Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Department of Obstetrics and Gynecology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Pediatr Res. 2024 Apr;95(5):1325-1330. doi: 10.1038/s41390-023-02870-1. Epub 2023 Oct 28.
We often encounter preterm infants with Down syndrome (DS) who die in the neonatal intensive care unit (NICU). In this study, we examined survival until NICU discharge and assessed the developmental prognosis of preterm infants with DS.
We retrospectively reviewed 416 infants with DS hospitalized during the past 27 years at our NICU.
Death occurred in 8/20 (40%) infants at <32 weeks' gestation, 11/23 (48%) at 32-33 weeks, 9/99 (9%) at 34-36 weeks, and 9/274 (3%) at >36 weeks. In total, 84% of infants who died and 25% of those who survived had a non-reassuring fetal status (p < 0.001). Sex, small-for-gestational-age status, and postnatal transport were not associated with death. The main causes of death were bronchopulmonary dysplasia in 4/8 (50%) infants at <32 weeks' gestation, transient abnormal myelopoiesis in 11/20 (55%) and lymphatic dysplasia in 6/20 (30%) at 32-36 weeks, and varied causes at >36 weeks. Among survivors born at <34 weeks' gestation, 6/19 (32%) aged >2 years had moderate or severe cerebral palsy.
These data on the high mortality and morbidity of preterm infants with DS may be useful for patient treatment and parent counseling in NICUs treating critically ill infants.
Most infants with Down syndrome born at <34 weeks' gestation are born by cesarean section because of the non-reassuring fetal status. The mortality rate before discharge for infants with Down syndrome born at <34 weeks' gestation was 40%, and 30% of survivors developed moderate or severe cerebral palsy. The risk of death due to bronchopulmonary dysplasia and pulmonary hypertension was high in very preterm infants with Down syndrome despite the absence of chorioamnionitis. Infants with Down syndrome were born 1-2 weeks earlier than unaffected controls.
我们经常在新生儿重症监护病房（NICU）遇到患有唐氏综合征（DS）的早产儿死亡。在这项研究中，我们检查了直至 NICU 出院的存活率，并评估了患有 DS 的早产儿的发育预后。
我们回顾性分析了过去 27 年在我们的 NICU 住院的 416 名患有 DS 的婴儿。
<32 周胎龄的 20 名婴儿中有 8 名（40%）死亡，32-33 周的 23 名婴儿中有 11 名（48%）死亡，34-36 周的 99 名婴儿中有 9 名（9%）死亡，>36 周的 274 名婴儿中有 9 名（3%）死亡。总的来说，84%死亡的婴儿和 25%存活的婴儿都有不安定的胎儿状态（p<0.001）。性别、小于胎龄儿状态和出生后转运与死亡无关。死亡的主要原因是<32 周胎龄的 8 名婴儿中有 4 名（50%）患有支气管肺发育不良，32-36 周胎龄的 20 名婴儿中有 11 名（55%）患有短暂性骨髓异常增生和 6 名（30%）患有淋巴发育不良，>36 周胎龄的婴儿死因各不相同。在<34 周出生的幸存者中，有 6 名（32%）年龄大于 2 岁的婴儿患有中度或重度脑瘫。
这些有关患有唐氏综合征的早产儿死亡率和发病率高的数据可能对治疗危重症婴儿的 NICU 中的患者治疗和家长咨询有用。
由于胎儿状态不稳定，大多数<34 周胎龄出生的唐氏综合征婴儿通过剖宫产分娩。<34 周胎龄出生的唐氏综合征婴儿的出院前死亡率为 40%，30%的幸存者发展为中度或重度脑瘫。尽管没有绒毛膜羊膜炎，患有唐氏综合征的极早产儿死于支气管肺发育不良和肺动脉高压的风险很高。唐氏综合征婴儿的出生时间比未受影响的对照组早 1-2 周。
