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Morbidity and mortality in neonates with Down Syndrome based on gestational age

Journal of Perinatology volume 43, pages 445–451 (2023)Cite this article

Subjects

Abstract

Background

Greater than 50% of neonates with Down Syndrome (DS) have perinatal complications that require admission to the neonatal intensive care unit (NICU) at birth. Previous studies have shown increased morbidity and mortality rates in neonates without DS delivered prior to 39 weeks of completed gestation.

Objective

To determine if an association exists between gestational age at delivery and adverse outcomes in neonates with DS.

Study design

Neonates with DS admitted to a large, tertiary care center NICU from 2010 to 2020 were evaluated. Gestational age (GA) was stratified into 4 groups: <34 (preterm), 34–36 (late-preterm), 37–38 (early-term) and ≥39 (term + post-term) completed weeks. Fisher’s exact tests were used to evaluate morbidity and mortality rates between groups.

Result

Of the 314 neonates with DS, 10% (N = 31) were <34 weeks, 22% (N = 68) 34–36 weeks, 40% (N = 127) 37–38 weeks, and 28% (N = 88) ≥39 completed weeks at birth. Baseline characteristics were similar between groups. GA at birth <34 weeks was associated with a higher in-hospital mortality rate when compared to those born 37–38 (19% vs. 0%, P < 0.001) and ≥39 (19% vs. 3%, P = 0.01). Neonates with DS born <34 weeks had a higher likelihood of oxygen requirement at time of discharge compared to 34–36, 37–38, and ≥39 groups (P = 0.01; P < 0.001; P < 0.001 respectively). Neonates with DS < 34 weeks were more likely to develop necrotizing enterocolitis (P = 0.02) and require nitric oxide (P = 0.014) compared to neonates with DS ≥ 39. We observed no differences in the need for surgical interventions between groups aside from the rate of gastrostomy/jejunostomy tube placement between 34–36 weeks and 37–38 weeks GA.

Conclusion

Neonates with DS born preterm (<34 weeks) represent a highly vulnerable subgroup. Multidisciplinary strategies are needed to address their higher rates of morbidity and mortality.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This research was supported by the Ohio Perinatal Research Network (OPRN) at Nationwide Children’s Hospital. OPRN is supported by the Center for Perinatal Research at Nationwide Children’s Hospital. Funding is provided by the Abigail Wexner Research Institute at Nationwide Children’s Hospital (IRB10-00035).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA

    Emily A. Messick, Carl H. Backes, Stephen A. Hart & Clifford L. Cua

  2. Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, USA

    Carl H. Backes

  3. Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA

    Carl H. Backes, Stephen A. Hart & Clifford L. Cua

  4. Biostatistics Resource, Nationwide Children’s Hospital, Columbus, OH, USA

    Kenneth Jackson & Sara Conroy

  5. Department of Biostatistics, The Ohio State University, Columbus, OH, USA

    Kenneth Jackson & Sara Conroy

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  1. Emily A. Messick
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Contributions

EM, CB, CC designed the study and contributed to IRB submission. KJ and SC designed and implemented statistical analysis. All authors (EM, CB, CC, SH, KJ, SC) participated in interpretation of results and manuscript preparation and editing. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

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Correspondence to Emily A. Messick.

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Messick, E.A., Backes, C.H., Jackson, K. et al. Morbidity and mortality in neonates with Down Syndrome based on gestational age. J Perinatol 43, 445–451 (2023). https://doi.org/10.1038/s41372-022-01514-2

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