evaluate patients with congenital
heart disease. The detailed dysmorphological physical examination is of great
importance to indicate the need of a karyotype.
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8
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Correia JD, da Rosa EB, Silveira DB, Correia EPE, Lorenzen MB, Travi GM, Rosa RCM, Zen PRG, Zen TD, Rosa RFM. Trisomy 18 and eye anomalies. Am J Med Genet A 2016; 173:553-555. [PMID: 27792864 DOI: 10.1002/ajmg.a.38036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/07/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Jamile D Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ernani B da Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Giovanni M Travi
- Pediatric Ophthalmology, Hospital da Criança Santo Antônio (HCSA)/Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil
| | - Rosana C M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, UFCSPA, Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and CHSCPA, Porto Alegre, RS, Brazil
| | - Tatiana D Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Pharmacy, Faculdade de Ciências da Saúde, Centro Universitário Ritter dos Reis-UniRitter, Porto Alegre, RS, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, UFCSPA, Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and CHSCPA, Porto Alegre, RS, Brazil
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9
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Donovan JH, Krigbaum G, Bruns DA. Medical interventions and survival by gender of children with trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:272-8. [DOI: 10.1002/ajmg.c.31522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Management Considerations for Ongoing Pregnancies Complicated by Trisomy 13 and 18. Obstet Gynecol Surv 2016; 71:295-300. [DOI: 10.1097/ogx.0000000000000304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Murakami A, Tanaka M, Ijiri R, Kato K, Yamashita S, Kurosawa K, Arai N, Aoki I, Tanaka Y. A morphometric study to establish criteria for fetal and neonatal cerebellar hypoplasia: A special emphasis on trisomy 18. Pathol Int 2015; 66:15-22. [PMID: 26669480 DOI: 10.1111/pin.12371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/26/2015] [Indexed: 11/28/2022]
Abstract
Cerebellar hypoplasia (CH) is one of the congenital abnormalities of the central nervous system and is seen in several diseases and syndromes. This study was conducted in order to examine methods for evaluating CH in fetus and neonate because CH has been diagnosed without any morphometric criteria at autopsy. We sampled 140 autopsied cases including nineteen trisomy 18 (T18), four non-T18 with presumed CH, and 117 control cases without any brain malformation. Statistical significance was present in the cerebellar weight and weight ratio of cerebellum per total brain between T18 and the control. The exponential regression models (ERM) showed that cerebral weight, cerebellar weight, and weight ratio of cerebellum per total brain increased gradually relative to gestational age in both T18 and the control. However, cerebellar weight and weight ratio of cerebellum per total brain of T18 showed growth delay with clear distinction between the two groups. The non-T18 with presumed CH showed similar results. Body weight, total brain, and gestational age should be considered totally when evaluating fetal and neonatal cerebellar development. Furthermore, the ERM results may be useful to evaluate the cerebellar development of fetus and neonate at autopsy.
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Affiliation(s)
- Ayumi Murakami
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan.,Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mio Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Rieko Ijiri
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Keisuke Kato
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan.,Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Sumimasa Yamashita
- Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kenji Kurosawa
- Department of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Nobutaka Arai
- Brain Pathology, Research Center, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ichiro Aoki
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
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Denardin D, Savaris FE, da Cunha AC, Betat RDS, Telles JAB, Targa LV, Weiss A, Zen PRG, Rosa RFM. Retrospective cohort of trisomy 18 (Edwards syndrome) in southern Brazil. SAO PAULO MED J 2015; 133:320-5. [PMID: 25388684 PMCID: PMC10876362 DOI: 10.1590/1516-3180.2013.79900715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 11/20/2013] [Accepted: 07/11/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Trisomy 18 (T18), or Edwards syndrome, is a chromosomal disease characterized by a broad clinical picture and a poor prognosis. Our aim was to describe clinical, radiological and survival data of a cohort of patients prenatally diagnosed with T18. DESIGN AND SETTING Retrospective single cohort in the Fetal Medicine Service of Hospital Materno Infantil Presidente Vargas (HMIPV). METHODS All sequential patients with T18 registered at the Fetal Medicine Service of HMIPV between January 2005 and September 2013 were considered. We gathered their clinical, radiological and survival data and used the Kaplan-Meier test for survival analysis. RESULTS Ten patients were diagnosed with T18, of whom seven (70%) were female. The majority (90%) were referred due to malformations seen on ultrasound. The mean gestational age at the first evaluation was 25.5 weeks. At karyotyping, the defects were considered multiple in only four patients (40%). All the fetuses presented full trisomy of chromosome 18. The main abnormality observed was congenital heart disease (n = 7). Intrauterine death occurred in half of the patients (50%). All live patients (n = 5) were born through cesarean section presenting low weight and low Apgar scores. The median length of survival after birth was 18 days. CONCLUSIONS T18 is associated with a high risk of fetal and neonatal death. The majority of the patients present major malformations identified through ultrasound, such as congenital heart defects, which could help in identifying such cases prenatally.
