Preterm Birth Increases Health Vulnerabilities of Babies With Down Syndrome

Babies with Down syndrome who are born preterm have higher prenatal morbidity and mortality rates than those in babies with Down syndrome born at term, suggesting pediatricians can lower their risk threshold for certain screenings or interventions.

Compared with age-matched neonates without Down syndrome, babies with Down syndrome are more likely to experience developmental delay, gastrointestinal disorders and poor growth, among other challenges.

Neonates with Down syndrome who are born prematurely face an even steeper uphill health battle.

In a study published in the Journal of Perinatology, researchers reported that morbidity and mortality rates were significantly higher in neonates with Down syndrome born before 34 weeks of gestation than in those born later.

“Studies of babies with Down syndrome have not reported health outcomes according to gestational age,” says Emily Messick, DO, pediatrician at Nationwide Children’s Hospital and lead author of the study. “We began this project to address this gap in the literature.”

For their single-center retrospective study, the team analyzed the medical records of 314 neonates with Down syndrome who were treated at Nationwide Children’s NICU from 2010 to 2020.

Neonates were grouped according to gestational age: <34 weeks (n=31), 34 to 36 weeks (n=68), 37 to 38 weeks (n-127) and ≥39 weeks (n=88).

Data collected included prenatal and neonatal characteristics and morbidities experienced during the first year of life, such as necrotizing enterocolitis (NEC) and congenital abnormalities.

Morbidity rates were highest in neonates born before 34 weeks of gestation.

Fox example, three of the six neonates in the study who developed NEC were born before 34 weeks. The rates of oxygen supplementation and gastrostomy tube placement were greatest for the <34-week group than the other groups. Also, the use of nitric oxide, commonly used to treat respiratory failure associated with persistent pulmonary hypertension of the newborn, was highest for neonates born before 34 weeks.

The overall mortality rate in the study was 4.5%, with in-hospital mortality rates being highest (19%) in those born before 34 weeks. The most recent data for infant mortality in the US indicate a <1% mortality rate for infants born at 34 to 36 weeks.

“Awareness of those neonates’ higher morbidity risks can drop the threshold for certain screening tests and prompt the early involvement of other sub-specialists to help improve long term outcomes,” says Dr. Messick.

A multidisciplinary approach that is comprehensive and individualized is integral to improving outcomes for neonates with Down syndrome. For example, “A team of dietitians, speech therapists and gastroenterologists can help optimize growth for patients with feeding difficulties and poor growth,” notes Dr. Messick.

Keeping a patient’s family informed while the baby is in the NICU is key. “It is also helpful to look at the big picture and assess what goals need to be met for the baby to be discharged home with the family,” she adds.

References:

1. Messick EA, Backes CH, Jackson K, Conroy S, Hart SA, Cua CL. Morbidity and mortality in neonates with Down Syndrome based on gestational age. Journal of Perinatology. 2022 Sep 21. Online ahead of print.
2. Ely DM, Driscoll AK. Infant mortality in the United States, 2017: data from the period linked birth/infant death file. National Vital Statistics Reports. 2019;68:1–20.

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