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Differences in mortality characteristics in neonates with Down's syndrome.

C L Cua1, U Haque1, S Santoro1

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Neonates with Down syndrome face increased mortality risk due to specific cardiac conditions and complications like necrotizing enterocolitis. Early identification of these risk factors is crucial for high-risk newborns.

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Area of Science:

  • Neonatology
  • Genetics
  • Pediatric Cardiology

Background:

  • Neonates with Down syndrome (nDS) are susceptible to numerous medical issues.
  • These conditions elevate the risk of mortality during the neonatal period.

Purpose of the Study:

  • To investigate differences in baseline characteristics, medical complications, and procedures.
  • To compare outcomes between nDS who survived and those who died during initial hospitalization.

Main Methods:

  • Retrospective review of 5737 nDS patients from the Pediatric Health Information Systems (PHIS) database (2000-2014).
  • Analysis included demographics, complications, procedures, and mortality.
  • Multivariate logistic regression identified predictors of death (P<0.05).

Main Results:

  • Overall mortality was 7.5%.
  • Higher mortality was associated with lower birth weight, diaphragmatic hernia, and specific cardiac anomalies (pulmonary venous abnormality, Ebstein's anomaly, left-sided obstructive lesion).
  • Increased odds of death linked to hydrops, necrotizing enterocolitis, mechanical ventilation, and ECMO.

Conclusions:

  • Certain cardiac diagnoses and complications significantly increase mortality risk in nDS.
  • The need for specific procedures like mechanical ventilation or ECMO further elevates mortality odds.
  • Caregivers must recognize these risk factors in nDS to manage this high-risk population effectively.