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Affiliation(s)
- Daniela Denardin
- MD. Physician, Residency Program on Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fabíola Elizabete Savaris
- MD. Physician, Residency Program on Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - André Campos da Cunha
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rosilene da Silveira Betat
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Jorge Alberto Bianchi Telles
- MD. Fetologist, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Luciano Vieira Targa
- MD. Pediatric Radiologist, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Aline Weiss
- MD. Neonatologist, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Ricardo Gazzola Zen
- PhD. Adjunct Professor of Clinical Genetics and of the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rafael Fabiano Machado Rosa
- PhD. Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA) and Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
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Rosa RFM, Rosa RCM, Lorenzen MB, Zen PRG, Graziadio C, Paskulin GA. Craniofacial abnormalities among patients with Edwards Syndrome. REVISTA PAULISTA DE PEDIATRIA 2014; 31:293-8. [PMID: 24142310 PMCID: PMC4182981 DOI: 10.1590/s0103-05822013000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/25/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the frequency and types of craniofacial abnormalities observed
in patients with trisomy 18 or Edwards syndrome (ES). METHODS This descriptive and retrospective study of a case series included all
patients diagnosed with ES in a Clinical Genetics Service of a reference
hospital in Southern Brazil from 1975 to 2008. The results of the karyotypic
analysis, along with clinical data, were collected from medical records.
RESULTS: The sample consisted of 50 patients, of which 66% were female. The median
age at first evaluation was 14 days. Regarding the karyotypes, full trisomy
of chromosome 18 was the main alteration (90%). Mosaicism was observed in
10%. The main craniofacial abnormalities were: microretrognathia (76%),
abnormalities of the ear helix/dysplastic ears (70%), prominent occiput
(52%), posteriorly rotated (46%) and low set ears (44%), and short palpebral
fissures/blepharophimosis (46%). Other uncommon - but relevant -
abnormalities included: microtia (18%), orofacial clefts (12%), preauricular
tags (10%), facial palsy (4%), encephalocele (4%), absence of external
auditory canal (2%) and asymmetric face (2%). One patient had an initial
suspicion of oculo-auriculo-vertebral spectrum (OAVS) or Goldenhar syndrome.
CONCLUSIONS: Despite the literature description of a characteristic clinical presentation
for ES, craniofacial alterations may be variable among these patients. The
OAVS findings in this sample are noteworthy. The association of ES with OAVS
has been reported once in the literature.
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14
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Rosa RFM, Sarmento MV, Polli JB, Groff DDP, Petry P, Mattos VFD, Rosa RCM, Trevisan P, Zen PRG. Gestational, perinatal and family findings of patients with Patau syndrome. REVISTA PAULISTA DE PEDIATRIA 2014; 31:459-65. [PMID: 24473950 PMCID: PMC4183046 DOI: 10.1590/s0103-05822013000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/12/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe gestational, perinatal and family findings of patients with Patau syndrome (PS). METHODS The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. RESULTS The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%). Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%); multiparous mothers (92.6%); vaginal delivery (77%); preterm birth (34.6%); birth weight <2500g (33.3%), and Apgar scores <7 in the 1st (75%) and in the 5th minute (42.9%). About half of them (53%) died during the first month of life. CONCLUSIONS The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients.
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Affiliation(s)
| | | | | | | | - Patrícia Petry
- Hospital Materno Infantil Presidente Vargas, Porto AlegreRS, Brasil
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15
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Betat RDS, Telles JAB, Gobatto AM, Bicca AMDH, Arcolini CP, Dal Pai TKV, Faria AEV, Zen PRG, Rosa RFM. Ruptured omphalocele mimicking gastroschisis in a fetus with edwards syndrome. Am J Med Genet A 2013; 164A:559-60. [DOI: 10.1002/ajmg.a.36289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Rosilene da S. Betat
- Fetal Medicine; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
| | - Jorge A. B. Telles
- Fetal Medicine; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
| | - Amanda M. Gobatto
- Graduation in Medicine; Universidade Luterana do Brasil (ULBRA); Canoas RS Brazil
| | - Anna M. de H. Bicca
- Graduation in Medicine; Universidade Luterana do Brasil (ULBRA); Canoas RS Brazil
| | - Camila P. Arcolini
- Graduation in Medicine; Universidade Luterana do Brasil (ULBRA); Canoas RS Brazil
| | - Thaís K. V. Dal Pai
- Graduation in Medicine; Universidade Luterana do Brasil (ULBRA); Canoas RS Brazil
| | - Adyr E. V. Faria
- Pediatric Surgery; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
| | - Paulo R. G. Zen
- Clinical Genetics; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA); Porto Alegre RS Brazil
- Graduate Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); Porto Alegre RS Brazil
| | - Rafael F. M. Rosa
- Fetal Medicine; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
- Clinical Genetics; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA); Porto Alegre RS Brazil
- Graduate Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); Porto Alegre RS Brazil
- Clinical Genetics; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
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Rosa RFM, Trevisan P, Rosa RCM, Lorenzen MB, Zen PRG, Oliveira CA, Graziadio C, Paskulin GA. Trisomy 18 and neural tube defects. Pediatr Neurol 2013; 49:203-4. [PMID: 23831245 DOI: 10.1016/j.pediatrneurol.2013.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 03/11/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Trisomy 18 or Edwards syndrome is a chromosomal abnormality characterized by a broad clinical picture and a limited survival. More than 130 different abnormalities have been described in these patients-among them are neural tube defects. METHODS We verified the frequency and types of major neural tube defects observed among patients with trisomy 18. Our sample consisted of consecutive patients evaluated by a clinical genetics service of a referral hospital in southern Brazil between 1975 and 2008. Fisher's exact test (two-tailed) and chi-square test with Yates' correction were used to compare frequencies (P < 0.05 values were considered as significant). RESULTS During the period of evaluation, we identified 50 patients with trisomy 18; 33 (66%) were female and age at the first evaluation ranged from 1 day to 16 years (median 14 days). One cell line with full trisomy 18 was the predominant cytogenetic finding (90%). Three patients (6%) had major neural tube defects, all females. These were two patients (4%) with encephaloceles and one (2%) with myelomeningocele. This last patient undergo to correction surgery on her first day of life. CONCLUSIONS Our data, in accordance with the literature, support the idea that the presence of neural tube defects among patients with trisomy 18 is not coincidental (i.e., these defects are actually part of the spectrum of abnormalities presented in trisomy 18). Thus, the diagnosis of trisomy 18 should be considered in children with major neural tube defects, especially in the presence of other abnormalities or dysmorphisms.
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Rosa RFM, Rosa RCM, Zen PRG, Graziadio C, Paskulin GA. Trissomia 18: revisão dos aspectos clínicos, etiológicos, prognósticos e éticos. REVISTA PAULISTA DE PEDIATRIA 2013; 31:111-20. [DOI: 10.1590/s0103-05822013000100018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/21/2012] [Indexed: 12/21/2022]
Abstract
OBJETIVO: Revisar as características clínicas, etiológicas, diagnósticas e prognósticas da trissomia do cromossomo 18 (síndrome de Edwards). FONTES DE DADOS: Foram pesquisados artigos científicos presentes nos portais MedLine, Lilacs e SciELO, utilizando-se os descritores 'trisomy 18' e 'Edwards syndrome'. A pesquisa não se limitou a um período determinado e englobou artigos presentes nestes bancos de dados. SÍNTESE DOS DADOS: A síndrome de Edwards é uma doença caracterizada por um quadro clínico amplo e prognóstico bastante reservado. Há descrição na literatura de mais de 130 anomalias diferentes, as quais podem envolver praticamente todos os órgãos e sistemas. Seus achados são resultantes da presença de três cópias do cromossomo 18. A principal constituição cromossômica observada entre estes pacientes é a trissomia livre do cromossomo 18, que se associa ao fenômeno de não disjunção, especialmente na gametogênese materna. A maioria dos fetos com síndrome de Edwards acaba indo a óbito durante a vida embrionária e fetal. A mediana de sobrevida entre nascidos vivos tem usualmente variado entre 2,5 e 14,5 dias. CONCLUSÕES: O conhecimento do quadro clínico e do prognóstico dos pacientes com a síndrome de Edwards tem grande importância no que diz respeito aos cuidados neonatais e à decisão de instituir ou não tratamentos invasivos. A rapidez na confirmação do diagnóstico é importante para a tomada de decisões referentes às condutas médicas. Muitas vezes, as intervenções são realizadas em condições de emergência, sem muita oportunidade de reflexão ou discussão, e envolvem questões médicas e éticas difíceis.
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Rosa RFM, Rosa RCM, Lorenzen MB, Zen PRG, de Oliveira CAV, Graziadio C, Paskulin GA. Trisomy 18 (Edwards syndrome) and major gastrointestinal malformations. SAO PAULO MED J 2013; 131:133-4. [PMID: 23657517 PMCID: PMC10871733 DOI: 10.1590/s1516-31802013000100025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 04/25/2012] [Accepted: 07/30/2012] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rafael Fabiano Machado Rosa
- PhD. Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rosana Cardoso Manique Rosa
- MD. Postgraduate, Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marina Boff Lorenzen
- Undergraduate Medical Student, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Ricardo Gazzola Zen
- PhD. Adjunct Professor of Clinical Genetics and Professor of the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ceres Andréia Vieira de Oliveira
- MD. Professor, Instituto de Educação e Pesquisa (IEP), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Carla Graziadio
- MD. Postgraduate Student, Postgraduate Program on Pathology, and Assistant Professor of Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Giorgio Adriano Paskulin
- PhD. Associate Professor of Clinical Genetics and Coordinator of the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
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Rosa RF, Rosa RC, Lorenzen MB, de Oliveira CA, Graziadio C, Zen PR, Paskulin GA. Trisomy 18: Frequency, types, and prognosis of congenital heart defects in a Brazilian cohort. Am J Med Genet A 2012; 158A:2358-61. [DOI: 10.1002/ajmg.a.35492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/18/2012] [Indexed: 11/11/2022]
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