Impacts of surgical interventions on the long-term outcomes in individuals with trisomy 18
| Autor: | Chie Yokota, Junya Ohmura, Chiaki Iida, Tetsuro Kamimura, Jun Muneuchi, Yasuhiko Takahashi, Yoshihiro Sakemi, Junko Yamamoto, Yoshie Ochiai, Mamie Watanabe, Yuichiro Sugitani, Daisuke Shimizu, Naoko Matsumoto, Shunsuke Araki, Kenichiro Yamaguchi |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Birth weight Gestational Age 03 medical and health sciences 0302 clinical medicine Median follow-up Pregnancy 030225 pediatrics Internal medicine Digestive disorder Medicine Birth Weight Humans Survival rate Retrospective Studies business.industry Hazard ratio Infant Newborn Gestational age General Medicine medicine.disease 030220 oncology & carcinogenesis Case-Control Studies Pediatrics Perinatology and Child Health Cohort Surgery Female business Trisomy Trisomy 18 Syndrome |
| Zdroj: | Journal of pediatric surgery. 55(11) |
| ISSN: | 1531-5037 |
| Popis: | Objective We aim to clarify whether surgical interventions can contribute to improve the long-term outcomes among individuals with trisomy 18. Methods We retrospectively studied 69 individuals with trisomy 18 admitted to 4 tertiary neonatal centers between 2003 and 2017. A cohort was divided into two groups: subjects with surgical interventions and conservative treatments. We compared the rates of survival and achieving homecare between the groups. Results Gestational age and birth weight were 37 (27-43) week's and 1,700 (822-2,546) g, respectively. There were 68 patients with congenital heart disease and 20 patients with digestive disease. Surgical interventions including cardiac and digestive surgery were provided in 41% of individuals. There was no difference in gestational age (P = 0.30), birth weight (P = 0.07), gender (P = 0.30), and fetal diagnosis (P = 0.87) between the groups. During the median follow up duration of 51 (2-178) months, overall survival rates in 6, 12 and 60 months were 57%, 43% and 12%, respectively. Survival to hospital discharge occurred in 23 patients, and the rates of achieving homecare in 1, 6, and 12 months are 1%, 18% and 30%, respectively. There was no significant difference in survival rate (P = 0.26) but in the rate of achieving home care (P = 0.02) between the groups. Cox hazard analysis revealed that prenatal diagnosis (hazard ratio 0.30, 95%CI: 0.13-0.75), cardiac surgery (hazard ratio 2.40, 95%CI:,1.03-5.55), and digestive surgery (hazard ratio 1.20, 95%CI: 1.25-3.90) were related to the rate of achieving homecare. Conclusion Aggressive surgical interventions contribute not to the long-term survival but to achieve homecare among individuals with trisomy 18. Evidence Level Level 3 (Prognostic study, Case-Control study) |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect