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Gorini F, Coi A, Pierini A, Assanta N, Bottoni A, Santoro M. Hypothyroidism in Patients with Down Syndrome: Prevalence and Association with Congenital Heart Defects. CHILDREN (BASEL, SWITZERLAND) 2024; 11:513. [PMID: 38790508 PMCID: PMC11119539 DOI: 10.3390/children11050513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
This population-based study aimed to assess the prevalence of congenital hypothyroidism (CH) and overt hypothyroidism (OH) and their association with congenital heart defects (CHDs) in patients with Down syndrome (DS). The population included all live births residing in Tuscany (Italy) diagnosed with DS recorded in the Registry of Congenital Defects and in the Registry of Rare Diseases of Tuscany in the years 2003-2017. The prevalence of CH and OH in DS patients was calculated by sex and by period. The association of CH and OH with CHDs in DS patients was assessed using multivariate logistic regression. The cohort included 228 subjects. The prevalence of CH and OH was 11.4% (95%CI: 7.4-16.7%) and 12.7% (95%CI: 8.5-12.3%), respectively, with no significant difference by sex. A significant increase in the prevalence of CH (p < 0.0001) was found in the years 2010-2017 compared to the previous period, and among preterm infants (p = 0.009). The presence of CH was associated with a higher prevalence of CHDs (adjusted OR = 2.24, p = 0.082). A significant association between ventricular septal defects (VSDs) and the occurrence of OH (adjusted OR = 3.07, p = 0.025) was also observed. This study confirmed the higher prevalence of both CH and OH in DS compared to the general population. Furthermore, the risk of association between DS and CHDs was higher in the presence of CH, while VSDs are associated with OH, providing relevant insights into the epidemiology of hypothyroidism in DS and associated anomalies.
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Affiliation(s)
- Francesca Gorini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
- Foundation Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Nadia Assanta
- Foundation Gabriele Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Antonio Bottoni
- Foundation Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
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Bourdon G, Lenne X, Godart F, Storme L, Theis D, Subtil D, Bruandet A, Rakza T. Epidemiology of congenital heart defects in France from 2013 to 2022 using the PMSI-MCO (French Medical Information System Program in Medicine, Surgery, and Obstetrics) database. PLoS One 2024; 19:e0298234. [PMID: 38626139 PMCID: PMC11020754 DOI: 10.1371/journal.pone.0298234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/19/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Congenital heart defects are common and occur in approximately 0.9% of births. In France, the registries cover approximately 20% of the population but not the entirety of France; therefore, we aimed to update the incidence data for congenital heart defects in France from 2013 to 2022 using the medico-administrative database PMSI-MCO (French Medical Information System Program in Medicine, Surgery, and Obstetrics). We aimed to compare the frequency of risk factors in a population with congenital heart defects and a reference population. METHODS From 2013 to 2022, we included children aged < 3 years diagnosed with congenital heart defects according to the International Classification of Diseases, 10th Revision, in the PMSI-MCO database. We compared them with a population without congenital defects on several medical data items (e.g., parity, gemellarity, and mortality rate). Bivariate and multivariate analyses compared children with congenital heart defects and children without congenital malformation. RESULTS We identified 83,879 children with congenital heart defects in France from 2013 to 2022 in the PMSI-MCO database and 7,739,840 children without such defects, including 7,218,952 without any congenital defects. We observed more deaths (7.49% vs. 0.68%, d = 0.59) and more twinning (8.67% vs. 1.23%, d = 0.35) among children with congenital heart defects. Multivariate analysis revealed an increased risk of congenital heart defects in male individuals (OR [odds ratio] 1.056, 95% CI [confidence interval] [1.039-1.076]) and cases of medically assisted reproduction (OR 1.115, 95% CI [1.045-1.189]) and a reduced risk in the case of multiparity (OR 0.921, 95% CI [0.905-0.938]). CONCLUSIONS According to the PMSI-MCO database, the incidence of congenital heart defects in France from 2013 to 2022 is 1% of births. Congenital heart defects are more frequent in cases of prematurity, twinning, primiparity, male sex, and maternal age > 40 years.
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Affiliation(s)
- Gurvan Bourdon
- Maternity Unit, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - François Godart
- Cardiology Unit, Department of Pediatrics, Lille University Hospital, Lille, France
| | - Laurent Storme
- Department of Neonatology, Lille University Hospital, Lille, France
| | - Didier Theis
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Damien Subtil
- Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Amelie Bruandet
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Thameur Rakza
- Maternity Unit, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
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Geleta BE, Seyoum G. Prevalence and Patterns of Congenital Heart Defects and Other Major Non-Syndromic Congenital Anomalies Among Down Syndrome Patients: A Retrospective Study. Int J Gen Med 2024; 17:1337-1347. [PMID: 38596643 PMCID: PMC11001559 DOI: 10.2147/ijgm.s453181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024] Open
Abstract
Background Children with DS are at higher risk of developing congenital anomalies, particularly cardiac anomalies. Methods Medical records of 502 DS patients were reviewed. The logistic regression analyses were performed to determine independent predictors. Results Of the total 502 study subjects, 53.4% were males. Only 1.4% of the DS case diagnosis were confirmed by karyotyping. All cases were diagnosed postnatally. The median age at DS diagnosis was 5 months. About 13% were born preterm; 50.2% of the subjects maternal age at conception were thirty-five years and above. Over three-quarters (75.1%) had at least one structural congenital anomaly. Multiple anomalies were diagnosed in 12.8% of the subjects. At least one cardiac congenital anomaly was diagnosed in 67.3% of the study subjects, and 32.8% of them were diagnosed with multiple cardiac anomalies. Patent ductus arteriosus (28.5%), Ventricular septal defect (23.2%), and AVSD (21.9%) were the three common lesions. At least one genitourinary system anomaly was identified in 32 (6.4%) of them. Roughly, 8% of study participants exhibited congenital anomaly of the head, eye, nose, and throat. Anorectal malformation was found as the most common gastrointestinal anomaly. Maternal age at conception was found as independent predictor for presence of structural congenital anomaly (AOR 2.59; 95% CI 1.58-4.23, p-value < 0.01). Advanced maternal age is also found increasing the risk of developing congenital heart defect (AOR 2.37; 95% CI 1.52-3.7, p-value < 0.01). Conclusion High prevalence of congenital anomalies has been noted in the current study compared to previous studies. Predictive factors increasing risk of congenital anomalies in DS patients have been identified. The current findings may help in developing strategies and more targeted preventive and therapeutic interventions.
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Affiliation(s)
| | - Girma Seyoum
- Department of Anatomy, Addis Ababa University, Addis Ababa, Ethiopia
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Ranchin B, Bidault V, Zekre F, DeMul A, Sanlaville D, Bacchetta J. Kidney and urological involvement in Down syndrome: frequent, underestimated, but associated with impaired quality of life and risk of kidney failure. Pediatr Nephrol 2024; 39:347-355. [PMID: 37386331 DOI: 10.1007/s00467-023-05986-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/01/2023]
Abstract
Patients with Down syndrome (DS) are at risk of multiorgan dysfunction; kidney and urological impairment are common. This is due to a likely increased risk of congenital kidney and urological malformations (odds ratio of 4.5 compared to the general population in one study), more frequent associated comorbidities at risk of kidney dysfunction (such as prematurity in 9-24% of children, intrauterine growth retardation or low birth weight in 20%, and congenital heart disease in 44%), and more frequent lower urinary tract dysfunction (reported in 27-77% of children with DS). If present, malformations and comorbidities at risk of kidney dysfunction warrant regular kidney monitoring in addition to their treatment. Serum creatinine in children with DS has been shown to be higher than in the general population and asymptomatic hyperuricemia is reported in 12-33% of children or young adults with DS. Moreover cryptorchidism and testicular cancer are also more common and should be detected by clinical examination. Thus, persons with DS at risk of presenting kidney and urological impairment should be identified by prenatal ultrasonography, comorbidities at risk of kidney sequelae considered, and during regular medical follow-up, clinically examined and questioned to diagnose testicular anomalies and lower urinary tract dysfunction. This is of importance as such kidney and urological impairments are associated with impaired quality of life and mental health, and risk of kidney failure.
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Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France.
| | - Valeska Bidault
- Service de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Franck Zekre
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Aurelie DeMul
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Damien Sanlaville
- Service de Génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Sud Charles Mérieux, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
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Engsner S, Giang KW, Dellborg M, Fedchenko M, Eriksson P, Mandalenakis Z. Impact of Down Syndrome on Survival Among Patients With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e031392. [PMID: 38214262 PMCID: PMC10926807 DOI: 10.1161/jaha.123.031392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Increasing survival among patients with congenital heart disease (CHD) has recently been reported. However, the impact of Down syndrome (DS) in patients with CHD is still debated. We aimed to estimate survival in patients with CHD with versus without DS compared with matched controls from the general population without CHD or DS. METHODS AND RESULTS We linked data from Swedish health registries to identify patients with CHD born between 1970 and 2017. Data from the Total Population Register were used to match each patient with CHD by sex and birth year with 8 controls without CHD or DS. A Cox proportional regression model was used to estimate mortality risk, and Kaplan-Meier curves were analyzed for the survival analysis. We identified 3285 patients with CHD-DS, 64 529 patients with CHD without DS, and 26 128 matched controls. The mortality risk was 25.1 times higher (95% CI, 21.3-29.5) in patients with CHD-DS versus controls. The mortality rate was 2 times higher (95% CI, 1.94-2.31) for patients with CHD with versus without DS. Lower mortality was found during the second versus first birth periods in patients with CHD-DS compared with controls; hazard ratio: 46.8 (95% CI, 29.5-74.0) and 17.7 (95% CI, 12.8-24.42) in those born between 1970 and 1989 versus 1990 and 2017, respectively. CONCLUSIONS In this retrospective cohort study, the mortality risk among patients with CHD-DS was 25 times higher compared with matched controls and 2 times higher compared with patients with CHD without DS. Survival was higher in patients with CHD-DS born after versus before 1990, coinciding with the modern era of congenital heart care.
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Affiliation(s)
- Stella Engsner
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Kok Wai Giang
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Mikael Dellborg
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Maria Fedchenko
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Peter Eriksson
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Adult Congenital Heart Unit, Department of MedicineSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Adult Congenital Heart Unit, Department of MedicineSahlgrenska University Hospital/ÖstraGothenburgSweden
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Tuppin P, Barthelemy P, Debeugny G, Rachas A. A French nationwide study compared various conditions and healthcare use of individuals < 65 years with a Down's syndrome to those without. Sci Rep 2023; 13:21865. [PMID: 38071383 PMCID: PMC10710479 DOI: 10.1038/s41598-023-49102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
Few regular national clinical data are available for individuals with Down's syndrome (IDS) bearing in mind that they are subject to countries variations in medical termination of pregnancy and screening. Individuals < 65 in 2019 were selected in view of the low number of older IDS. Thus, 98% of 52.4 million people with correct data were included from the national health data system. IDS (35,342) were identified on the basis of the International Classification of Diseases 10th revision code (Q90). Risk ratios (RR) were calculated to compare the frequencies in 2019 between IDS and individual without Down's syndrome (IWDS) of use of health care. The prevalence of IDS was 0.07% (48% women), comorbidities were more frequent, especially in younger patients (24% < 1 year had another comorbidity, RR = 20), as was the percentage of deaths (4.6%, RR = 10). Overall, tumours were less frequent in IDS compared with IWDS (1.2%, RR = 0.7) except for certain leukaemias and testicular tumours (0.3%, RR = 4). Cardiac malformations (5.2%, RR = 52), dementia (1.2%, RR = 29), mental retardation (5%, RR = 21) and epilepsy (4%, RR = 9) were also more frequent in IDS. The most frequent hospital diagnoses for IDS were: aspiration pneumonia (0.7%, RR = 89), respiratory failure (0.4%, RR = 17), sleep apnoea (1.1%, RR = 8), cryptorchidism (0.3%, RR = 5.9), protein-energy malnutrition (0.1%, RR = 7), type 1 diabetes (0.2%, RR = 2.8) and hypothyroidism (0.1%, RR = 72). IDS were more likely to use emergency services (9%, RR = 2.4), short hospital stay (24%, RR = 1.6) or hospitalisation at home (0.6%, RR = 6). They consulted certain specialists two to three times more frequently than IWDS, for example cardiologists (17%, RR = 2.6). This study is the first detailed national study comparing IDS and non-IDS by age group. These results could help to optimize prenatal healthcare, medical and social support.
