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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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Lebedoff AN, Carey JC. Parent-reported histories of adults with trisomy 13 syndrome. Am J Med Genet A 2021; 185:1743-1756. [PMID: 33750000 DOI: 10.1002/ajmg.a.62165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/10/2021] [Indexed: 11/10/2022]
Abstract
Clinical histories and outcome data of long-term survivors with trisomy 13 are rare. The goal of this study was to collect the medical histories of adult individuals (≥18 years old) with apparent non-mosaic trisomy 13/Patau syndrome to help gain further insight in to the clinical course for individuals with this condition and to characterize the manifestations for surveillance and management. We collected 11 families through a contact person with the LWT13 (Living with Trisomy 13) LIFE support group. We performed telephone interviews to gather their medical histories and report these data in system-based summaries, tables, and clinical vignettes. In instances where parents retained copies of genetic testing reports or clinicians currently taking care of the individual with trisomy 13 were able to provide documentation, we confirmed diagnosis. All clinical histories and reported manifestations were consistent with a diagnosis of trisomy 13. We also elicited comments from parents on their personal experiences of raising an individual with trisomy 13.
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Affiliation(s)
- Amy N Lebedoff
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
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Carvajal HG, Callahan CP, Miller JR, Rensink BL, Eghtesady P. Cardiac Surgery in Trisomy 13 and 18: A Guide to Clinical Decision-Making. Pediatr Cardiol 2020; 41:1319-1333. [PMID: 32924070 DOI: 10.1007/s00246-020-02444-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
There has been substantial controversy regarding treatment of congenital heart defects in infants with trisomies 13 and 18. Most reports have focused on surgical outcomes versus expectant treatment, and rarely there has been an effort to consolidate existing evidence into a more coherent way to help clinicians with decision-making and counseling families. An extensive review of the existing literature on cardiac surgery in patients with these trisomies was conducted from 2004 to 2020. The effects of preoperative and perioperative factors on in-hospital and long-term mortality were analyzed, as well as possible predictors for postoperative chronic care needs such as tracheostomy and gastrostomy. Patients with minimal or no preoperative pulmonary hypertension and mechanical ventilation undergoing corrective surgery at a weight greater than 2.5 kg suffer from lower postoperative mortality. Infants with lower-complexity cardiac defects are likely to benefit the most from surgery, although their expected mortality is higher than that of infants without trisomy. Omphalocele confers an increased mortality risk regardless of cardiac surgery. Gastrointestinal comorbidities increased the risk of gastrostomy tube placement, while those with prolonged mechanical ventilation and respiratory comorbidities are more likely to require tracheostomy. Cardiac surgery is feasible in children with trisomies 13 and 18 and can provide improved long-term results. However, this is a clinically complex population, and both physicians and caretakers should be aware of the long-term challenges these patients face following surgery when discussing treatment options.
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Affiliation(s)
- Horacio G Carvajal
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA
| | - Connor P Callahan
- Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
| | - Jacob R Miller
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA
| | - Bethany L Rensink
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA.
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Shibuya S, Miyake Y, Takamizawa S, Nishi E, Yoshizawa K, Hatata T, Yoshizawa K, Fujita K, Noguchi M, Ohata J, Hiroma T, Nakamura T, Kosho T. Safety and efficacy of noncardiac surgical procedures in the management of patients with trisomy 13: A single institution‐based detailed clinical observation. Am J Med Genet A 2018; 176:1137-1144. [DOI: 10.1002/ajmg.a.38678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 02/10/2018] [Accepted: 02/22/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Soichi Shibuya
- Department of Pediatric SurgeryNagano Children's HospitalAzumino Japan
- Department of Pediatric General and Urogenital SurgeryJuntendo University HospitalTokyo Japan
| | - Yuichiro Miyake
- Department of Pediatric SurgeryNagano Children's HospitalAzumino Japan
- Department of Pediatric General and Urogenital SurgeryJuntendo University HospitalTokyo Japan
| | | | - Eriko Nishi
- Division of Medical GeneticsNagano Children's HospitalAzumino Japan
| | - Katsumi Yoshizawa
- Department of Pediatric SurgeryNagano Children's HospitalAzumino Japan
| | - Tomoko Hatata
- Department of Pediatric SurgeryNagano Children's HospitalAzumino Japan
| | - Kazuki Yoshizawa
- Department of Pediatric SurgeryNagano Children's HospitalAzumino Japan
| | - Kenya Fujita
- Department of Plastic SurgeryNagano Children's HospitalAzumino Japan
| | - Masahiko Noguchi
- Department of Plastic SurgeryNagano Children's HospitalAzumino Japan
| | - Jun Ohata
- Department of AnesthesiologyNagano Children's HospitalAzumino Japan
| | - Takehiko Hiroma
- Department of NeonatologyNagano Children's HospitalAzumino Japan
| | | | - Tomoki Kosho
- Division of Medical GeneticsNagano Children's HospitalAzumino Japan
- Center for Medical Genetics, Shinshu University HospitalMatsumoto Japan
- Department of Medical GeneticsShinshu University School of MedicineMatsumoto Japan
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Takahashi K, Sasaki A, Wada S, Wada Y, Tsukamoto K, Kosaki R, Ito Y, Sago H. The outcomes of 31 cases of trisomy 13 diagnosed in utero with various management options. Am J Med Genet A 2017; 173:966-971. [PMID: 28266126 DOI: 10.1002/ajmg.a.38132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 10/16/2016] [Accepted: 12/15/2016] [Indexed: 11/11/2022]
Abstract
There are few reports on the prognosis of prenatally diagnosed trisomy 13 in relation to postnatal management. The aim of this study was to report on the prenatal and postnatal outcomes and postnatal management of trisomy 13 fetuses that were prenatally diagnosed at our center between 2003 and 2015. The data were retrospectively reviewed from medical records. Of the 31 cases of trisomy 13, 12 patients were diagnosed before 22 weeks of gestation, and 19 were diagnosed at or after 22 weeks of gestation. Nine families opted for termination of the pregnancy, 14 fetuses died, and 8 were born alive. Aggressive treatment was requested in two of the live births, with one patient achieving long-term survival (7 years). The other died during infancy (Day 61). One out of four who received palliative treatment is alive at two years of age with only nutrition supplementation. These three patients who achieved neonatal survival had few structural anomalies. Fetal death and early neonatal death are common in trisomy 13; however, fetuses that receive medical treatment for cases without major ultrasound abnormalities may achieve neonatal survival. Therefore, it is useful to provide comprehensive information, including precise ultrasound findings and treatment options, to parents with trisomy 13 fetuses during genetic counseling.
