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Jaspersen SL, Bruns DA, Candee MS, Battaglia A, Carey JC, Fishler KP. Seizures in trisomy 18: Prevalence, description, and treatment. Am J Med Genet A 2023; 191:1026-1037. [PMID: 36601988 DOI: 10.1002/ajmg.a.63113] [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: 11/12/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
Changes in medical intervention over the last decade have improved outcomes for individuals with trisomy 18, the second most common human aneuploidy syndrome at birth. As children with trisomy 18 live longer, a shared concern of medical experts and parents is the occurrence and treatment of seizures. Previously published surveillance guidelines for this condition have not addressed seizure management. Using parent-reported data collected as part of the Tracking Rare Incidence Syndromes project, we report on the prevalence, course, and management of seizures in individuals with trisomy 18. Twenty-eight percent (52/186) of individuals diagnosed with trisomy 18 in our retrospective cohort experienced generalized, focal, or mixed seizures at some point in their lifetime. For many individuals, seizures were effectively managed by broad-spectrum anti-seizure medications. Correlation analysis showed that focal and generalized seizures were more likely to occur in individuals who had previously experienced infantile spasms or central apnea. Electroencephalogram testing should be considered as part of a standard screening approach in individuals with trisomy 18 to enable early diagnosis and treatment of seizures. An international registry that incorporates parent-reported and clinical data for patients with trisomy 18 may facilitate ongoing research and recruitment into clinical trials for seizure management.
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Affiliation(s)
- Sue L Jaspersen
- Genetic Counseling Program, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deborah A Bruns
- Special Education Program, School of Education, Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | - Meghan S Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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2
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Hu RS, Heffernan J, Sims J, Wojcik MH. Trisomy 13: Survival beyond the NICU. Neoreviews 2023; 24:51-56. [PMID: 36587011 PMCID: PMC10184504 DOI: 10.1542/neo.24-1-e51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Trisomy 13 is the third most common autosomal aneuploidy disorder and is associated with a number of congenital malformations. Survival of infants with trisomy 13 has improved over time as life-prolonging technological interventions are more commonly offered. In this article, we describe the course of a child with trisomy 13 who has been followed at our hospital since infancy and explore the changing landscape of care for children with trisomy 13.
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Affiliation(s)
- Rachel S Hu
- Divisions of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School
| | - Jody Heffernan
- Divisions of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School
| | - Jessica Sims
- Divisions of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School
| | - Monica H Wojcik
- Divisions of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School
- Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School
- Maternal Fetal Care Center, Boston Children’s Hospital, Boston, MA
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3
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Kusano ME, Schmidt A. Teaching motor responses to a child with trisomy 18: A preliminary study. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Elisa Kusano
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (USP—FFCLRP), Departamento de Psicologia Universidade de São Paulo – Brasil São Paulo Brazil
| | - Andréia Schmidt
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (USP—FFCLRP), Departamento de Psicologia Universidade de São Paulo – Brasil São Paulo Brazil
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Langarika-Rocafort A, Mondragon NI, Etxebarrieta GR. A Systematic Review of Research on Augmentative and Alternative Communication Interventions for Children Aged 6-10 in the Last Decade. Lang Speech Hear Serv Sch 2021; 52:899-916. [PMID: 33909476 DOI: 10.1044/2021_lshss-20-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this systematic review was to identify, appraise, and critically synthesize the latest available evidence on the effects of augmentative and alternative communication (AAC)-based interventions on communication skills in children aged between 6 and 10 years with mixed diagnoses. Method MEDLINE (OVID), PsycINFO (EBSCO), ERIC (ProQuest), SCIELO (WOS), Teacher Reference Center (EBSCO), and Education Database (ProQuest) were searched. The studies were independently selected by two reviewers for the purposes of the review. The methodological quality of the included studies was assessed, and characteristics and results of the studies were extracted. Results This review included 14 studies from a total of 1,204 found through an electronic search. The AAC interventions studied were effective at improving various outcomes in children with mixed diagnoses. Interventions that focused on narrative skills were the most common type. When considering the quality of the studies, the independence of assessors, data analysis, replication, and generalization of interventions were the weaker areas. Conclusions Interventions analyzed in this review improve communication skills, including phonological awareness, vocabulary, requesting, and developing narrative skills in children aged between 6 and 10 years with mixed diagnoses. The results of one study also indicate that the acquisition of skills using an AAC method is superior when the child prefers the method. Supplemental Material https://doi.org/10.23641/asha.14462256.