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Affiliation(s)
- Philippe Tuppin
- Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale de L'Assurance Maladie, 26‑50, Avenue du Professeur Andre Lemierre, 75986, Paris Cedex 20, France.
| | - Pauline Barthelemy
- Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale de L'Assurance Maladie, 26‑50, Avenue du Professeur Andre Lemierre, 75986, Paris Cedex 20, France
| | - Gonzague Debeugny
- Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale de L'Assurance Maladie, 26‑50, Avenue du Professeur Andre Lemierre, 75986, Paris Cedex 20, France
| | - Antoine Rachas
- Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale de L'Assurance Maladie, 26‑50, Avenue du Professeur Andre Lemierre, 75986, Paris Cedex 20, France
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Kaemmerer H, Diller GP, Dähnert I, Eichstaedt CA, Eicken A, Freiberger A, Freilinger S, Geiger R, Gorenflo M, Grünig E, Hager A, Herberg U, Huntgeburth M, Kaemmerer AS, Kozlik-Feldmann R, Lammers A, Nagdyman N, Michel S, Schmidt KH, Uebing A, von Scheidt F, Apitz C. [Pulmonary arterial hypertension in congenital heart disease - Part I]. Pneumologie 2023; 77:956-961. [PMID: 37963485 DOI: 10.1055/a-2146-7434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The number of adults with congenital heart disease (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary arterial hypertension (PAH), which may develop early in untreated CHD. Despite timely treatment of CHD, PAH often persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart defects" is addressed only relatively superficially in these guidelines. Therefore, this article addresses the perspective of congenital cardiology in greater depth.
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Affiliation(s)
- Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Gerhard Paul Diller
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Ingo Dähnert
- Universitätsklinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Christina A Eichstaedt
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Institut für Humangenetik, Universität Heidelberg, INF 366, Heidelberg, Deutschland
| | - Andreas Eicken
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Freilinger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Geiger
- Univ.-Klinik für Pädiatrie III, Kardiologie, Pneumologie, Allergologie, Cystische Fibrose, Innsbruck, Österreich
| | - Matthias Gorenflo
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Alfred Hager
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ulrike Herberg
- Klinik für Kinderkardiologie und Angeborene Herzfehler, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Michael Huntgeburth
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | | | - Rainer Kozlik-Feldmann
- Klinik und Poliklinik für Kinderkardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Deutschland
| | - Astrid Lammers
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Nicole Nagdyman
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Michel
- LMU Klinikum, Herzchirurgische Klinik und Poliklinik, Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie, Campus Großhadern, München
| | - Kai Helge Schmidt
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie I, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Anselm Uebing
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Deutschland
| | - Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin Ulm, Ulm, Deutschland
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Kosiv KA, Mercurio MR, Carey JC. The common trisomy syndromes, their cardiac implications, and ethical considerations in care. Curr Opin Pediatr 2023; 35:531-537. [PMID: 37551160 DOI: 10.1097/mop.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW To review the incidence of congenital heart disease in the trisomies, highlight the history of cardiac surgery in trisomy 21 comparing it to the increase in cardiac surgery in trisomies 13 and 18, discuss ethical issues specific to trisomies 13 and 18, and suggest a pathway of shared decision-making in the management of congenital heart disease in trisomy 13 and 18, specifically congenital heart surgery. RECENT FINDINGS Congenital heart disease is prevalent in the trisomies and the management of these defects, especially surgical intervention, has changed. In the late 20th century, survival after cardiac surgery in trisomy 21 vastly improved, significantly decreasing morbidity and mortality secondary to pulmonary hypertension. Similarly, procedures and surgeries have been performed with increasing frequency in trisomy 13 and 18 patients and concomitantly, survival in this patient population is increasing. Yet across the United States, the willingness to perform cardiac surgery in trisomy 13 and 18 is variable, and there is ethical controversy about the correct action to take. To address this concern, a shared decision-making approach with an informed parent(s) is advised. SUMMARY As the care and management of congenital heart disease changed in trisomy 21, so too it has with trisomy 13 and 18. Physicians and parents should develop goal-directed treatment plans balancing the risk versus benefit and consider cardiac surgical repair if feasible and beneficial.
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Steffensen EH, Pedersen LH, Lou S, Vogel I. Impact of a prenatal screening program on the Down syndrome phenotype: An interrupted time series analysis. Acta Obstet Gynecol Scand 2023; 102:751-759. [PMID: 37186080 DOI: 10.1111/aogs.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION We hypothesized that children with Down syndrome who were born after the implementation of first-trimester combined screening for trisomy 13, 18, and 21 and a second-trimester ultrasound scan in Denmark would show a milder syndrome phenotype. We investigated the birth biometry, prevalence of congenital malformations, and early childhood morbidity of children with Down syndrome before and after implementation of this screening program. MATERIAL AND METHODS A nationwide register-based study of all live born singletons with Down syndrome in Denmark from 1995 to 2018. In interrupted time series analyses, we studied the temporal developments in birth biometry, prevalence of congenital malformations, and early childhood morbidity related to the implementation of a national prenatal screening program. RESULTS We included 602 singletons with Down syndrome born before and 308 after implementation of the screening program. Z-scores of birthweight and head circumference increased over time before screening, but this temporal development changed after implementation by -0.05 (95% confidence interval [CI]: -0.11 to 0.01) and -0.05 (95% CI -0.12 to 0.02), respectively. Just after implementation, the prevalence of non-severe congenital heart disease decreased (relative change in odds 0.48 [95% CI: 0.24-0.94]). For severe congenital heart disease, atrioventricular septal defect, and non-heart malformations, this change was 1.16 (95% CI: 0.56-2.41), 0.95 (95% CI: 0.43-2.03), and 0.98 (95% CI: 0.33-2.76), respectively. For all malformations, pre-existing temporal developments did not change following implementation of screening. The implementation was associated with higher odds of admission to a neonatal intensive care unit (relative change 1.98 [95% CI: 0.76-5.26]) and an increased risk of hearing impairment (risk difference 3.4% [95% CI: -0.4% to 7.1%]). In contrast, the implementation was not associated with the incidence of hospital admissions by 2 years of age or with the probability of a thyroid disorder. CONCLUSIONS After implementation of a national prenatal screening program, we did not observe a milder Down syndrome phenotype apart from an apparent reduction in the proportion of children with non-severe congenital heart disease; this result is, however, limited by small numbers.
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Affiliation(s)
- Ellen Hollands Steffensen
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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10
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Dimopoulos K, Constantine A, Clift P, Condliffe R, Moledina S, Jansen K, Inuzuka R, Veldtman GR, Cua CL, Tay ELW, Opotowsky AR, Giannakoulas G, Alonso-Gonzalez R, Cordina R, Capone G, Namuyonga J, Scott CH, D’Alto M, Gamero FJ, Chicoine B, Gu H, Limsuwan A, Majekodunmi T, Budts W, Coghlan G, Broberg CS, Constantine A, Clift P, Condliffe R, Moledina S, Jansen K. Cardiovascular Complications of Down Syndrome: Scoping Review and Expert Consensus. Circulation 2023; 147:425-441. [PMID: 36716257 PMCID: PMC9977420 DOI: 10.1161/circulationaha.122.059706] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in individuals with Down syndrome. Congenital heart disease is the most common cardiovascular condition in this group, present in up to 50% of people with Down syndrome and contributing to poor outcomes. Additional factors contributing to cardiovascular outcomes include pulmonary hypertension; coexistent pulmonary, endocrine, and metabolic diseases; and risk factors for atherosclerotic disease. Moreover, disparities in the cardiovascular care of people with Down syndrome compared with the general population, which vary across different geographies and health care systems, further contribute to cardiovascular mortality; this issue is often overlooked by the wider medical community. This review focuses on the diagnosis, prevalence, and management of cardiovascular disease encountered in people with Down syndrome and summarizes available evidence in 10 key areas relating to Down syndrome and cardiac disease, from prenatal diagnosis to disparities in care in areas of differing resource availability. All specialists and nonspecialist clinicians providing care for people with Down syndrome should be aware of best clinical practice in all aspects of care of this distinct population.
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Affiliation(s)
- Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.D., A.C.).,National Heart and Lung Institute, Imperial College London, United Kingdom (K.D., A.C.)
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.D., A.C.).,National Heart and Lung Institute, Imperial College London, United Kingdom (K.D., A.C.)
| | - Paul Clift
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom (P.C.)
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C.)
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom (S.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (K.J.).,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (K.J.)
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital, Japan (R.I.)
| | - Gruschen R. Veldtman
- Scottish Adult Congenital Cardiac Service, Golden Jubilee Hospital, Glasgow, Scotland, United Kingdom (G.R.V.)
| | - Clifford L. Cua
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH (C.L.C.)
| | - Edgar Lik Wui Tay
- Department of Cardiology, National University Hospital Singapore (E.T.L.W.)
| | - Alexander R. Opotowsky
- The Heart Institute, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, OH (A.R.O.)
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital School of Medicine, Aristotle University of Thessaloniki, Greece (G.G.)
| | - Rafael Alonso-Gonzalez
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Canada (R.A.-G.).,Toronto Adult Congenital Heart Disease Program, Canada (R.A.-G.)
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, New South Wales, Australia (R.C.)
| | - George Capone
- Down Syndrome Clinical and Research Center, Kennedy Krieger Institute, Baltimore, MD (G. Capone).,Johns Hopkins School of Medicine, Baltimore, MD (G. Capone)
| | - Judith Namuyonga
- Department of Paediatric Cardiology, Uganda Heart Institute, Kampala (J.N.).,Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda (J.N.)
| | | | - Michele D’Alto
- Department of Cardiology, University “L. Vanvitelli”–Monaldi Hospital, Naples, Italy (M.D.)
| | - Francisco J. Gamero
- Department of Cardiovascular Surgery, Benjamin Bloom Children’s Hospital, El Salvador (F.J.G.)
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL (B.C.)
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (H.G.)
| | - Alisa Limsuwan
- Division of Pediatric Cardiology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (A.L.)
| | - Tosin Majekodunmi
- Department of Cardiology, Euracare Multi-specialist Hospital, Nigeria (T.M.)
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Science, Catholic University Leuven, Belgium (W.B.)
| | - Gerry Coghlan
- Department of Cardiology, Royal Free Hospital, London, United Kingdom (G. Coghlan)
| | - Craig S. Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.S.B.)
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11
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Niemann A, Boudriot A, Brett B, Fritzsch C, Götz D, Haase R, Höhne S, Jorch G, Köhn A, Lux A, Zenker M, Rissmann A. Impact of the COVID-19 Pandemic Regulations on the Health Status and Medical Care of Children with Trisomy 21. KLINISCHE PADIATRIE 2023; 235:31-37. [PMID: 36108644 DOI: 10.1055/a-1757-9948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND While children are considered at low risk for COVID-19, little is known about the impact of SARS-CoV-2 on paediatric risk patients like children with Trisomy 21 (T21). As these children often need regular therapy and various medical appointments, this study aimed to investigate the possible impact of the COVID-19 pandemic on children with T21. PATIENTS AND METHODS Parents of children with T21 in the age of 0-12 years in Saxony-Anhalt were interviewed via phone in June 2021 regarding the health status and medical care of their children during the past 15 months of pandemic. RESULTS 37 children with mean age of 6.1 years (min 0; max 12) were included in the study. The majority did not have any additional congenital anomalies. Surveyed parents hardly reported adverse changes of health status during the pandemic, but rather improvements, such as decreased number of respiratory infections and more time spend with their children. Outpatient appointments and therapy were cancelled or postponed at the onset of the pandemic, but parents reported low impact on their child's health and development. The main concern seemed to be lack of childcare during school and day-care closures and uncertainty concerning possible health impacts of an infection on their children. CONCLUSION There was low impact of the COVID-19 pandemic on health and medical care of children with T21 in our study population. Further research is needed to help weigh the child's individual risk of infection against the need for medical treatment and therapy when dealing with paediatric risk patients.
