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Kepple JW, Fishler KP, Peeples ES. Surveillance guidelines for children with trisomy 13. Am J Med Genet A 2021; 185:1631-1637. [PMID: 33709620 DOI: 10.1002/ajmg.a.62133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Trisomy 13 is one of the three most common aneuploidy syndromes in live-born infants. It is associated with mortality rates as high as 90% within the first year of life, in large part, due to the high prevalence of severe congenital abnormalities that increase mortality and morbidity. However, life-saving and life-prolonging medical interventions are being performed at a higher rate for these infants, resulting in increased rates of survival. Although cardiac complications have been well described in infants with trisomy 13, these patients also experience other complications such as respiratory, neurological, genitourinary, abdominal, otolaryngologic, and orthopedic complications that can impact their quality of life. The goal of this review is to present a comprehensive description of complications in children with trisomy 13 to aid in the development of monitoring and treatment guidelines for the increasing number of providers who will be caring for these patients throughout their lives. Where the evidence is available, this review presents screening recommendations to allow for more rapid detection and documentation of these complications.
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Affiliation(s)
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Kepple JW, Fishler KP, Peeples ES. Surveillance guidelines for children with trisomy 18. Am J Med Genet A 2021; 185:1294-1303. [PMID: 33527722 DOI: 10.1002/ajmg.a.62097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/31/2022]
Abstract
Trisomy 18 is the second most common aneuploidy syndromes in live born infants. It is associated with high mortality rates, estimated to be 75%-95% in the first year of life, as well as significant morbidity in survivors. The low survival is largely due to the high prevalence of severe congenital anomalies in infants with this diagnosis. However, interventions to repair or palliate those life-threatening anomalies are being performed at a higher rate for these infants, resulting in increased rates of survival beyond the first year of life. While it is well documented that trisomy 18 is associated with several cardiac malformations, these patients also have respiratory, neurological, neoplastic, genitourinary, abdominal, otolaryngologic, and orthopedic complications that can impact their quality of life. The goal of this review is to present a comprehensive description of complications in children with trisomy 18 to aid in the development of monitoring and treatment guidelines for the increasing number of providers who will be caring for these patients throughout their lives. Where the evidence is available, this review presents screening recommendations to allow for more rapid detection and documentation of these complications.
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Affiliation(s)
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Petersen ME, Zhang F, Schupf N, Krinsky‐McHale SJ, Hall J, Mapstone M, Cheema A, Silverman W, Lott I, Rafii MS, Handen B, Klunk W, Head E, Christian B, Foroud T, Lai F, Rosas HD, Zaman S, Ances BM, Wang M, Tycko B, Lee JH, O'Bryant S. Proteomic profiles for Alzheimer's disease and mild cognitive impairment among adults with Down syndrome spanning serum and plasma: An Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS) study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12039. [PMID: 32626817 PMCID: PMC7327223 DOI: 10.1002/dad2.12039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previously generated serum and plasma proteomic profiles were examined among adults with Down syndrome (DS) to determine whether these profiles could discriminate those with mild cognitive impairment (MCI-DS) and Alzheimer's disease (DS-AD) from those cognitively stable (CS). METHODS Data were analyzed on n = 305 (n = 225 CS; n = 44 MCI-DS; n = 36 DS-AD) enrolled in the Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS). RESULTS Distinguishing MCI-DS from CS, the serum profile produced an area under the curve (AUC) = 0.95 (sensitivity [SN] = 0.91; specificity [SP] = 0.99) and an AUC = 0.98 (SN = 0.96; SP = 0.97) for plasma when using an optimized cut-off score. Distinguishing DS-AD from CS, the serum profile produced an AUC = 0.93 (SN = 0.81; SP = 0.99) and an AUC = 0.95 (SN = 0.86; SP = 1.0) for plasma when using an optimized cut-off score. AUC remained unchanged to slightly improved when age and sex were included. Eotaxin3, interleukin (IL)-10, C-reactive protein, IL-18, serum amyloid A , and FABP3 correlated fractions at r2 > = 0.90. DISCUSSION Proteomic profiles showed excellent detection accuracy for MCI-DS and DS-AD.