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Affiliation(s)
- Argia Langarika-Rocafort
- Faculty of Education of Bilbao, Department of Didactics of Musical, Plastic and Body Expression, University of the Basque Country (EHU/UPV), Leioa, Spain
| | - Nahia Idoiaga Mondragon
- Faculty of Education of Bilbao, Department of Developmental and Educational Psychology, University of the Basque Country (EHU/UPV), Leioa, Spain
| | - Gorka Roman Etxebarrieta
- Faculty of Education of Bilbao, Department of Didactics of Language and Literature, University of the Basque Country (EHU/UPV), Leioa, Spain
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Weaver MS, Anderson V, Beck J, Delaney JW, Ellis C, Fletcher S, Hammel J, Haney S, Macfadyen A, Norton B, Rickard M, Robinson JA, Sewell R, Starr L, Birge ND. Interdisciplinary care of children with trisomy 13 and 18. Am J Med Genet A 2020; 185:966-977. [PMID: 33381915 DOI: 10.1002/ajmg.a.62051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/21/2020] [Accepted: 12/12/2020] [Indexed: 01/20/2023]
Abstract
Children with trisomy 13 and 18 (previously deemed "incompatible with life") are living longer, warranting a comprehensive overview of their unique comorbidities and complex care needs. This Review Article provides a summation of the recent literature, informed by the study team's Interdisciplinary Trisomy Translational Program consisting of representatives from: cardiology, cardiothoracic surgery, neonatology, otolaryngology, intensive care, neurology, social work, chaplaincy, nursing, and palliative care. Medical interventions are discussed in the context of decisional-paradigms and whole-family considerations. The communication format, educational endeavors, and lessons learned from the study team's interdisciplinary care processes are shared with recognition of the potential for replication and implementation in other care settings.
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Affiliation(s)
- Meaghann S Weaver
- Division of Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Venus Anderson
- Division of Cardiology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jill Beck
- Division of Oncology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeffrey W Delaney
- Division of Cardiology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cynthia Ellis
- Division of Developmental Pediatrics, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA.,Munroe-Meyer Institute for Genetics and Rehabilitation, Omaha, Nebraska, USA
| | - Scott Fletcher
- Division of Cardiology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Cardiology, Department of Pediatrics, Creighton University, Omaha, Nebraska, USA
| | - James Hammel
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Suzanne Haney
- Division of Child Advocacy, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Macfadyen
- Division of Critical Care, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Bridget Norton
- Division of Critical Care, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mary Rickard
- Division of Neurology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeffrey A Robinson
- Division of Cardiology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ryan Sewell
- Division of Otolaryngology, Department of Pediatrics, Children's Hospital and Medical Center and ENT Specialists PC, Omaha, Nebraska, USA
| | - Lois Starr
- Munroe-Meyer Institute for Genetics and Rehabilitation, Omaha, Nebraska, USA.,Division of Genetics, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nicole D Birge
- Division of Neonatology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Nebraska Medical Center, Omaha, Nebraska, USA
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6
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Perinatal Counseling Following a Diagnosis of Trisomy 13 or 18: Incorporating the Facts, Parental Values, and Maintaining Choices. Adv Neonatal Care 2020; 20:204-215. [PMID: 31996562 DOI: 10.1097/anc.0000000000000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Families with a prenatal diagnosis of trisomy 13 or 18 are told many things, some true and some myths. They present with differing choices on how to proceed that may or may not be completely informed. PURPOSE To provide the prenatal counselor with a review of the pertinent obstetrical and neonatal outcome data and ethical discussion to help them in supporting families with the correct information for counseling. METHODS/SEARCH STRATEGY This article provides a review of the literature on facts and myths and provides reasonable outcome data to help families in decision making. FINDINGS/RESULTS These disorders comprise a heterogeneous group regarding presentation, outcomes, and parental goals. The authors maintain that there needs to be balanced decision-making between parents and providers for the appropriate care for the woman and her infant. IMPLICATIONS FOR PRACTICE Awareness of this literature can help ensure that prenatal and palliative care consultation incorporates the appropriate facts and parental values and in the end supports differing choices that can support the infant's interests.