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Affiliation(s)
- Annika Niemann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anett Boudriot
- Social Paediatric Centre, Children's Centre Magdeburg gGmbH, Magdeburg, Germany
| | - Birgit Brett
- Social Paediatric Centre, Children's Centre Magdeburg gGmbH, Magdeburg, Germany
| | - Christiane Fritzsch
- Social Paediatric Centre, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Dorit Götz
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Roland Haase
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany.,Department of Neonatology and Paediatric Intensive Care, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Sibylle Höhne
- Social Paediatric Centre, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Gerhard Jorch
- Universitätsklinikum Magdeburg, Universitätskinderklinik, Magdeburg, Germany
| | - Andrea Köhn
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Martin Zenker
- Institut für Humangenetik, Otto von Guericke Universitat Magdeburg, Magdeburg, Germany.,Department of Paediatrics, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
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12
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de Groot-van der Mooren MD, Scheerman BC, Rammeloo LAJ, van Wieringen H, van Wermeskerken AM, van der Plas R, de Winter P, Weijerman ME, Cornel MC, van Kaam AH. Neonatal mortality and morbidity in Down syndrome in the time of prenatal aneuploidy testing: a retrospective cohort study. Eur J Pediatr 2023; 182:319-328. [PMID: 36350406 PMCID: PMC9829636 DOI: 10.1007/s00431-022-04686-3] [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: 09/01/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
Abstract
The total uptake of prenatal aneuploidy screening for Down syndrome (DS) is increasing worldwide. As a result of increasing prenatal diagnosis of DS and subsequent termination of pregnancy, livebirth prevalence of DS is decreasing. The aim of this study is to explore the impact of an increasing uptake of prenatal aneuploidy screening on the neonatal mortality and morbidity in DS. This is a retrospective cohort study of 253 neonates with DS born between 2012 and 2018 that were seen at the outpatient clinic of five hospitals in the Netherlands. The medical files were reviewed for maternal and neonatal characteristics and neonatal morbidities. The Dutch national birth registry (Perined) provided mortality numbers of neonates with DS. The results were interpreted in the context of other published studies. Neonatal mortality in DS remained stable, ranging from 1.4 to 3.6%. A congenital heart defect (CHD) was found in 138 of the 251 neonates (55.0%) with atrial septal defect, atrioventricular septal defect, and ventricular septal defect being the most common. The type of CHD in DS did not change over time. Gastro-intestinal defects were present in 22 of the 252 neonates with DS (8.7%), with duodenal atresia as the most reported anomaly. Persistent pulmonary hypertension of the neonate (PPHN) was found in 31 of the 251 infants (12.4%). Conclusions: Although uptake of prenatal aneuploidy screening increased, neonatal mortality and morbidity in DS appears to be stable. An increased incidence of PPHN was found. What is Known: • The total uptake of prenatal aneuploidy screening for Down syndrome is increasing worldwide. • As a result of increasing prenatal diagnosis of Down syndrome and subsequent termination of pregnancy, the livebirth prevalence of Down syndrome is decreasing. What is New: • Although uptake of prenatal aneuploidy screening increased, neonatal mortality and morbidity in Down syndrome appears to be stable. • An increased incidence of persistent pulmonary hypertension of the neonate was found.
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Affiliation(s)
- Maurike Dorothea de Groot-van der Mooren
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. .,Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.
| | - Brigitta Catharina Scheerman
- Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Hester van Wieringen
- Department of Pediatrics, St. Antonius Ziekenhuis, Koekoekslaan 1, Nieuwegein, the Netherlands
| | | | - Roos van der Plas
- Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem & Spaarnepoort 1, Hoofddorp, the Netherlands ,Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,Child & Youth Institute, KU Leuven, Leuven, Belgium
| | - Michel Emile Weijerman
- Department of Pediatrics, Alrijne Hospital, Simon, Smitweg 1, Leiderdorp, the Netherlands
| | - Martina Cornelia Cornel
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands ,Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Anton Hubertus van Kaam
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands ,Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
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13
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Urhoj SK, Tan J, Morris JK, Given J, Astolfi G, Baldacci S, Barisic I, Brigden J, Cavero-Carbonell C, Evans H, Gissler M, Heino A, Jordan S, Lutke R, Odak L, Puccini A, Santoro M, Scanlon I, de Walle HEK, Wellesley D, Zurriaga Ó, Loane M, Garne E. Hospital length of stay among children with and without congenital anomalies across 11 European regions—A population-based data linkage study. PLoS One 2022; 17:e0269874. [PMID: 35867669 PMCID: PMC9307180 DOI: 10.1371/journal.pone.0269874] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Congenital anomalies are a leading cause of childhood morbidity, but little is known about the long-term outcomes. Objective To quantify the burden of disease in childhood for children with congenital anomalies by assessing the risk of hospitalisation, the number of days spent in hospital and proportion of children with extended stays (≥10 days). Methods European population-based record-linkage study in 11 regions in eight countries including children with congenital anomalies (EUROCAT children) and without congenital anomalies (reference children) living in the same regions. The children were born between 1995 and 2014 and were followed to their tenth birthday or 31/12/2015. European meta-analyses of the outcome measures were performed by two age groups, <1 year and 1–4 years. Results 99,416 EUROCAT children and 2,021,772 reference children were linked to hospital databases. Among EUROCAT children, 85% (95%-CI: 79–90%) were hospitalised in the first year and 56% (95%-CI: 51–61%) at ages 1–4 years, compared to 31% (95%-CI: 26–37%) and 25% (95%-CI: 19–31%) of the reference children. Median length of stay was 2–3 times longer for EUROCAT children in both age groups. The percentages of children with extended stays (≥10 days) in the first year were 24% (95%-CI: 20–29%) for EUROCAT children and 1% (95%-CI: 1–2%) for reference children. The median length of stay varied greatly between congenital anomaly subgroups, with children with gastrointestinal anomalies and congenital heart defects having the longest stays. Conclusions Children with congenital anomalies were more frequently hospitalised and median length of stay was longer. The outlook improves after the first year. Parents of children with congenital anomalies should be informed about the increased hospitalisations required for their child’s care and the impact on family life and siblings, and they should be adequately supported.
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Affiliation(s)
- Stine Kjaer Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Joachim Tan
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joan K. Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joanne Given
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - Gianni Astolfi
- Dept. of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Baldacci
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ingeborg Barisic
- Children’s Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Joanna Brigden
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (UVEG-FISABIO), Valencia, Spain
| | - Hannah Evans
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Anna Heino
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Sue Jordan
- Faculty of Medicine, Health and Life Sciences, Swansea University, Wales, United Kingdom
| | - Renée Lutke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ljubica Odak
- Children’s Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Aurora Puccini
- Territorial Assistance Service–Drug and Medical Device Area, Emilia Romagna Health Department, Bologna, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ieuan Scanlon
- Faculty of Medicine, Health and Life Sciences, Swansea University, Wales, United Kingdom
| | - Hermien E. K. de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Diana Wellesley
- Clinical Genetics, Princess Anne Hospital, University of Southampton and Wessex Clinical Genetics Service, Southampton, United Kingdom
| | - Óscar Zurriaga
- Department of Preventive Medicine and Public Health, Rare Diseases Research Unit UVEG-FISABIO Valencia and Spanish Consortium for Biomedical Research in Epidemiology and Public Health, University of Valencia (Spain) and Valencia Region (Spain) Health Authority (Conselleria de Sanitat Universal I Salut Pública), Valencia, Spain
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- * E-mail:
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14
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Sugo Y, Kurasawa K, Saigusa Y, Hamanoue H, Hirahara F, Miyagi E. Changes in the number of babies born with Down syndrome in Japan. J Obstet Gynaecol Res 2022; 48:2385-2391. [PMID: 35762191 DOI: 10.1111/jog.15342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
AIM The number of babies born with Down syndrome has changed in recent years because of widespread availability of prenatal screening and advanced maternal age at delivery. In Japan, which has no public institutions that record data on babies born with chromosomal abnormalities (including Down syndrome), the accurate number remains unknown. METHODS The Japan Association of Obstetricians and Gynecologists Birth Defects Monitoring Program (hereafter the JAOG Program) is the only national survey of congenital anomalies in Japan. Using data from this survey and vital statistics, we investigated the changes in the number of babies born with Down syndrome in Japan from 2006 to 2019. RESULTS On performing linear regression analysis with the proportion of babies born with Down syndrome as the response variable, and the proportion of mothers giving birth at the age of 35 years or older as the explanatory variable, the regression coefficient was 0.0054 (p < 0.001). The proportion of mothers giving birth at the age of 35 years or older was useful for predicting the proportion of babies born with Down syndrome. This proportion has increased since 2006 but has remained almost unchanged since 2015. In 2019, it was 1/734. CONCLUSIONS This study revealed that the proportion of mothers giving birth at the age of 35 years or older strongly affected the proportion of babies born with Down syndrome. We assume that the proportion of babies is slightly affected by the increased number of pregnant women currently undergoing prenatal screening after the introduction of noninvasive prenatal genetic testing in 2013.
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Affiliation(s)
- Yoshinobu Sugo
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kentaro Kurasawa
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Haruka Hamanoue
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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15
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Impact of prenatal screening on congenital heart defects in neonates with Down syndrome in the US. Pediatr Res 2021; 90:1081-1085. [PMID: 33674738 DOI: 10.1038/s41390-021-01416-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Non-invasive prenatal screening (NIPS) has fundamentally changed the screening process for Down syndrome (DS). Rates of complex congenital heart defects (CHD) have decreased in international studies but whether these shifts exist in the US is unknown. METHODS Encounters for neonates with DS from 2007 to 2018 were obtained from the Pediatric Health Information System database. CHD were categorized as complex CHD, atrioventricular septal defects (AVSD), ventricular septal defects (VSD), and tetralogy of Fallot (TOF). Comparisons were made between pre-NIPS era (2007-2010) vs. post-NIPS era (2014-2018) and between states with low vs. high access to pregnancy termination as described by the Guttmacher Institute. RESULTS Among 9122 patients, 6% had complex CHD, 22% had an AVSD, 22% had a VSD, and 4% had TOF. No difference in proportions of CHD was seen between eras. A small difference was observed in the proportion of AVSD between states with low vs. high access to pregnancy termination (23 vs. 17%, p < 0.001). CONCLUSIONS The proportion of CHD in patients with DS appears to be stable despite widespread adoption of NIPS in the US. Variations were observed between states with low vs. high access to pregnancy termination. Population based studies are needed to fully evaluate the current epidemiology of CHD in DS. IMPACT Through investigation of the Pediatric Health Information System database, this study assesses contemporary epidemiology of congenital heart disease among patients with Down syndrome. It has been suggested that improved prenatal screening for Down syndrome has altered the cardiac phenotype in international populations. Whether a similar shift also exists in the United States is unknown. In a contemporary United States cohort, a shift in the proportion or type of heart defects over the past decade was not observed. Regional differences in the proportion of heart defects were seen and may be due to differential access to prenatal care.
