Trends in Invasive Procedures, Surgery and Mortality Among Neonatal Hospitalizations with Trisomy 13 and 18 in the United States, 2009-2018

Background: Due to the presumed lethality of Trisomy 13 (T13) and Trisomy 18 (T18), management has historically been suggested to be comfort-focused. However, recent studies have demonstrated decreased mortality in those who undergo cardiac surgery and some patients live beyond their life expectancy. It is unknown if there have been changes in cardiac and invasive procedures in neonates with T13 and T18 over the last decade. Our aim was to evaluate the trends in invasive procedures, surgical interventions, and mortality among neonatal hospitalizations with T13 and T18 in the United States from 2009 through 2018.

Methods: This was a retrospective repeated cross-sectional analysis of neonatal hospitalizations with T13 and T18 diagnostic codes within the National Inpatient Sample database. Outcomes examined included the proportion of T13 and T18 patients that underwent surgical intervention/invasive procedures and in-hospital mortality. Outcomes examined included the proportion of T13 and T18 patients that underwent surgical intervention/invasive procedures and in-hospital mortality. Trends were assessed with Cochran-Armitage trend test. P-value <0.05 was considered significant.

Results: There were 3,354 T13 and 6,598 T18 neonatal hospitalizations during the study period. There was no significant change in the prevalence of both conditions. For T13 (Table 1), gastrointestinal (GI) procedures (8.4 to 14.9%), gastrostomy tube (GT) placement (3.7 to 8.5%), and central nervous system (CNS) procedures (1.5 to 2.8%) significantly increased from 2009-2010 through 2017-2018. In contrast, there was a significant decline in invasive mechanical ventilation (IMV) continuously for >96 hours (25.7 to 14.9%), laryngobronchoscopy (24.1 to 2.1%), and cardiovascular procedures (30.3 to 16.3%). There was no significant change in tracheostomy over time. The overall mortality for T13 was 56.3% before discharge with no significant change over time (56.5 to 54.5%; P=0.49). The median LOS was 3 days (IQR, 0-11) for all T13 neonatal hospitalizations and 8 days (IQR, 2-26) for those that survived to discharge.

Similarly, for T18 (Table 2), GT placement (6.5 to 7.2%) and CNS procedures significantly increased, while the proportion that received IMV continuously for >96 hours (25.9 to 17%), laryngobronchoscopy (21.9 to 1.9%), and cardiovascular procedures (25.9 to 13.2%) significantly declined. Tracheostomy increased from 0.4% to 3.4%. The overall mortality before discharge was 47.5% with no significant trend (46.7 to 47.5%). The median LOS was 3 days (IQR, 1-14) for all T18 hospitalizations and 7 days (IQR, 2-21) for those that survived to discharge. There was no significant change in LOS for T13 and T18.

Conclusion: Among T13 and T18 neonatal hospitalizations, GI and CNS procedures increased while cardiovascular procedures and IMV decreased with no significant change in mortality or LOS. Further research is needed to explore the factors influencing these trends to assist parents and care teams formulate individualized comprehensive care plans for infants born with T13 and T18.