Perinatal Outcomes of Fetuses and Infants Diagnosed with Trisomy 13 or Trisomy 18

Objectives: To identify factors associated with adverse prenatal, perinatal and postnatal outcomes, and determine the utilization medical care for fetuses & infants with trisomy 13 (T13) and trisomy (T18). Study Design: This population-based retrospective cohort study included all prenatal and postnatal diagnoses of T13 or T18 in the Greater Cincinnati area from 1/1/12-12/31/18. Overall survival, survival to hospital discharge, approach to medical management, and maternal, fetal and neonatal characteristics are analyzed. Results: 124 pregnancies (125 fetuses) were identified, which resulted in 72 liveborn infants. Male fetal sex and hydrops were associated with a higher rate of spontaneous loss. The median length of survival was 7 days (95% CI, 0-18 days) and 29 days (95% CI, 2-115 days), for infants with T13 and T18, respectively. Of the 27 infants who were alive at 1 month of age, 14 (52%) were alive at 1 year of age. Only the trisomy type, chosen goals of care (comfort care), and extremely low birthweight were associated with overall length of survival. A high degree of variability existed in the use of medical services, with 28% of infants undergoing at least one surgical procedure and some children requiring repeated (up to 29) or prolonged hospitalization (> 1 year). Conclusions: Although many infants with T13 or T18 did not survive past the first week of life, up to 25% of infants lived for more than one year. Length of survival for an individual infant cannot be easily predicted, and surviving infants have high health care utilization throughout their lifespan.