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16
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Nishino T, Endo S, Miyano H, Takemasa Y, Saito M, Umeda C, Tomii Y, Watanabe Y, Nakagawa M, Kakegawa D, Fujinaga S. Reference serum creatinine levels according to sex, age, and height in children with Down syndrome. Eur J Pediatr 2021; 180:2977-2983. [PMID: 33860353 DOI: 10.1007/s00431-021-04078-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
Standard serum creatinine (S-Cr) levels in healthy children fluctuate with age and sex. However, it is unclear if this fluctuation in S-Cr levels is present for children with Down syndrome (DS) who show atypical growth rate. Therefore, we aimed to establish specific reference S-Cr levels for DS and compare them with the prevailing standard levels. We retrospectively reviewed 984 children with DS aged 3 months to 18 years who visited our medical center. Patients with diseases affecting S-Cr levels were excluded. We calculated the reference S-Cr levels according to sex, age, and length/height using medical records. A total of 3765 examinations of 568 children with DS were registered for this study. Ages and S-Cr levels were examined for boys (y = 0.032x + 0.20; r = 0.868, P < 0.0001), and girls (y = 0.024x + 0.23; r = 0.835, P < 0.0001). S-Cr levels in children aged >9 years were significantly higher in boys than in girls. The 430 children with DS aged 2-8 years were examined 1867 times. Height and S-Cr levels showed a significantly strong positive correlation (r = 0.670, P < 0.001) with regression equation y = 0.37x. The quintic equations calculated with S-Cr levels and length/height for boys (336 children, 2043 tests, r = 0.887) and girls (232 children, 1722 tests, r = 0.805) werey = - 6.132x5 + 32.78x4 - 67.86x3 + 68.31x2 - 33.14x + 6.41, and y = 0.09542x5 + 1.295x4 - 6.401x3 + 10.35x2 - 6.746x + 1.772. All calculated results varied from the standard levels for healthy children.Conclusion: This study established reference S-Cr levels and quintic equations specific for children with DS. These reference levels would be potentially useful in evaluating S-Cr levels and renal function in this population. What is Known: •Standard serum creatinine levels vary with age and sex to reflect muscle mass. •Reference serum creatinine levels specific to children with Down syndrome who show growth rates different from those of healthy children have not been established. What is New: •Serum creatinine levels in children with Down syndrome showed different trajectories for sex, age, and length/height when compared with the standard levels for healthy children. •This report on specific reference serum creatinine levels for children with Down syndrome is useful in the assessment of renal function in these children.
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Affiliation(s)
- Tomohiko Nishino
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan. .,Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Shota Endo
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Hiroki Miyano
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Yoichi Takemasa
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Masahito Saito
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Chisato Umeda
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Yuji Tomii
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Yoshitaka Watanabe
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Mayu Nakagawa
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Daisuke Kakegawa
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-City, Saitama, 330 8777, Japan
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17
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Wyatt BH, Amin NM, Bagley K, Wcisel DJ, Dush MK, Yoder JA, Nascone-Yoder NM. Single-minded 2 is required for left-right asymmetric stomach morphogenesis. Development 2021; 148:dev199265. [PMID: 34486651 PMCID: PMC8512893 DOI: 10.1242/dev.199265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023]
Abstract
The morphogenesis of left-right (LR) asymmetry is a crucial phase of organogenesis. In the digestive tract, the development of anatomical asymmetry is first evident in the leftward curvature of the stomach. To elucidate the molecular events that shape this archetypal laterality, we performed transcriptome analyses of the left versus right sides of the developing stomach in frog embryos. Besides the known LR gene pitx2, the only gene found to be expressed asymmetrically throughout all stages of curvature was single-minded 2 (sim2), a Down Syndrome-related transcription factor and homolog of a Drosophila gene (sim) required for LR asymmetric looping of the fly gut. We demonstrate that sim2 functions downstream of LR patterning cues to regulate key cellular properties and behaviors in the left stomach epithelium that drive asymmetric curvature. Our results reveal unexpected convergent cooption of single-minded genes during the evolution of LR asymmetric morphogenesis, and have implications for dose-dependent roles of laterality factors in non-laterality-related birth defects.
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Affiliation(s)
- Brent H. Wyatt
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Nirav M. Amin
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Kristen Bagley
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Dustin J. Wcisel
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Michael K. Dush
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Jeffrey A. Yoder
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27607, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
| | - Nanette M. Nascone-Yoder
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27607, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27607, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
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18
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Sorop VB, Enatescu I, Malita DC, Szuhanek C, Florea MS, Balan L, Istrate SL, Boruga MV, Radu D, Anastasiu DM, Susan M. A survey to assess the incidence of Down syndrome risk in rural southwestern Romania. Exp Ther Med 2021; 22:1066. [PMID: 34434280 PMCID: PMC8353639 DOI: 10.3892/etm.2021.10500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the significant evolution in recent years in the medical field, many fetal conditions that can be detected in the early stages, remain a social and economic burden due to a lack of diagnostic and treatment programs. The main objective of the present study was to realize a screening program related to the early detection of Down syndrome, by analyzing biochemical and imaging markers, in women from the rural areas of Southwest Romania. Accordingly, data from 269 pregnant women were taken into evaluation for maternal age, maternal weight, smoking and diabetic statuses, along with ultrasound measurements that were performed to establish fetal nuchal translucency (FNT) and biochemical analysis of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein (PAPP-A). Patients at high risk for trisomy 21 (≥1:250) were counseled and the optimal protocol was established for each case. Of the 269 patients studied, 5.6% were included in the risk group based on β-hCG-associated MoM (multiple median approaches) analysis, sonographic measurements and maternal age correlation. Specifically, 60% of patients at risk presented a β-hCG MoM value >1.5 and 20% of patients at risk presented a value ≤0.5 for PAPP-A MoM, and the average maternal age was 33. Measurement of FNT and serum markers, together with associated MoM intervals, was not sufficient to establish the diagnosis of trisomy 21 and to make a risk group inclusion. In summary, the association between sonographic measurements and serum marker values, together with maternal age, are predetermined and indispensable conditions for the most accurate classification in a high-risk group.
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Affiliation(s)
- Virgiliu-Bogdan Sorop
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ileana Enatescu
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniel C Malita
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Camelia Szuhanek
- Faculty of Dental Medicine, Department of Orthodontics, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria Sorop Florea
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Lavinia Balan
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Sinziana L Istrate
- Faculty of Medicine, Department of Opthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Madalina V Boruga
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniela Radu
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Doru M Anastasiu
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Susan
- Faculty of Medicine, Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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19
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Panigrahi I, Bhatt Y, Malik S, Kaur P, Kaur A. Clinical Profile of Indian Children with Down Syndrome. J Pediatr Genet 2021; 12:53-57. [PMID: 36684542 PMCID: PMC9848754 DOI: 10.1055/s-0041-1732475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 01/25/2023]
Abstract
This retrospective study was performed on 208 patients with Down syndrome (DS) from heterogeneous ethnic population and admitted under Genetics Metabolic Unit. The aim of the study was to look for phenotypic variability and associated complications in children and adolescents with DS. The average age of the evaluated DS patients was 34 months. Cardiac anomalies were found in 128 (62%) of the 208 cases. Among the cardiac disorders, atrial septal defects accounted for 30% of cases. Other complications observed were hypothyroidism and developmental delay in around 31% cases and neonatal cholestasis in 14% cases. Also, we report two cases with Moya-Moya disease and one case with atlanto-axial dislocation.
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Affiliation(s)
- Inusha Panigrahi
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India,Address for correspondence Inusha Panigrahi, MD, DM Department of Pediatrics, Genetic Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research Chandigarh 160012India
| | - Yogita Bhatt
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Shivani Malik
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Parminder Kaur
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Anupriya Kaur
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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20
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Postolache L, Monier A, Lhoir S. Neuro-Ophthalmological Manifestations in Children with Down Syndrome: Current Perspectives. Eye Brain 2021; 13:193-203. [PMID: 34321946 PMCID: PMC8311006 DOI: 10.2147/eb.s319817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/11/2021] [Indexed: 12/03/2022] Open
Abstract
Down syndrome, caused by an extra copy of all or part of chromosome 21, is the most prevalent intellectual disability of genetic origin. Among numerous comorbidities which are part of the phenotype of individuals with Down syndrome, ocular problems appear to be highly prevalent. Neuro-ophthalmological manifestations, such as ocular alignment and motility disturbances, amblyopia, hypoaccommodation or optic nerve abnormalities, and other organic ocular anomalies frequently reported in Down syndrome, may lead to an overall decrease in visual acuity. Although numerous studies have reported ocular anomalies related to Down syndrome, it remains challenging to determine the impact of each anomaly upon the decreased visual acuity, as most such individuals have more than one ocular problem. Even in children with Down syndrome and no apparent ocular defect, visual acuity has been found to be reduced compared with typically developing children. Pediatric ophthalmological examination is a critical component of a multidisciplinary approach to prevent and treat ocular complications and improve the visual outcome in children with Down syndrome. This narrative review aims to provide a better understanding of the neuro-ophthalmological manifestations and discuss the current ophthalmological management in children with Down syndrome.
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Affiliation(s)
- Lavinia Postolache
- Department of Pediatric Ophthalmology, Queen Fabiola University Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Monier
- Department of Pediatric Neurology, Queen Fabiola University Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Lhoir
- Department of Pediatric Ophthalmology, Queen Fabiola University Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium
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21
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Congenital heart defects among Down’s syndrome cases: an updated review from basic research to an emerging diagnostics technology and genetic counselling. J Genet 2021. [DOI: 10.1007/s12041-021-01296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Tidrenczel Z, Hajdu J, Simonyi A, Szabó I, Ács N, Demeter J, Beke A. Trends in the prenatal diagnosis of trisomy 21 show younger maternal age and shift in the distribution of congenital heart disease over a 20-year period. Am J Med Genet A 2021; 185:1732-1742. [PMID: 33683014 DOI: 10.1002/ajmg.a.62162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/20/2020] [Accepted: 02/20/2021] [Indexed: 11/07/2022]
Abstract
Prenatal testing has changed greatly over the past two decades, which may affect the diagnosis of congenital heart disease (CHD) in Down syndrome. The present study aimed to analyze changes in the prevalence and distribution of CHD diagnosed via ultrasonography and fetopathology in 462 fetuses with trisomy 21 between two consecutive 10-year periods (1999-2018), as well as the associations between CHDs, ultrasound markers, and extracardiac malformations. Overall, the frequency of cardiovascular malformations in trisomy 21 was 27.7 and 26.5%, and ultrasound identified 70 and 62% of CHDs during these periods. A profound increase in first-trimester ultrasound findings and associated anomalies with CHDs (ventricular septal defect, Tetralogy of Fallot) since 2009 were observed. Second-trimester nonstructural heart abnormalities were associated with ultrasound anomalies (74%) and major extracardiac malformations (42.9%). During both study periods, mothers carrying fetuses with CHD were significantly younger than those without CHD (p = 0.038, p = 0.009, respectively). Comparing the two 10-year periods, there were no changes in the prevalence and detection of CHDs. Trend analysis revealed that, although the frequency of CHD remained stable, the diagnostic spectrum had shifted between the study periods. Detection of nonstructural heart abnormalities necessitates detailed follow-up for cardiac/extracardiac malformations and chromosomal disorders.
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Affiliation(s)
- Zsolt Tidrenczel
- Genetic Center, Department of Obstetrics and Gynecology, Medical Centre Hungarian Defense Forces, Budapest, Hungary
| | - Julia Hajdu
- Gottsegen György Institute of Cardiology, Budapest, Hungary
| | - Aténé Simonyi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - István Szabó
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - János Demeter
- Genetic Center, Department of Obstetrics and Gynecology, Medical Centre Hungarian Defense Forces, Budapest, Hungary
| | - Artúr Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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23
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Santoro SL, Steffensen EH. Congenital heart disease in Down syndrome – A review of temporal changes. JOURNAL OF CONGENITAL CARDIOLOGY 2021. [DOI: 10.1186/s40949-020-00055-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Congenital heart disease (CHD) is a well-known co-occurring condition in Down syndrome (DS). We aimed to review the literature to evaluate the current evidence to address key questions.
