Clinical characteristics and survival of trisomy 18 in a medical center in Taipei, 1988-2004.

Title

Clinical characteristics and survival of trisomy 18 in a medical center in Taipei, 1988-2004.

Creator

Lin HY; Lin SP; Chen YJ; Hung HY; Kao HA; Hsu CH; Chen MR; Chang JH; Ho CS; Huang FY; Shyur SD; Lin DS; Lee HC

Publisher

American Journal Of Medical Genetics.Part A

Date

2006

Subject

Child; Female; Humans; infant; Male; Survival Rate; Pregnancy; Adult; Middle Aged; Prenatal Diagnosis; Survival Analysis; Longitudinal Studies; Time Factors; Hospitals; Birth Weight; Preschool; infant; Newborn; retrospective studies; Abnormalities; Brain Diseases/ultrasonography; Child Health Services/economics/organization & administration/statistics & numerical data; Chromosomes; Congenital/ultrasonography; gestational age; Heart Defects; Human; Karyotyping; Maternal Age; Multiple/genetics/mortality/pathology; Pair 18/genetics; Paternal Age; Taiwan; Trisomy/diagnosis/genetics; Ultrasonography/methods

Description

Trisomy 18 is the second most common autosomal trisomy in newborns. The birth prevalence of this disorder is approximately 1 in 3,000 to 1 in 8,000, and the life span of the majority of patients is less than 1 year. As information regarding outcome in trisomy 18 is rather fragmentary in the literature, this study is aimed at investigating the survival and natural history of trisomy 18. We also evaluated the survival age and management of trisomy 18 in two different periods, before and after the implementation of National Health Insurance (NHI) program. Thirty-nine cases of trisomy 18 were collected in Mackay Memorial Hospital in a 17-year period, from 1988 to 2004. Delivery data, survival age, management before and after the implementation of NHI program, structural defects, image findings and cytogenetic results were analyzed by medical and nurse's records. The diagnosis of trisomy 18 was based on the prenatal amniocentesis or postnatal chromosome analysis. Three patients had trisomy 18 mosaicism. Since cardiovascular and central nervous systems are the most common organ systems involved in this disorder, 31 patients received brain ultrasonography and heart ultrasonography for evaluation of their multiple anomalies after admission. All patients except one died in their first year due to severe malformations of the cardiovascular or central nervous systems. The median survival age was 6 days. We found a longer survival with female patients than with male patients (P < 0.05). Implementation of NHI program in the more recent decade of this study period was associated with longer survival of trisomy 18 (P < 0.05). The three most common structural defects were clenched hands (95%), rocker bottom feet (90%), and low set or malformed ears (90%). Low birth weight was present in 90%. By cardiac ultrasonography, the top four heart defects were ventricular septal defect (94%), patent ductus arteriosus (77%) and atrial septal defect (68%). However, ten cases (32%) had complex congenital heart defects. By brain ultrasonography, the most common brain lesion was cerebellar hypoplasia (32%), followed by brain edema (29%), enlarged cisterna magna (26%) and choroid plexus cysts (19%). Although most patients with trisomy 18 die within the first few weeks after birth, it is important to recognize that a small but notable percentage of these patients will survive the first year. When prenatal or postnatal decisions need to be made, the possibility of long-term survival should be included in any discussion to enable families to make the most appropriate decision.
2006

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Citation

Lin HY; Lin SP; Chen YJ; Hung HY; Kao HA; Hsu CH; Chen MR; Chang JH; Ho CS; Huang FY; Shyur SD; Lin DS; Lee HC, “Clinical characteristics and survival of trisomy 18 in a medical center in Taipei, 1988-2004.,” Pediatric Palliative Care Library, accessed March 28, 2024, https://pedpalascnetlibrary.omeka.net/items/show/13807.