A child born with trisomy 13 or 18 presents challenges to families and pediatric health
care professionals starting at birth, including difficult ethical issues. Since these
children often have congenital heart disease as a result of their trisomy, the question
raised is whether or not to do surgery given the epidemiology showing significant
neurologic impairment and short lifespan for children with these disorders. Kosiv
et al. (10.1542/peds.2017-0772) decided to look further into this issue by looking at national data over a decade
from the Pediatric Health Information System database to study infants born with trisomy
13 or 18 with congenital heart disease and then follow their readmissions to determine
in-hospital mortality and length of stay for admissions and readmissions for those
with and without congenital heart disease and for those with heart disease whether
or not they received surgery. The authors studied over a thousand infants with trisomy
18 and more than 600 with trisomy 13 the majority of who had congenital heart disease.
Surgery was performed 7% of the time in both groups and interesting enough, in-hospital
mortality was less in those who underwent surgery in both trisomy 18 (64% less) and
13 (45% less) and stayed less on readmissions for the first two years of follow-up.
So what do these data mean? Is heart surgery a good thing for children with trisomy
13 and 18 to undergo so as to reduce their in-hospital mortality and prolong their
lives? To make sense of this study we asked cardiologists Drs. Kathy Jenkins and
Amy Roberts from Boston Children’s to get to the heart of the matter and provide a
commentary (10.1542/peds.2017-2809) to accompany this study. Both are important articles to read and in turn share
with families should they give birth to an infant with these two trisomy disorders.