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Affiliation(s)
- Ken Takahashi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Aiko Sasaki
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Seiji Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Yuka Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Keiko Tsukamoto
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Rika Kosaki
- Division of Medical Genetics, Department of Medical Subspecialties, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Yushi Ito
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
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Chung D, Haynes K, Haynes R. Surviving with trisomy 13: Provider and parent perspectives and the role of the pediatric palliative care program. Am J Med Genet A 2016; 173:813-815. [PMID: 28019075 DOI: 10.1002/ajmg.a.37984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 09/08/2016] [Indexed: 11/06/2022]
Abstract
Trisomy 13 typically denotes an overall poor prognosis in the setting of multisystem anomalies. Through a provider and parent perspective, this case illustrates the benefit of hope, communication, and teamwork through the integration of a palliative care team in the care of a medically complex child with trisomy 13, resulting in enhance survival and perceived quality of life for patient and family. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Duc Chung
- Department of Hospice and Palliative Medicine, UCSF Fresno, Fresno, California
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Bruns D, Martinez A, Campbell EA. Oral health needs in individuals with trisomy 18 and trisomy 13: Implications for dental professionals. SPECIAL CARE IN DENTISTRY 2015; 36:18-24. [PMID: 26585493 DOI: 10.1111/scd.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine oral health needs and dental care in individuals with trisomy 18 and trisomy 13 (full, mosaic, partial and other, mixed types). Primary feeding method was also examined. Data was collected from a parent-completed, mixed method survey (TRIS Survey). Mean age in months was 120.2 (range 38 to 394 months) and 133 (range 36 to 405 months), respectively, for trisomy 18 and trisomy 13 individuals. Results indicated the majority of individuals received routine dental care from their family dentist. Approximately 80% in both groups needed some form of specialized dental care. Close to 25% and 30% of trisomy 18 and trisomy 13 individuals, respectively, required hospital admission for specialized dental care. Responses indicated the presence of excessive plaque and tooth decay across the groups with a higher incidence for individuals with trisomy 13. Although not the primary form of intake, over half of the individuals received oral feedings. Implications for dental care and management are provided along with the need for additional research to confirm or disconfirm this study's findings.
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Affiliation(s)
- Deborah Bruns
- Southern Illinois University Carbondale, Carbondale, IL
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Bruns DA, Martinez A. An analysis of cardiac defects and surgical interventions in 84 cases with full trisomy 18. Am J Med Genet A 2015; 170A:337-343. [DOI: 10.1002/ajmg.a.37427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/23/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Deborah A. Bruns
- Department of Counseling; Quantitative Methods, and Special Education; Southern Illinois University Carbondale; Carbondale Illinois
| | - Alyssa Martinez
- Department of Counseling; Quantitative Methods, and Special Education; Southern Illinois University Carbondale; Carbondale Illinois
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9
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Bruns DA. Developmental status of 22 children with trisomy 18 and eight children with trisomy 13: implications and recommendations. Am J Med Genet A 2015; 167A:1807-15. [PMID: 25847310 DOI: 10.1002/ajmg.a.37102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/25/2015] [Indexed: 11/08/2022]
Abstract
Trisomy 18 and trisomy 13 are conditions often referred to as "incompatible with life" or "lethal anomalies." If there is long-term survival, the outlook is considered "grim." Developmental status is presumed to be minimal. Yet, Baty et al. [1994; 49:189-194] described a variety of developmental skills in their sample. An additional 22 children with trisomy 18 and eight with trisomy 13 are described here. A range of developmental skills is noted with strengths in the language and communication, gross and fine motor and social-emotional domains including indicating preferences, exploration of objects and a range of voluntary mobility. These results serve to expand the knowledge base on developmental status for these groups and advance the need to further explore developmental abilities rather than focus on deficits. Avenues for future research, implications, and recommendations are provided.
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Affiliation(s)
- Deborah A Bruns
- Southern Illinois University Carbondale, Carbondale, Illinois
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