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Nishi E, Takasugi M, Kawamura R, Shibuya S, Takamizawa S, Hiroma T, Nakamura T, Kosho T. Clinical courses of children with trisomy 13 receiving intensive neonatal and pediatric treatment. Am J Med Genet A 2018; 176:1941-1949. [PMID: 30152146 DOI: 10.1002/ajmg.a.40350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/22/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
Management of children with trisomy 13 (T13) is controversial because of a paucity of evidence of the natural history, especially focusing on efficacy of treatment. There has been no report regarding natural history of children with T13 receiving intensive neonatal and pediatric treatment without cardiac surgery, although several reports have suggested efficacy of cardiac surgery. To describe the detailed and comprehensive natural history of children with T13 receiving intensive neonatal and pediatric treatment without cardiac surgery, we reviewed clinical information of 24 children with full T13 (15 boys, 9 girls) who were admitted to Nagano Children's Hospital from 1994 to 2016. Intensive neonatal and pediatric treatment without cardiac surgery was provided through careful discussion with the parents. We detailed accurate frequencies of complications, survival, underlying factors and the final modes of death, and psychomotor development of survivors. Unpublished complications including aortopulmonary window, pulmonary-ductus-descending aorta-trunk, biliary system abnormalities, eosinophilic enteritis, and neuroblastoma were described. Accurate frequencies of congenital heart defects (92%) and laryngomalacia and/or tracheomalacia (42%) were determined. The median survival time was 451 days and the 1-year survival rate was 54%. The major underlying factor associated with death was congenital heart defects and heart failure (63%) and the major final mode of death was heart failure (50%). Long-term survivors appeared to show slow but constant psychomotor development. Intensive neonatal and pediatric treatment without cardiac surgery for children with T13 is efficient for survival and psychomotor development, and could be a reasonable choice for parents having fetuses or children with T13.
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Affiliation(s)
- Eriko Nishi
- Division of Medical Genetics, Nagano Children's Hospital, Azumino, Japan.,Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Mizue Takasugi
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan.,Division of Neonatology, Fukuyama Medical Center, Fukuyama, Japan
| | - Rie Kawamura
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Soichi Shibuya
- Department of Pediatric Surgery, Nagano Children's Hospital, Azumino, Japan.,Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Shigeru Takamizawa
- Department of Pediatric Surgery, Nagano Children's Hospital, Azumino, Japan
| | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
| | | | - Tomoki Kosho
- Division of Medical Genetics, Nagano Children's Hospital, Azumino, Japan.,Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
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9
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Braddock BA, Hilton J, Loncke F. Multimodal Behaviors in Autism Spectrum: Insights From Typical Development Inform AAC. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig12.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) who have limited natural speech may communicate using unaided and/or aided augmentative and alternative communication (AAC) and may combine potentially communicative behaviors in multimodal ways. Unaided AAC refers to the use of an alternative and augmentative system of communication that does not require aids external to the communicator's body. Aided AAC relies on the use of aids external to the body, such as pictures or a speech-generating device (SGD). Potential communicative acts refer to any behavior that others interpret as meaningful, including informal (unconventional) behaviors, such as body or hand movement, as well as a few words or (conventional) symbols, such as pointing to pictures. Foundational skills, such as communicative gesture and joint attention, can inform multimodal AAC practices in young children with or at risk for ASD. A data tracker of motor hand, oral-motor/vocal/verbal behaviors, and AAC is provided based on past research in children with or at risk for ASD. The data tracker highlights behaviors ranging from informal to conventional communication forms that may be produced in multimodal ways.
