304 - Increased Morbidity and Mortality of Neonates with Down Syndrome by Gestational Age

Poster Number: 304
Publication Number: 304.441

Emily A. Messick, Nationwide Children's Hospital, Columbus, OH, United States; Carl Backes, Nationwide Children's Hospital, Columbus, OH, United States; Kenneth Jackson, The Ohio State University, Columbus, OH, United States; Sara Conroy, Ohio State University College of Medicine, Columbus, OH, United States; Stephen A. Hart, The Heart Center, Nationwide Children's Hospital, Columbus, OH, United States; Clifford Cua, Nationwide Children's Hospital, Columbus, OH, United States

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 non-DS neonates delivered prior to 39 weeks of completed gestation.

Objective: We sought to determine if a similar association exists between gestational age at delivery and adverse outcomes in neonates with DS.

Design/Methods: Neonates with DS admitted to any Nationwide Children’s Hospital 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. Logistic regression analyses were used to evaluate morbidity and mortality rates between groups.

Results: 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. We observed no differences in distribution of small for gestational age neonates, head circumference percentile, gender, maternal ethnicity, or congenital anomalies 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 = 0.019). 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 (OR 3.06, P = 0.02; OR 6.5, P < 0.001; OR 5.3, P < 0.001 respectively). Neonates with DS < 34 weeks were more likely to develop respiratory distress syndrome (OR 28.9, P < 0.001), necrotizing enterocolitis (OR 11.6, P = 0.02), and require nitric oxide (OR 4.03, P = 0.02) compared to ≥ 39 weeks group. There were no differences in the need for surgical interventions between groups.Conclusion(s): Neonates with DS born preterm have increased rates of morbidity and mortality compared to term DS neonates. Neonates with DS born preterm ( < 34 weeks) represent a highly vulnerable subgroup. Multidisciplinary strategies to address higher rates of morbidity and mortality are needed.