Intensive versus comfort-focused care in neonates with trisomy 18: A systematic review and meta-analysis

ObjectiveTo evaluate whether intensive neonatal interventions improve survival outcomes compared with comfort-focused care in neonates with Trisomy 18.Study designWe conducted a systematic review and pairwise meta-analysis of observational studies reporting outcomes for neonates with Trisomy 18 receiving either intensive or comfort-focused care. Databases searched included PubMed, Embase, and Cochrane Central Register up to March 2026. Outcomes included mean survival days and 1-year survival as primary outcomes, and gestational age at delivery as a secondary exploratory outcome.ResultsFive observational studies including 211 patients were analyzed (133 received intensive care, and 78 received comfort-focused care). Pooled analyses showed no statistically significant differences between groups for mean survival days (MD -225.53 days; 95% CI -776.85 to 325.79), 1-year survival (RR 1.12; 95% CI 0.90 to 1.40), or gestational age at birth (MD -0.28 weeks; 95% CI -1.69 to 1.13).ConclusionDespite the absence of a demonstrated survival benefit of intensive neonatal interventions over non-intensive care in Trisomy 18, the findings should be interpreted cautiously given the small number of available studies, substantial clinical and statistical heterogeneity, and very low certainty of evidence. Findings highlight the importance of individualized, informed decision-making guided by prenatal counseling that integrates evidence-based outcomes and parental values. High-quality, multicenter prospective studies are needed to evaluate the impact of specific interventions and improve guidance for families and clinicians.