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Affiliation(s)
- Barbara A. Braddock
- Mercy Hospital
St. Louis, MO
- Department of Communication Sciences and Disorders, St. Louis, University
St. Louis, MO
| | - Jane Hilton
- Department of Communication Sciences and Disorders, James Madison University
Harrisonburg, VA
| | - Filip Loncke
- Department of Communication Disorders, University of Virginia
Charlottesville, VA
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Liang CA, Braddock BA, Heithaus JL, Christensen KM, Braddock SR, Carey JC. Reported communication ability of persons with trisomy 18 and trisomy 13. Dev Neurorehabil 2016; 18:322-9. [PMID: 24180637 DOI: 10.3109/17518423.2013.847980] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to describe the communication ability of individuals with trisomy 18 and trisomy 13 syndromes. METHODS Parents reported on children's potential communication acts, words, spontaneous gesture, and augmentative and alternative communication (AAC) using a parent report inventory (n = 32; age range 3-35 years). Potential communicative acts are defined as behaviors produced by an individual that may be interpreted by others to serve communicative functions. RESULTS Potential communicative acts categorized as body movement displayed the highest median rank for reported occurrence followed by vocalization and facial expression. Although symbolic forms were ranked lower, more than half of the parents (66%) reported that their children produced at least one word, gesture or AAC form. Challenging behaviors or stereotypic movement displayed lowest median ranks. CONCLUSIONS Results are discussed in terms of communication potential and the need to address AAC in trisomy 18 and 13.
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Affiliation(s)
- Cheryl A Liang
- a Department of Pediatrics , Saint Louis University School of Medicine , St. Louis , MO , USA and
| | - Barbara A Braddock
- a Department of Pediatrics , Saint Louis University School of Medicine , St. Louis , MO , USA and
| | - Jennifer L Heithaus
- a Department of Pediatrics , Saint Louis University School of Medicine , St. Louis , MO , USA and
| | - Katherine M Christensen
- a Department of Pediatrics , Saint Louis University School of Medicine , St. Louis , MO , USA and
| | - Stephen R Braddock
- a Department of Pediatrics , Saint Louis University School of Medicine , St. Louis , MO , USA and
| | - John C Carey
- b Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA
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Karimnejad K, Costa DJ. Otolaryngologic surgery in children with trisomy 18 and 13. Int J Pediatr Otorhinolaryngol 2015; 79:1831-3. [PMID: 26375930 DOI: 10.1016/j.ijporl.2015.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Trisomy 18 and 13 are the most common autosomal trisomy disorders after Down syndrome. Given the high mortality rate (5-10% one-year survival), trisomy 18 and 13 were historically characterized as uniformly lethal and palliation was the predominant management approach. Management strategy has shifted with recognition that through medical and surgical intervention, children with trisomy 18 and 13 can achieve developmental milestones, live meaningful lives, and exhibit long-term survival. Otolaryngologic surgery in children with trisomy 18 and 13 has not been described. The objective of this article is to describe the role of the otolaryngologist in the management of children with trisomy 18 and 13. METHODS AND MATERIALS Retrospective cohort analysis of the surgery registry for the Support Organization for Trisomy 18, 13 and Related Disorders for otolaryngologic surgeries reported from 1988 through June 1, 2014. RESULTS In the database of approximately 1349 children, 1380 procedures were reported, 231 (17%) of which were otolaryngologic. The most common otolaryngologic procedures were tympanostomy tube placement (57/231, 25%), cleft lip repair (40/231, 17%), tracheostomy (38/231, 16.5%), tonsillectomy and/or adenoidectomy (37/231, 16%), and cleft palate repair (30/231, 13%). Of the ten most common procedures reported, four were otolaryngologic. CONCLUSIONS Seventeen percent of procedures performed in children with trisomy 18 and 13 were otolaryngologic, highlighting the significant role of the otolaryngologist in the treatment of these patients. Surgical intervention may be considered as part of a balanced approach to patient care.
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Affiliation(s)
- Kaveh Karimnejad
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, 3635 Vista Avenue, St. Louis, MO 63110, United States.
| | - Dary J Costa
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, 3635 Vista Avenue, St. Louis, MO 63110, United States; SSM Cardinal Glennon Children's Medical Center, 1465 South Grand Avenue, Room B-826, St. Louis, MO 63104, United States.