Methods
A series of key questions were formulated a priori to inform the search strategy and review process. These addressed the topics of prevalence, type of CHD, severity, and screening. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarized, and knowledge gaps were identified.
Results
Fifty-six relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. The total prevalence of CHD reported in DS ranged from 20 to 57.9%. In later decades, the prevalence remained constant at 40—55%. The types and classification of CHD varied considerably between studies. Some studies indicate a trend towards a milder phenotype, but this was not consistent. Over time, some studies observed an improved prognosis for CHD in DS. Studies investigating screening for CHD by physical examination, chest X-ray, and electrocardiogram report sensitivities of 71–95%.
Conclusion
To further improve knowledge on CHD in DS, we suggest that future studies cover a wide range of nations and regions, with a longitudinal design, and account for potential confounding factors.
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24
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Heinke D, Isenburg JL, Stallings EB, Short TD, Le M, Fisher S, Shan X, Kirby RS, Nguyen HH, Nestoridi E, Nembhard WN, Romitti PA, Salemi JL, Lupo PJ. Prevalence of structural birth defects among infants with Down syndrome, 2013-2017: A US population-based study. Birth Defects Res 2020; 113:189-202. [PMID: 33348463 DOI: 10.1002/bdr2.1854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Down syndrome is the most common chromosomal disorder at birth and is often accompanied by structural birth defects. Current data on major structural defects in this population are limited. METHODS States and territorial population-based surveillance programs submitted data on identified cases of Down syndrome and identified structural birth defects during 2013-2017. We estimated prevalence by program type and maternal and infant characteristics. Among programs with active case ascertainment, we estimated the prevalence of birth defects by organ system and for specific defects by maternal age (<35, ≥35) and infant sex. RESULTS We identified 13,376 cases of Down syndrome. Prevalence among all programs was 12.7 per 10,000 live births. Among these children, 75% had at least one reported co-occurring birth defect diagnosis code. Among 6,210 cases identified by active programs, 66% had a cardiovascular defect with septal defects being the most common: atrial (32.5%), ventricular (20.6%), and atrioventricular (17.4%). Defect prevalence differed by infant sex more frequently than by maternal age. For example, atrioventricular septal defects were more common in female children (20.1% vs. 15.1%) while limb deficiencies were more prevalent in male children (0.4% vs. 0.1%). CONCLUSIONS Our study provides updated prevalence estimates for structural defects, including rare defects, among children with Down syndrome using one of the largest and most recent cohorts to date. These data may aid clinical care and surveillance.
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Affiliation(s)
- Dominique Heinke
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Jennifer L Isenburg
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin B Stallings
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tyiesha D Short
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Mimi Le
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Sarah Fisher
- Congenital Malformations Registry, New York State Department of Health, Albany, New York, USA
| | - Xiaoyi Shan
- Arkansas Reproductive Health Monitoring System, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Hoang H Nguyen
- Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Eirini Nestoridi
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences and Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
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25
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Iida C, Muneuchi J, Yamamoto J, Yokota C, Ohmura J, Kamimura T, Ochiai Y, Matsumoto N, Araki S, Shimizu D, Yamaguchi K, Sakemi Y, Watanabe M, Sugitani Y, Takahashi Y. Impacts of surgical interventions on the long-term outcomes in individuals with trisomy 18. J Pediatr Surg 2020; 55:2466-2470. [PMID: 31954556 DOI: 10.1016/j.jpedsurg.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aim to clarify whether surgical interventions can contribute to improve the long-term outcomes among individuals with trisomy 18. METHODS We retrospectively studied 69 individuals with trisomy 18 admitted to 4 tertiary neonatal centers between 2003 and 2017. A cohort was divided into two groups: subjects with surgical interventions and conservative treatments. We compared the rates of survival and achieving homecare between the groups. RESULTS Gestational age and birth weight were 37 (27-43) weeks and 1,700 (822-2,546) g, respectively. There were 68 patients with congenital heart disease and 20 patients with digestive disease. Surgical interventions including cardiac and digestive surgery were provided in 41% of individuals. There was no difference in gestational age (p=0.30), birth weight (p=0.07), gender (p=0.30), and fetal diagnosis (p=0.87) between the groups. During the median follow up duration of 51 (2-178) months, overall survival rates in 6, 12 and 60 months were 57%, 43% and 12%, respectively. Survival to hospital discharge occurred in 23 patients, and the rates of achieving homecare in 1, 6, and 12 months are 1%, 18% and 30%, respectively. There was no significant difference in survival rate (p=0.26) but in the rate of achieving home care (p=0.02) between the groups. Cox hazard analysis revealed that prenatal diagnosis (hazard ratio 0.30, 95%CI: 0.13-0.75), cardiac surgery (hazard ratio 2.40, 95%CI:,1.03-5.55), and digestive surgery (hazard ratio 1.20, 95%CI: 1.25-3.90) were related to the rate of achieving homecare. CONCLUSION Aggressive surgical interventions contribute not to the long-term survival but to achieve homecare among individuals with trisomy 18. EVIDENCE LEVEL Level 3 (Prognostic study, Case-Control study).
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Affiliation(s)
- Chiaki Iida
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan.
| | - Junko Yamamoto
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Chie Yokota
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Junya Ohmura
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Tetsuro Kamimura
- Department of Pediatric Surgery, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Naoko Matsumoto
- Department of Pediatrics, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakitaku, Kitakyushu, 802-0077, Japan
| | - Shunsuke Araki
- Department of Pediatrics, University of Occupational and Environmental Health, 1-1-1, Iseigaoka, Yatahanishiku, Kitakyushu, 807-8556, Japan
| | - Daisuke Shimizu
- Department of Pediatrics, University of Occupational and Environmental Health, 1-1-1, Iseigaoka, Yatahanishiku, Kitakyushu, 807-8556, Japan
| | - Kenichiro Yamaguchi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, 10-1, Harugaoka, Kokuraminamiku, Kitakyushu, 802-8533, Japan
| | - Yoshihiro Sakemi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, 10-1, Harugaoka, Kokuraminamiku, Kitakyushu, 802-8533, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Yasuhiko Takahashi
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
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26
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de Graaf G, Buckley F, Skotko BG. Estimation of the number of people with Down syndrome in Europe. Eur J Hum Genet 2020; 29:402-410. [PMID: 33130823 DOI: 10.1038/s41431-020-00748-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
We aimed to estimate the nonselective live birth prevalence, actual live birth prevalence, reduction percentage because of selective terminations, and population prevalence for Down syndrome (DS) in European countries. The number of people with DS alive in a country was estimated by first modeling the number of live births of children with DS by year of birth. Subsequently, for these different years of birth, survival curves for people with DS were constructed and then applied to these yearly estimates of live births with DS. For Europe, 2011-2015, we estimate 8,031 annual live births of children with DS, which would have been around 17,331 births annually, absent selective terminations. The estimated reduction of live birth prevalence was, on average, 54%, varying between 0% in Malta and 83% in Spain. As of 2015, we estimate 417,000 people with DS are living in Europe; without elective terminations, there would have been about 572,000 people with DS, which corresponds to a population reduction rate of 27%. Such statistics can be important barometers for prenatal testing trends and resource allocation within countries. Disability awareness initiatives and public policy initiatives can also be better grounded with these more precise estimates.
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Affiliation(s)
- Gert de Graaf
- Dutch Down Syndrome Foundation, Meppel, The Netherlands
| | - Frank Buckley
- Down Syndrome Education International, Kirkby Lonsdale, Cumbria, UK.,Down Syndrome Education USA, Irvine, CA, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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27
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Ghmaird A, Alrashidi TN, Alqahtani YS, Alanazi AH, Alaenzi YA, Almohammadi AM, Alzahrani HA, Alomrani NF, Altabbish W. Types and Distribution of Congenital Heart Defects in Pediatric Patients with Down’s Syndrome: A Retrospective Study. Cureus 2020; 12:e11133. [PMID: 33133793 PMCID: PMC7586367 DOI: 10.7759/cureus.11133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Congenital heart disease (CHD) is common in patients with Down’s syndrome (DS), rendering them at risk of significant mortality and morbidity. However, all patients with confirmed DS must undergo further investigation for a cardiac anomaly early in their lives. Objective To define frequency and patterns of CHD among children with DS in Northwest, Saudi Arabia (SA). Methods A five-year chart review study was conducted in Northwest SA between January 2015 and June 2019. We included all children referred to the pediatric cardiology clinic with a confirmed diagnosis of DS and CHD. Children were identified in the clinic’s database, and charts were reviewed retrospectively. Results Among 851 patients with CHD, 53 were identified with DS. Male patients represented 62.3%, while female patients represented 37.7%. The median patients’ age at the time of diagnosis was two days, with most patients diagnosed before 28 days old (67.9%). This study found that atrial septal defect (ASD) and patent ductus arteriosus (PDA) were the most common isolated lesions (37% of isolated cases), while the most common combined lesions were ASD, ventricular septal defect (VSD), and PDA, as well as combined ASD and VSD. Female gender was significantly associated with higher percentage of VSD (p = 0.031) more than male. While male patients had significantly higher percentages of ASD and valvular anomalies than female patients (p = 0.019 and 0.033, respectively). Conclusions The patient’s gender was significantly associated with some types of CHD. Both ASD and valvular lesions were more common among males, while VSD was more common among female patients, no gender differences were detected regarding the other types of CHD.
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Moyer AJ, Gardiner K, Reeves RH. All Creatures Great and Small: New Approaches for Understanding Down Syndrome Genetics. Trends Genet 2020; 37:444-459. [PMID: 33097276 DOI: 10.1016/j.tig.2020.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022]
Abstract
Human chromosome 21 (Hsa21) contains more than 500 genes, making trisomy 21 one of the most complex genetic perturbations compatible with life. The ultimate goal of Down syndrome (DS) research is to design therapies that improve quality of life for individuals with DS by understanding which subsets of Hsa21 genes contribute to DS-associated phenotypes throughout the lifetime. However, the complexity of DS pathogenesis has made developing appropriate animal models an ongoing challenge. Here, we examine lessons learned from a variety of model systems, including yeast, nematode, fruit fly, and zebrafish, and discuss emerging methods for creating murine models that better reflect the genetic basis of trisomy 21.
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Affiliation(s)
- Anna J Moyer
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Katheleen Gardiner
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA (retired)
| | - Roger H Reeves
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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The Effect of Fetal Trisomy 21 on Adverse Perinatal Obstetrical Outcomes in Nova Scotia, 2000-2019. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:583-588. [PMID: 33229281 DOI: 10.1016/j.jogc.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To understand the risks associated with trisomy 21 in pregnancy in order to inform obstetrical care and improve outcomes. METHODS A population-based retrospective cohort study was undertaken of all pregnancies involving a fetus with trisomy 21 in Nova Scotia, Canada, from 2000 to 2019. Cases were identified from the provincial laboratory genetics database, linked to the Nova Scotia Atlee Perinatal Database for pregnancy outcomes, and compared with the general obstetrical population. RESULTS A total of 350 pregnancies were identified, of which 23% were ongoing pregnancies in which trisomy 21 was diagnosed prenatally and 24% involved diagnoses made after delivery. Compared with the general obstetrical population, women with ongoing pregnancies affected by trisomy 21 were more likely to be older (mean age 34 vs. 29 y), multiparous (67% vs. 55%), and in a relationship (79% vs. 68%). Trisomy 21 was associated with a significantly increased risk of preterm birth (<37 weeks; 24.1% vs. 8.3%); small for gestational age (<10th percentile; 21.7% vs. 8.2%); cesarean delivery (31.5% vs. 27.1%); and combined perinatal/neonatal mortality (8.0% vs. 0.8%) (P < 0.001 for all). CONCLUSION Trisomy 21 is associated with significant adverse perinatal and neonatal risks. Population screening to identify trisomy 21 can be used to optimize perinatal outcomes with appropriate fetal surveillance in these pregnancies.
