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Patterns of cardiac care in infants with Down syndrome
D S Schneider1, K G Zahka, E B Clark
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore.
Insights
Infants with Down syndrome (DS) receive timely cardiac care comparable to those with isolated cardiovascular malformations (ICMs). Diagnosis and surgery patterns are similar, ensuring similar one-year outcomes for both groups.
Area of Science:
- Pediatric Cardiology
- Genetics
- Public Health
Background:
- Down syndrome (DS) is associated with congenital heart defects.
- Understanding cardiac care patterns in infants with DS is crucial for timely intervention.
- Previous studies have not fully elucidated care differences for DS versus isolated defects.
Purpose of the Study:
- To compare cardiac care patterns in infants with Down syndrome (DS) versus those with isolated cardiovascular malformations (ICMs).
- To assess differences in diagnosis timing, surgical intervention, and one-year outcomes.
Main Methods:
- Analysis of a regional case-control study (Baltimore-Washington Infant Study).
- Comparison of 160 infants with DS and 540 infants with ICMs with similar cardiac diagnoses.
- Evaluation of age at cardiac diagnosis, timing of cardiac surgery, and one-year outcomes.
Main Results:
- Cardiac diagnosis by 13 weeks in 78% of DS infants vs. 67% of ICMs; comparable by 26 weeks.
- Early cardiac surgery (before 1 year) in 99/160 DS infants and 141/540 ICMs.
- Similar one-year surgical outcomes for both groups.
Conclusions:
- Cardiac care for infants with DS in the Baltimore-Washington, DC, area is timely and comparable to infants with ICMs.
- Severity of defect is a key factor in care patterns, not solely the presence of DS.
- The study supports equitable and effective cardiac care for infants with Down syndrome.
Abstract:
To determine if the pattern of cardiac care is affected by the presence of Down syndrome (DS) we analyzed the records of infants enrolled in the Baltimore-Washington Infant Study, a regional case-control study of congenital cardiovascular malformations. The age at cardiac diagnosis, the timing of cardiac surgery, and the one-year outcome were compared in 160 infants with DS and 540 infants with the same cardiac diagnoses but without chromosomal or other extracardiac anomalies (Isolated cardiovascular malformation [ICM] group). Cardiac referral and diagnosis were accomplished by 13 weeks of age in 78% of infants with DS and 67% of those with ICMs. However, by 26 weeks of age, the proportion of infants in both groups was comparable. Cardiac surgery was performed before 1 year of age in 99 of 160 infants with DS and in 141 of 540 infants with ICMs. The surgical outcome was similar in the two groups. We conclude that for defects of comparable severity, the pattern of cardiac care in the Baltimore-Washington, DC, area for infants with DS is timely and comparable to care for infants with ICMs.