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12
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Bruns DA. Developmental status of 22 children with trisomy 18 and eight children with trisomy 13: implications and recommendations. Am J Med Genet A 2015; 167A:1807-15. [PMID: 25847310 DOI: 10.1002/ajmg.a.37102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/25/2015] [Indexed: 11/08/2022]
Abstract
Trisomy 18 and trisomy 13 are conditions often referred to as "incompatible with life" or "lethal anomalies." If there is long-term survival, the outlook is considered "grim." Developmental status is presumed to be minimal. Yet, Baty et al. [1994; 49:189-194] described a variety of developmental skills in their sample. An additional 22 children with trisomy 18 and eight with trisomy 13 are described here. A range of developmental skills is noted with strengths in the language and communication, gross and fine motor and social-emotional domains including indicating preferences, exploration of objects and a range of voluntary mobility. These results serve to expand the knowledge base on developmental status for these groups and advance the need to further explore developmental abilities rather than focus on deficits. Avenues for future research, implications, and recommendations are provided.
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Affiliation(s)
- Deborah A Bruns
- Southern Illinois University Carbondale, Carbondale, Illinois
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13
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Wilkinson KM, Light J. Preliminary Study of Gaze Toward Humans in Photographs by Individuals with Autism, Down Syndrome, or Other Intellectual Disabilities: Implications for Design of Visual Scene Displays. Augment Altern Commun 2014; 30:130-46. [DOI: 10.3109/07434618.2014.904434] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Vanzo RJ, Lortz A, Calhoun ARUL, Carey JC. Academia, advocacy, and industry: a collaborative method for clinical research advancement. Am J Med Genet A 2014; 164A:1619-21. [PMID: 24700599 DOI: 10.1002/ajmg.a.36509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/26/2014] [Indexed: 11/09/2022]
Abstract
Professionals who work in academia, advocacy, and industry often carry out mutually exclusive activities related to research and clinical care. However, there are several examples of collaboration among such professionals that ultimately allows for improved scientific and clinical understanding. This commentary recounts our particular experience (a collaboration between geneticists at the Universities of Minnesota and Utah, the 4p- Support Group, and Lineagen, Inc) and reviews other similar projects. We formally propose this collaborative method as a conduit for future clinical research programs. Specifically, we encourage academicians, directors of family/advocacy/support groups, and members of industry to establish partnerships and document their experiences. The medical community as a whole will benefit from such partnerships and, specifically, families will teach us lessons that could never be learned in a laboratory or textbook.
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Abstract
PURPOSE OF REVIEW To review the evolving management of infants/children with trisomy 18, the prognosis with and without medical intervention, the factors that have contributed to the evolving management strategies, and an approach to the formulation of healthcare management plans for newborns with trisomy 18. RECENT FINDINGS There has been a trend from nonintervention for infants/children with trisomy 18 toward management to prolong life. It has become clear that the prognosis for infants/children with trisomy 18 is not as 'hopeless' as was once asserted. However, case series of patients with trisomy 18 managed with a goal of prolonging life are not adequate to evaluate the efficacy of these interventions. They are also not adequate to support the contention that they have no efficacy. In fact, anecdotal evidence and medical plausibility suggest that treatment can prolong life in some cases. This trend has been supported by a change in emphasis from a largely physician-directed model of medical decision-making to a collaborative model, which respects parents' rights to make healthcare decisions for their children and recognizes that judgments about outcomes are often subjective, and social networks, which support and advocate for children with trisomy 18 and their families. An approach to collaborative medical decision-making that is goal-directed is recommended. SUMMARY Healthcare management approaches or policies that reject out of hand the goal of prolonging the life of any infant/child with trisomy 18 are not defensible. Management plans should be goal-directed, based on the physician-parent evaluation of the benefits and burdens of care options for the individual child.
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Light J, McNaughton D. The Changing Face of Augmentative and Alternative Communication: Past, Present, and Future Challenges. Augment Altern Commun 2012; 28:197-204. [DOI: 10.3109/07434618.2012.737024] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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