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Dhillon GS, Ghanayem NS, Broda CR, Lalani SR, Mery CM, Shekerdemian LS, Staffa SJ, Morris SA. An Analysis of Hospital Mortality After Cardiac Operations in Children With Down Syndrome. Semin Thorac Cardiovasc Surg 2020; 32:947-957. [PMID: 32621963 DOI: 10.1053/j.semtcvs.2020.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 11/11/2022]
Abstract
Children with Down syndrome (DS) have lower mortality compared to nonsyndromic (NS) children after atrioventricular septal defect (AVSD) repair. Limited data exist regarding hospital mortality and utilization after other congenital heart disease (CHD) operations in DS. We compared hospital mortality and utilization after CHD operations in both populations and hypothesized that the survival benefit in children with DS is not consistent across CHD lesions. The Texas Inpatient Public Use Datafile was queried for all patients <18 years old undergoing operations for CHD between 1999 and 2016. Hospital mortality, length-of-stay and charges were compared between DS and NS groups, stratified by CHD operation using mixed-effects multivariable analyses and propensity score matching analyses adjusting for prematurity, low birth weight, age, and sex. Over the 18-year period, 2841 cases with DS underwent CHD operations compared to 25,063 NS cases. The most common types of interventions performed in DS were AVSD repair, isolated ventricular septal defect (VSD) repair and tetralogy of Fallot (TOF) repair. By multivariable analyses, DS was associated with lower mortality after isolated AVSD repair (RR 0.40 [IQR 0.20-0.79]), and higher hospital mortality after bidirectional Glenn anastomosis (BDG) (RR 5.17 [IQR 2.10-12.77]) and TOF/pulmonary atresia repair (RR 9.71 [IQR 2.16-43.68]) compared to NS children. Similar results were noted using propensity score matching. Children with DS had lower mortality after AVSD repair than NS children, but higher mortality after operations for BDG and TOF/pulmonary atresia. Further study is needed to determine if the presence of pulmonary hypertension in DS modifies the association between DS and mortality depending on cardiac lesion.
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Affiliation(s)
- Gurpreet S Dhillon
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
| | - Nancy S Ghanayem
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Christopher R Broda
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School and Dell Children's Medical Center, Austin, Texas
| | - Lara S Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Shaine A Morris
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Vizitiu AC, Stambouli D, Pavel AG, Muresan MC, Anastasiu DM, Bejinar C, Alexa A, Marian C, Sirbu IO, Sima L. Mature miR-99a Upregulation in the Amniotic Fluid Samples from Female Fetus Down Syndrome Pregnancies: A Pilot Study. ACTA ACUST UNITED AC 2019; 55:medicina55110728. [PMID: 31703316 PMCID: PMC6915350 DOI: 10.3390/medicina55110728] [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: 09/17/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023]
Abstract
Background and Objective: Although Down syndrome is the most frequent aneuploidy, its pathogenic molecular mechanisms are not yet fully understood. The aim of our study is to quantify-by qRT-PCR-the expression levels of both the mature forms and the pri-miRNAs of the microRNAs resident on chromosome 21 (miR(21)) in the amniotic fluid samples from Down syndrome singleton pregnancies and to estimate the impact of the differentially expressed microRNAs on Down syndrome fetal heart and amniocytes transcriptomes. Materials and methods: We collected amniotic fluid samples harvested by trained obstetricians as part of the second trimester screening/diagnostic procedure for aneuploidies to assess the trisomy 21 status by QF-PCR and karyotyping. Next, we evaluated-by Taqman qRT-PCR-the expression levels of both the mature forms and the pri-miRNA precursors of the microRNAs resident on chromosome 21 in amniotic fluid samples from singleton Down syndrome and euploid pregnancies. Further, we combined miRWalk 3.0 microRNA target prediction with GEO DataSets analysis to estimate the impact of hsa-miR-99a abnormal expression on Down syndrome heart and amniocytes transcriptome. Results: We found a statistically significant up-regulation of the mature form of miR-99a, but not pri-miR-99a, in the amniotic fluid samples from Down syndrome pregnancies with female fetuses. GATHER functional enrichment analysis of miRWalk3.0-predicted targets from Down syndrome amniocytes and fetal hearts transcriptome GEODataSets outlined both focal adhesion and cytokine-cytokine receptor interaction signaling as novel signaling pathways impacted by miR-99a and associated with cardiac defects in female Down syndrome patients. Conclusions: The significant overexpression of miR-99a, but not pri-miR-99a, points towards an alteration of the post-transcriptional mechanisms of hsa-miR-99a maturation and/or stability in the female trisomic milieu, with a potential impact on signaling pathways important for proper development of the heart.
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Affiliation(s)
- Anda-Cornelia Vizitiu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Nr. 2, Timisoara 300041, Romania;
| | - Danae Stambouli
- CytoGenomic Medical Laboratory, Calea Floreasca Nr. 35, Sector 1, Bucharest 014451, Romania; (D.S.); (A.-G.P.)
| | - Anca-Gabriela Pavel
- CytoGenomic Medical Laboratory, Calea Floreasca Nr. 35, Sector 1, Bucharest 014451, Romania; (D.S.); (A.-G.P.)
| | - Maria-Cezara Muresan
- Obstetrics and Gynecology Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania (D.M.A.)
| | - Diana Maria Anastasiu
- Obstetrics and Gynecology Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania (D.M.A.)
| | - Cristina Bejinar
- Biochemistry Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania; (C.B.); (A.A.); (C.M.)
| | - Anda Alexa
- Biochemistry Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania; (C.B.); (A.A.); (C.M.)
| | - Catalin Marian
- Biochemistry Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania; (C.B.); (A.A.); (C.M.)
| | - Ioan Ovidiu Sirbu
- Biochemistry Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania; (C.B.); (A.A.); (C.M.)
- Correspondence: ; Tel.: +40-756-136-272
| | - Laurentiu Sima
- Surgical Semiology Department, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Nr. 2, Timisoara 300041, Romania;
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Corona-Rivera JR, Nieto-García R, Gutiérrez-Chávez AS, Bobadilla-Morales L, Rios-Flores IM, Corona-Rivera A, Fabián-Morales GE, Zavala-Cortés I, Lugo-Iglesias C, Peña-Padilla C. Maternal risk factors for congenital heart defects in infants with Down syndrome from Western Mexico. Am J Med Genet A 2019; 179:1857-1865. [PMID: 31321895 DOI: 10.1002/ajmg.a.61300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/01/2019] [Accepted: 07/10/2019] [Indexed: 11/07/2022]
Abstract
Atrioventricular septal defects (AVSDs) have been identified as intriguingly infrequent among Hispanics with Down syndrome (DS) born in the United States. The aim of this study was to evaluate the effect of possible maternal risk factors in the presence of congenital heart defects (CHDs) in Mexican infants with DS. A total of 231 live birth infants born with DS during 2009-2018 at the "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara (Guadalajara, Mexico) were ascertained in a case-control study. Patients with DS with any major CHD were included as cases and those without major CHD as controls. Potential risk factors were analyzed using logistic regression. Of eligible infants with DS, 100 (43.3%) had ≥1 major CHDs (cases) and were compared with a control group of 131 infants (56.7%) with DS without CHDs. Prevalent CHDs were ostium secundum atrial septal defects (ASDs) (46.9%), ventricular septal defects (27.3%), and AVSDs (14%). Lack of folic acid supplementation before pregnancy had a significant risk for CHDs in infants with DS (adjusted odds ratio [aORs] = 2.9 (95% confidence interval [95% CI]: 1.0-8.6) and in the analysis by subtype of CHDs, also, for the occurrence of ASDs (aOR = 11.5, 95% CI: 1.4-94.4). Almost half of the infants with DS in our sample had CHDs, being ASD the commonest subtype and AVSD the rarest. Our ethnic background alone or in concomitance with observed nutritional disadvantages seems to contribute differences in CHD subtype rates in our DS patients.
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Affiliation(s)
- Jorge Román Corona-Rivera
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico.,Dr. Enrique Corona-Rivera Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Rafael Nieto-García
- Service of Cardiology, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Andrea S Gutiérrez-Chávez
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Lucina Bobadilla-Morales
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico.,Dr. Enrique Corona-Rivera Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Izabel M Rios-Flores
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Alfredo Corona-Rivera
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico.,Dr. Enrique Corona-Rivera Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Gerardo E Fabián-Morales
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ignacio Zavala-Cortés
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Cynthia Lugo-Iglesias
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Christian Peña-Padilla
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
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Martini J, Bidondo MP, Duarte S, Liascovich R, Barbero P, Groisman B. Birth prevalence of Down syndrome in Argentina. Salud Colect 2019; 15:e1863. [PMID: 31365691 DOI: 10.18294/sc.2019.1863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/04/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to describe the prevalence at birth of Down syndrome in Argentina. The prevalence by jurisdiction and maternal age was calculated for the 2009-2015 period and the prevalence and proportion of prenatal diagnosis was compared according to sub-sector (public and private) and complexity level of the maternity wards. The association of Down syndrome with birth weight and gestational age was analyzed. The data source was the National Network of Congenital Anomalies of Argentina [Red Nacional de Anomalías Congénitas] (RENAC). The prevalence was 17.26 per 10,000 births; by jurisdictions it varied between 10.99 and 23.71; and by maternal age, between 10.32 in women <20 years of age and 158.06 in those ≥45 years of age. In hospitals of the private subsector there was a higher prevalence, attributable to differences in the structure of maternal age, and a greater proportion of prenatal diagnosis. There was a negative correlation between birth weight and Down syndrome (ß=-294.7; p<0.001). No difference in the median gestational age at birth between Down syndrome newborns and newborns without major anomalies was found, but the distribution of gestational age differed. Knowledge of certain epidemiological characteristics of this health issue could contribute to the implementation of health policies.
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Affiliation(s)
- Javier Martini
- Médico residente en Genética Médica. RENAC-CNGM, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Desarrollo Social, Argentina.
| | - María Paz Bidondo
- Médico especialista en Genética Médica y Epidemiología. RENAC-CNGM, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Desarrollo Social, Argentina.
| | - Santiago Duarte
- Médico residente en Genética Médica. RENAC-CNGM, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Desarrollo Social, Argentina.
| | - Rosa Liascovich
- Doctora en Ciencias Biológicas. RENAC-CNGM, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Desarrollo Social, Argentina.
| | - Pablo Barbero
- Médico especialista en Genética Médica, Doctor en Medicina. RENAC-CNGM, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Desarrollo Social, Argentina.
| | - Boris Groisman
- Médico especialista en Genética Médica y Epidemiología. RENAC-CNGM, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Desarrollo Social, Argentina.
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Zhang H, Liu L, Tian J. Molecular mechanisms of congenital heart disease in down syndrome. Genes Dis 2019; 6:372-377. [PMID: 31832516 PMCID: PMC6889238 DOI: 10.1016/j.gendis.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Down syndrome (DS), as a typical genomic aneuploidy, is a common cause of various birth defects, among which is congenital heart disease (CHD). 40-60% neonates with DS have some kinds of CHD. However, the molecular pathogenic mechanisms of DS associated CHD are still not fully understood. This review summarizes available studies on DS associated CHD from seven aspects so as to provide a crucial and updated overview of what we known so far in this domain.
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Affiliation(s)
- Hui Zhang
- Department of Cardiology, Heart Centre, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
| | - Lingjuan Liu
- Department of Cardiology, Heart Centre, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
| | - Jie Tian
- Department of Cardiology, Heart Centre, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
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Takano T, Akagi M, Takaki H, Inuzuka R, Nogimori Y, Ono H, Kaneko M, Hagiwara N. Sex differences in congenital heart disease in Down syndrome: study data from medical records and questionnaires in a region of Japan. BMJ Paediatr Open 2019; 3:e000414. [PMID: 31321317 PMCID: PMC6598551 DOI: 10.1136/bmjpo-2018-000414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/01/2019] [Indexed: 11/09/2022] Open
Abstract
Reports indicate lower Down syndrome (DS) survival among females than among males in Australia, contrasting with female longevity in the general population. Using data on 1310 people with DS (626 females and 684 males) in Japan from five hospitals' medical records and questionnaires completed by parents of people with DS, we investigated sex differences in congenital heart disease (CHD), which may be related to mortality. The CHD rate was significantly higher for females (354, 57%) than for males (338, 49%; p=0.010). Significantly more females (199, 32%) than males (175, 26%) underwent surgery for CHD (p=0.018).
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Affiliation(s)
- Takako Takano
- Department of Child Health, Tokyo Kasei University, Itabashi-ku, Japan
| | - Michio Akagi
- Department of Medical Education, Kyorin University, Mitaka, Japan
| | - Haruyoshi Takaki
- Department of Nursing, Tokyo Healthcare University, Meguro-ku, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, University of Tokyo, Bunkyo-ku, Japan
| | - Yoshitsugu Nogimori
- Department of Cardiovascular Medicine, Kanagawa Childrens Medical Center, Yokohama, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Masahide Kaneko
- Department of Pediatrics, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Japan
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Moorthie S, Blencowe H, Darlison MW, Gibbons S, Lawn JE, Mastroiacovo P, Morris JK, Modell B. Chromosomal disorders: estimating baseline birth prevalence and pregnancy outcomes worldwide. J Community Genet 2018; 9:377-386. [PMID: 28948513 PMCID: PMC6167258 DOI: 10.1007/s12687-017-0336-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/18/2017] [Indexed: 01/28/2023] Open
Abstract
Chromosomal disorders, of which Down syndrome is the most common, can cause multi-domain disability. In addition, compared to the general population, there is a higher frequency of death before the age of five. In many settings, large gaps in data availability have hampered policy-making, programme priorities and resource allocation for these important conditions. We have developed methods, which overcome this lack of data and allow estimation of the burden of affected pregnancies and their outcomes in different settings worldwide. For example, the methods include a simple equation relating the percentage of mothers 35 and over to Down syndrome birth prevalence. The results obtained provide a starting point for consideration of services that can be implemented for the care and prevention of these disorders.
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Affiliation(s)
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew W Darlison
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Stephen Gibbons
- Department of Geography and Environment, London School of Economics, London, UK
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pierpaolo Mastroiacovo
- Coordinating Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Joan K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bernadette Modell
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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Sex differences for major congenital heart defects in Down Syndrome: A population based study. Eur J Med Genet 2018; 61:546-550. [DOI: 10.1016/j.ejmg.2018.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022]
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38
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NICU management and outcomes of infants with trisomy 21 without major anomalies. J Perinatol 2018; 38:1068-1073. [PMID: 29795453 PMCID: PMC6335104 DOI: 10.1038/s41372-018-0136-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe how trisomy 21 affects neonatal intensive care management and outcomes of full-term infants without congenital anomalies. STUDY DESIGN Retrospective cohort of full-term infants without anomalies with and without trisomy 21 admitted to Pediatrix NICUs from 2005 to 2012. We compared diagnoses, management, length of stay, and discharge outcomes. RESULTS In all, 4623 infants with trisomy 21 and 606 770 infants without trisomy 21 were identified. One-third of infants in the NICU with and without trisomy 21 were full term without major anomalies. Trisomy 21 infants had more respiratory distress, thrombocytopenia, feeding problems, and pulmonary hypertension. They received respiratory support for a longer period of time and had a longer length of stay. CONCLUSION 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.
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Masaki N, Saiki Y, Endo M, Maeda K, Adachi O, Akiyama M, Kawamoto S, Saiki Y. Is Trisomy 21 a Risk Factor for Rapid Progression of Pulmonary Arteriopathy? ― Revisiting Histopathological Characteristics Using 282 Lung Biopsy Specimens ―. Circ J 2018; 82:1682-1687. [DOI: 10.1253/circj.cj-17-0754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yuriko Saiki
- Department of Molecular Pathology, Tohoku University Graduate School of Medicine
| | - Masato Endo
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Kay Maeda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Osamu Adachi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Masatoshi Akiyama
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
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Ravel A. [Genetics, diagnosis and characteristics of trisomy 21]. SOINS. PEDIATRIE, PUERICULTURE 2018; 39:10-14. [PMID: 29747764 DOI: 10.1016/j.spp.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Trisomy 21 remains relevant today. As patients' life expectancy increases, medical monitoring shows the importance of screening for associated complications such as epilepsy and sleep apnoea. For caregivers, it constitutes a care model for intellectually disabled people notably with regard to anxiety, poor expression of pain and family suffering. Scientific advances raise hope of progress in therapeutic practices.
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Affiliation(s)
- Aimé Ravel
- Institut Jérôme Lejeune, 337 rue des Volontaires, 75725 Paris cedex 15, France.
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Brodwall K, Greve G, Leirgul E, Klungsøyr K, Holmstrøm H, Vollset SE, Øyen N. The five-year survival of children with Down syndrome in Norway 1994-2009 differed by associated congenital heart defects and extracardiac malformations. Acta Paediatr 2018; 107:845-853. [PMID: 29341296 DOI: 10.1111/apa.14223] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/31/2017] [Accepted: 01/11/2018] [Indexed: 01/28/2023]
Abstract
AIM We investigated the prevalence of Down syndrome in a nationwide birth cohort, focusing on congenital heart defects (CHDs), their associations with extracardiac malformations (ECM) and survival. METHODS National registers were used to identify Norwegian births (1994-2009) and deaths (1994-2014) and updated with hospital diagnoses. We estimated birth defect frequencies in Down syndrome and the general population, the association between CHDs and ECM and hazard ratios for death from different combinations of CHDs and ECM. RESULTS Down syndrome was found in 1672 of 953 450 births (17.6 per 10 000). Of the 1251 live births (13.3 per 10 000), 58% had CHD and 9% ECM. CHDs were associated with oesophageal atresia (p = 0.02) and Hirschsprung's disease (p = 0.03) but with no other malformations. The five-year survival for Down syndrome increased from 91.8% (1994-1999) to 95.8% (2000-2009) (p = 0.006), and overall survival was 92.0% with CHD and 97.4% without. Compared with Down syndrome children without CHD or ECM, the five-year mortality was similar for those with nonsevere CHDs, without or with ECM, but 4-7 times higher in those with severe CHDs without ECM and 13-28 times higher in those with severe CHDs and ECM. CONCLUSION Down syndrome childhood survival improved, but mortality remained high with severe CHDs and extracardiac defects.
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Affiliation(s)
- Kristoffer Brodwall
- Department of Global Public Health and Primary Care; Faculty of Medicine; University of Bergen; Bergen Norway
- Department of Paediatrics; Haukeland University Hospital; Bergen Norway
| | - Gottfried Greve
- Department of Medical Science; University of Bergen; Bergen Norway
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
| | - Elisabeth Leirgul
- Department of Global Public Health and Primary Care; Faculty of Medicine; University of Bergen; Bergen Norway
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care; Faculty of Medicine; University of Bergen; Bergen Norway
- Division of Mental and Physical Health; Norwegian Institute of Public Health; Bergen Norway
| | - Henrik Holmstrøm
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care; Faculty of Medicine; University of Bergen; Bergen Norway
- Norwegian Institute of Public Health; Oslo Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care; Faculty of Medicine; University of Bergen; Bergen Norway
- Department of Medical Genetics; Haukeland University Hospital; Bergen Norway
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Pfitzer C, Helm PC, Rosenthal LM, Berger F, Bauer UMM, Schmitt KR. Dynamics in prevalence of Down syndrome in children with congenital heart disease. Eur J Pediatr 2018; 177:107-115. [PMID: 29127498 DOI: 10.1007/s00431-017-3041-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 01/22/2023]
Abstract
UNLABELLED We assessed the dynamics in the prevalence of children with congenital heart disease (CHD) and Down syndrome in Germany with regard to phenotype, severity, and gender. Data from patients with CHD and Down syndrome born between 1980 and 2014 were analyzed, who are registered with the German National Register for Congenital Heart Defects. One thousand six hundred eighteen CHD patients with Down syndrome were identified. The prevalence of children born with both Down syndrome and CHD was constant from 2005 to 2009 but increased from 2010 to 2014. Regarding CHD groups, complex and simple lesions have become more equal since 2005. The number of simple lesions with shunt has a peak prevalence in the period of 2010-2014. Atrioventricular septal defect was the most common CHD phenotype, but temporal changes were found within the group of CHD phenotypes over the observation period. CONCLUSION Our findings suggest a growing number of CHD and Down syndrome, which may be the result of improved medical management and progress in educational, social, and financial support. This development is noteworthy as it adds new aspects to present discussions in the media and political settings. What is known: • Congenital heart disease is regarded to be the most important clinical phenomenon in children with Down syndrome, due to its significant impact on morbidity and mortality. • New developments in prenatal diagnostic and therapy management of congenital heart disease continue to influence the number of patients diagnosed with congenital heart disease and Down syndrome. What is New: • This study provides essential data giving the first overview of the dynamics in the prevalence of congenital heart disease and Down syndrome over an extended length of time up to 2015 in a large patient cohort, taking recent developments into account. • Our data suggest a growing prevalence of congenital heart disease and Down syndrome, which may be the result of improved medical management for Down syndrome patients and progress in educational, social, and financial support for their families; this development is noteworthy as it adds new aspects to the present discussion in the media and political settings.
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Affiliation(s)
- Constanze Pfitzer
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| | - Paul C Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Lisa-Maria Rosenthal
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Paediatric Cardiology, Charite-Universitaetsmedizin, Berlin, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Katharina Rl Schmitt
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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Mann JP, Statnikov E, Modi N, Johnson N, Springett A, Morris JK. Management and outcomes of neonates with down syndrome admitted to neonatal units. ACTA ACUST UNITED AC 2017; 106:468-74. [PMID: 27301559 DOI: 10.1002/bdra.23513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonates with Down syndrome have an increased risk of being admitted to a neonatal unit compared with unaffected neonates. We aimed to estimate the proportion of neonates with Down syndrome admitted to a neonatal unit and compare their management and outcomes with other neonatal admissions. METHODS Case-control study of neonates born from 2009 to 2011 admitted to 122 NHS Neonatal Units in England using data from the National Down Syndrome Cytogenetic Register and the National Neonatal Research Database. For each neonate with Down syndrome, three neonates admitted to the same unit in the same month and born at the same gestation were identified. RESULTS Forty-six percent of neonates with Down syndrome were admitted to a neonatal unit. Boys were more likely to be admitted than girls (odds ratio = 1.7; 95% confidence interval, 1.4-2.0). Neonates with Down syndrome required more intensive or high dependency care compared with unaffected neonates (37% vs. 27%. p < 0.01) and stayed in neonatal units for longer (11 days vs. 5 days, p < 0.01). A total of 31% of neonates with Down syndrome required respiratory support compared with 22% (p < 0.001) of unaffected neonates, and 11% were discharged requiring oxygen supplementation compared with 3% (p < 0.001) of unaffected neonates. A total of 3% of neonates with Down syndrome died in a neonatal unit compared with 1% (p = 0.01) of unaffected neonates. CONCLUSION Neonates with Down syndrome are more likely than unaffected neonates to be admitted to a neonatal unit, have a prolonged stay, and be discharged home on supplemental oxygen. Birth Defects Research (Part A) 106:468-474, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jake P Mann
- Department of paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Eugene Statnikov
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom
| | - Nik Johnson
- Children's unit, Hinchingbrooke Hospital, Huntingdon, United Kingdom
| | - Anna Springett
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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Diogenes TCP, Mourato FA, de Lima Filho JL, Mattos SDS. Gender differences in the prevalence of congenital heart disease in Down's syndrome: a brief meta-analysis. BMC MEDICAL GENETICS 2017; 18:111. [PMID: 28985718 PMCID: PMC6389118 DOI: 10.1186/s12881-017-0475-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Down's syndrome (DS) affects one per 700 live births and congenital heart disease (CHD) occurs in 40-60% of these patients. Contributing factors to the association between DS and CHD are being unraveled. Gender could be one of them. METHODS We performed a meta-analysis of CHD prevalence in DS, separated by gender. Three search engines were used and 578 articles were reviewed. Twelve articles were included. RESULTS Quantitative analysis showed a higher prevalence of CHD, particularly atrioventricular septal defects (AVSD), in female patients. No differences were found in others forms of CHD. CONCLUSION CHD, particularly AVSD, are more common in the female gender of Down's syndrome patients.
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Affiliation(s)
| | - Felipe Alves Mourato
- Círculo do Coração de Pernambuco, Recife, Pernambuco, Brazil. .,Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil. .,Unidade de Cardiologia Materno e Fetal (UCMF), Av. Governador Agamenon Magalhães, 4760, Paissandu, PE, CEP 52010-902, Brazil.
| | | | - Sandra da Silva Mattos
- Círculo do Coração de Pernambuco, Recife, Pernambuco, Brazil.,Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Manzoni P, Figueras-Aloy J, Simões EAF, Checchia PA, Fauroux B, Bont L, Paes B, Carbonell-Estrany X. Defining the Incidence and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Children with Chronic Diseases. Infect Dis Ther 2017; 6:383-411. [PMID: 28653300 PMCID: PMC5595774 DOI: 10.1007/s40121-017-0160-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION REGAL (RSV Evidence-a Geographical Archive of the Literature) has provided a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This review covers the risk and burden of RSV infection in children with underlying medical conditions or chronic diseases (excluding prematurity and congenital heart disease). METHODS A systematic review of publications between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov was supplemented by papers identified by the authors through March 2017. Studies reporting data for hospital visits/admissions for RSV infection as well as studies reporting RSV-associated morbidity and mortality were included. Study quality and strength of evidence (SOE) were graded. RESULTS A total of 2703 studies were identified and 58 were included. Down syndrome, irrespective of prematurity and congenital heart disease (moderate SOE), immunocompromised children (low SOE), cystic fibrosis (low SOE), and neurologic conditions (low SOE) were associated with a significantly increased risk of RSV hospitalization. A number of other congenital malformations and chronic conditions were also associated with severe RSV disease (low SOE). In general, pre-existing disease was also a predisposing factor for RSV-related mortality (low SOE). CONCLUSION Severe RSV infection in infants and young children with underlying medical conditions or chronic diseases poses a significant health burden. Further studies are needed to fully quantify the epidemiology, burden and outcomes in these populations, in particular RSV-attributable mortality.
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Affiliation(s)
- Paolo Manzoni
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
- ReSViNET (Respiratory Syncytial Virus Network), Málaga, Spain
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Eric A F Simões
- Center for Global Health, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Louis Bont
- ReSViNET (Respiratory Syncytial Virus Network), Málaga, Spain
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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Sharma S, Bhanot R, Deka D, Bajpai M, Gupta DK. Impact of fetal counseling on outcome of antenatal congenital surgical anomalies. Pediatr Surg Int 2017; 33:203-212. [PMID: 27864598 DOI: 10.1007/s00383-016-4015-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 12/27/2022]
Abstract
AIM To analyze the impact of counseling on antenatal congenital surgical anomalies (ACSA). METHODS Cases presenting with ACSA for fetal counseling and those presenting in post-natal period following diagnosis of ACSA (PACSA) for surgical opinion were analyzed for spectrum, presentation and outcome. RESULTS 117 cases including ACSA(68);PACSA(49) were analyzed. Gestational age at diagnosis of ACSA;PACSA was 17-37;17-39 weeks (median 24;32 weeks). Diagnoses in ACSA;PACSA included urological (26;31), neurological (10;5), congenital diaphragmatic hernia (CDH)(5;1), gastrointestinal (5;5), lung and chest anomalies (5;1), intraabdominal cysts (4;1), abdominal wall defects (4;0), tumors (3;3), limb anomaly (1;1), esophageal atresia (1;1), conjoint twins (1;0), hepatomegaly (1;0), and major cardiac anomalies (2;0). Two antenatal interventions were done for ACSA; vesicoamniotic shunt and amnioinfusion for oligohydramnios. 17;24 ACSA;PACSA required early surgical intervention in post-natal period. Nine ACSA underwent medical termination of pregnancy and 4 had intrauterine demise. Nine ACSA babies died including two CDH, one gastroschisis, one duodenal atresia, one conjoint twins, one megacystitis with motility disorder and three posterior urethral valves. All PACSA babies survived. CONCLUSION Fetal counseling for CSA portrays true outcome of ACSA with 32.3% (22/68) mortality versus 0% for PACSA due to selection bias. However, fetal counseling ensures optimal perinatal care.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ranjana Bhanot
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- Department of Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Berg E, Sivertsen Å, Ariansen AMS, Filip C, Vindenes HA, Feragen KB, Moster D, Lie RT, Haaland ØA. Socio-Economic Status and Reproduction among Adults Born with an Oral Cleft: A Population-Based Cohort Study in Norway. PLoS One 2016; 11:e0162196. [PMID: 27631472 PMCID: PMC5025077 DOI: 10.1371/journal.pone.0162196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/18/2016] [Indexed: 11/21/2022] Open
Abstract
Background It has been reported that people born with orofacial clefts do worse in life than their peers regarding a range of social markers, such as academic achievement and reproduction. We have compared otherwise healthy individuals with and without clefts, to investigate if these differences are due to the cleft or other background factors. Materials and Methods In a retrospective national cohort study, based on compulsory registers with data collected prospectively, we included everybody born in Norway between 1967 and 1992 (1490279 individuals, 2584 with clefts). This cohort was followed until the year 2010, when the youngest individuals were 18 years old. In order to ensure that the individuals were not affected by unknown syndromes or diseases, we excluded all individuals with any chronic medical condition, or who had other birth defects than clefts, hydroceles and dislocated hips. Individuals with oral clefts who were included in the study are said to have isolated clefts. Results Isolated cleft patients are similar to the general population regarding education, income and social class. Isolated cleft patients have lower fertility than the background population, but considering only married couples this difference in fertility disappeared. Conclusions An oral cleft did not appear to affect future socioeconomic status or chances of becoming a parent for children born in Norway. An exception was males with cleft lip and palate, but differences were small.
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Affiliation(s)
- Erik Berg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Åse Sivertsen
- Department of Plastic Surgery, Haukeland University Hospital, Bergen, Norway
- Norwegian Quality Registry of Cleft Lip and Palate, Bergen, Norway
| | | | - Charles Filip
- Norwegian Quality Registry of Cleft Lip and Palate, Bergen, Norway
- Department of Plastic and Reconstructive Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Halvard A. Vindenes
- Department of Plastic Surgery, Haukeland University Hospital, Bergen, Norway
- Norwegian Quality Registry of Cleft Lip and Palate, Bergen, Norway
| | | | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Rolv Terje Lie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
| | - Øystein A. Haaland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
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48
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Matthiesen NB, Agergaard P, Henriksen TB, Bach CC, Gaynor JW, Hjortdal V, Østergaard JR. Congenital Heart Defects and Measures of Fetal Growth in Newborns with Down Syndrome or 22q11.2 Deletion Syndrome. J Pediatr 2016; 175:116-122.e4. [PMID: 27245297 DOI: 10.1016/j.jpeds.2016.04.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/18/2016] [Accepted: 04/20/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To estimate the association between congenital heart defects (CHD) and indices of fetal growth in Down and 22q11.2 deletion syndromes. STUDY DESIGN We established 2 Danish nationwide cohorts of newborn singletons with either Down syndrome (n = 670) or 22q11.2 deletion syndrome (n = 155), born 1997-2011. In both cohorts, we analyzed the association between CHD, CHD severity, and indices of fetal growth by multivariable linear regression adjusted for potential confounders. We report mean differences in gestational age specific z-scores compared with newborns without CHD. RESULTS Down syndrome and 22q11.2 deletion syndrome were both associated with lower mean birth weight and head circumference z-scores. We found no association between CHD or CHD severity and indices of fetal growth. In Down syndrome, the association between any CHD and the mean difference in head circumference z-score was 0.03 (95% CI -0.12, 0.18), and the estimate regarding birth weight z-score was 0.09 (95% CI -0.08, 0.25). The corresponding estimates in 22q11.2 deletion syndrome were 0.00 (95% CI -0.33, 0.32) and -0.09 (95% CI -0.45, 0.26). CONCLUSIONS We found no association between CHD and fetal growth measures in newborns with Down syndrome or 22q11.2 deletion syndrome. Thus, in certain subtypes of CHD, the contribution of genetic factors to prenatal growth impairment may be more important than circulatory disturbances.
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Affiliation(s)
- Niels B Matthiesen
- Centre for Rare Diseases and Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Horsens Regional Hospital, Horsens, Denmark.
| | - Peter Agergaard
- Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Denmark
| | - Tine B Henriksen
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Cathrine C Bach
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Denmark
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49
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Bergström S, Carr H, Petersson G, Stephansson O, Bonamy AKE, Dahlström A, Halvorsen CP, Johansson S. Trends in Congenital Heart Defects in Infants With Down Syndrome. Pediatrics 2016; 138:peds.2016-0123. [PMID: 27252035 DOI: 10.1542/peds.2016-0123] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As a result of antenatal screening, abortion of fetuses with Down syndrome has become increasingly common. Little is known about the cardiovascular phenotype in infants with Down syndrome born today. METHODS Population-based cohort study based on national health registers including 2588 infants with Down syndrome, live-born in Sweden from 1992 to 2012. Risk ratios for congenital heart defects were calculated per 3-year period, adjusted for maternal age, parity, BMI, smoking, diabetes and hypertensive disease, and infant gender. RESULTS Any congenital heart defect was diagnosed in 54% of infants with Down syndrome. Overall, year of birth was not associated with risk of any congenital heart defect. However, the risk of complex congenital heart defects decreased over time. Compared with 1992 to 1994, the risk in 2010 to 2012 was reduced by almost 40% (adjusted risk ratio 0.62, 95% confidence interval 0.48-0.79). In contrast, risks for isolated ventricular septal defect (VSD) or atrial septal defect showed significant increases during latter years. Overall, the 3 most common diagnoses were atrioventricular septal defect, VSD, or atrial septal defect, accounting for 42%, 22%, and 16% of congenital heart defects, respectively. Although atrioventricular septal defect was far more common than VSD in 1992 to 1994, they were equally common in 2010 to 2012. CONCLUSIONS Complex congenital heart defects have become less common in infants diagnosed with Down syndrome. This phenotypic shift could be a result of selective abortion of fetuses with Down syndrome, or due to general improvements in antenatal diagnostics of complex congenital heart defects.
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Affiliation(s)
- Sofie Bergström
- Clinical Epidemiology Unit, Department of Medicine Solna, and
| | - Hanna Carr
- Clinical Epidemiology Unit, Department of Medicine Solna, and
| | | | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine Solna, and School of Public Health, University of California, Berkeley, California
| | | | | | - Cecilia Pegelow Halvorsen
- Departments of Clinical Research and Education, and Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden; and
| | - Stefan Johansson
- Clinical Epidemiology Unit, Department of Medicine Solna, and Departments of Clinical Research and Education, and
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Dimopoulos K, Kempny A. Patients with Down syndrome and congenital heart disease: survival is improving, but challenges remain: Table 1. Heart 2016; 102:1515-7. [DOI: 10.1136/heartjnl-2016-309835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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