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Affiliation(s)
- Melissa E. Petersen
- Department of Family Medicine Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Fan Zhang
- Vermont Genetics NetworkUniversity of VermontBurlingtonVermontUSA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University Irving Medical CenterNew YorkNew YorkUSA
- G.H. Sergievsky CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyNeurological InstituteColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Sharon J. Krinsky‐McHale
- Department of PsychologyNYS Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - James Hall
- Department of Pharmacology and Neuroscience Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Mark Mapstone
- Department of NeurologyUniversity of CaliforniaIrvineCaliforniaUSA
| | - Amrita Cheema
- Georgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Wayne Silverman
- Department of Pediatrics, School of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Ira Lott
- Department of Pediatrics, School of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Michael S. Rafii
- Department of Neurology, Keck School of MedicineUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Benjamin Handen
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - William Klunk
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Elizabeth Head
- Department of PathologyUniversity of CaliforniaIrvineCaliforniaUSA
| | - Brad Christian
- Department of Medical Physics and PsychiatryUniversity of Wisconsin MadisonMadisonWisconsinUSA
| | - Tatiana Foroud
- Department of Medical & Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Florence Lai
- Department of Neurology, Massachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - H. Diana Rosas
- Departments of Neurology and Radiology, Massachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Shahid Zaman
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustFulbourn HospitalCambridgeUK
| | - Beau M. Ances
- Washingston University School of Medicine in St. LouisSt. LouisMissouriUSA
| | - Mei‐Cheng Wang
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Benjamin Tycko
- Department of Pathology and Cell BiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Joseph H. Lee
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University Irving Medical CenterNew YorkNew YorkUSA
- G.H. Sergievsky CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyNeurological InstituteColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Sid O'Bryant
- Department of Pharmacology and Neuroscience Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
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Sugiyama M, Terashita Y, Takeda A, Iguchi A, Manabe A. Immune thrombocytopenia in a case of trisomy 18. Pediatr Int 2020; 62:240-242. [PMID: 32067321 DOI: 10.1111/ped.14116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/04/2019] [Accepted: 11/14/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Minako Sugiyama
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Hokkaido, Japan
| | - Yukayo Terashita
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Hokkaido, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Hokkaido, Japan
| | - Akihiro Iguchi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Hokkaido, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Hokkaido, Japan
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MacQueen BC, Christensen RD, Henry E, Romrell AM, Pysher TJ, Bennett ST, Sola-Visner MC. The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias. J Perinatol 2017; 37:834-838. [PMID: 28383532 PMCID: PMC6192246 DOI: 10.1038/jp.2017.48] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The immature platelet fraction (IPF) is a laboratory measurement analogous to the reticulocyte count, but reflecting the thrombopoietic state. Similar to a reticulocyte count, it can be expressed as a percent (IPF%=percent of platelets that are immature) or as an absolute number per μl blood; the immature platelet count (IPC=IPF% × platelets per μl of blood). STUDY DESIGN Using a retrospective analysis of de-identified data from non-thrombocytopenic neonates, we created reference intervals for IPF% and IPC. We then tested the value of these measurements for categorizing thrombocytopenic neonates. RESULTS New charts display reference intervals for IPF% and IPC on the day of birth according to gestational age, and during the first 90 days after birth. Neonates with hyporegenerative varieties of thrombocytopenias (syndromes, small for gestational age, birth asphyxia) had lower IPF% and IPC than did neonates with consumptive thrombocytopenias (immune-mediated, infection, disseminated intravascular coagulation, necrotizing enterocolitis; both P<0.0001). CONCLUSION The new reference interval charts can be used to recognize abnormal IPFs. The IPF parameters can help clarify the kinetic mechanism responsible for thrombocytopenias in neonates.
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Affiliation(s)
- BC MacQueen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - RD Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA;,Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA;,Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - E Henry
- Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA;,Institute for Healthcare Delivery Research, Salt Lake City, UT, USA
| | - AM Romrell
- Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - TJ Pysher
- Department of Pathology, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - ST Bennett
- Department of Pathology, Intermountain Medical Center, Murray, UT, USA;,Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - MC Sola-Visner
- Division of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
The various blood cell counts of neonates must be interpreted in accordance with high-quality reference intervals based on gestational and postnatal age. Using very large sample sizes, we generated neonatal reference intervals for each element of the complete blood count (CBC). Knowledge of whether a patient has CBC values that are too high (above the upper reference interval) or too low (below the lower reference interval) provides important insights into the specific disorder involved and in many instances suggests a treatment plan.
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Affiliation(s)
- Erick Henry
- Women and Newborn's Program, Intermountain Healthcare, 36 S. State Street, Salt Lake City, UT 84111, USA; The Institute for Healthcare Delivery Research, 36 S. State Street Salt Lake City, UT 84111, USA.
| | - Robert D Christensen
- Women and Newborn's Program, Intermountain Healthcare, 36 S. State Street, Salt Lake City, UT 84111, USA; Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108 USA; Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108 USA
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Christensen RD, Del Vecchio A, Henry E. Expected erythrocyte, platelet and neutrophil values for term and preterm neonates. J Matern Fetal Neonatal Med 2013; 25:77-9. [PMID: 23025775 DOI: 10.3109/14767058.2012.715472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reference ranges are an important guide for properly interpreting the clinical laboratory studies obtained from newborn infants. To judge whether the data contained in a CBC (complete blood count) is "normal," a neonatologist cannot utilize the normal ranges of CBCs constructed by sampling healthy adult volunteers. This is because important developmental differences are present between CBC values from adults vs. neonates. Also, differences in gestational age and post-natal age of neonates result in a need to have separate sets of reference range values for each. Otherwise, much confusion can exist in determining whether the CBC values are lower or higher than they should be. We reasoned that reference ranges constructed from very large databases would be a valuable new tool for neonatologists. To create these, we used the electronic data of Intermountain Healthcare, a multihospital healthcare system in the western USA, focusing on each of the various CBC elements. This presentation will review this process and display some of the novel clinically useful findings resulting from these studies.
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Affiliation(s)
- Robert D Christensen
- Women and Newborns Program, Intermountain Healthcare, McKay-Dee Hospital Center, Harrison Blvd, Ogden, UT 84403, USA.
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Abstract
PURPOSE To provide information about neonatal experiences for newborns with full trisomy 18 (t18). SUBJECTS Mothers of 21 newborns with full t18 (13 survivors; 8 who died prior to mothers' participation in the study). DESIGN Mixed method, descriptive, online survey. METHODS Subjects completed an online survey. Data were downloaded into an SPSS database. Descriptive statistics were used to analyze resulting data. MAIN OUTCOME MEASURES Subjects' responses on Tracking Rare Incidence Syndromes survey. PRINCIPAL RESULTS Newborns presented with syndrome-related physical characteristics (eg, low-set ears, small jaw) and medical conditions (eg, heart defects). Gestational age was generally older than what is described in the existent literature. In the NICU, newborns were provided with a variety of equipments (eg, nasal cannula, pulse oximeter) and received treatments including blood transfusions and echocardiograms. Data also indicate longer survival rates (103.3 months for survivors, 37.5 months for nonsurvivors) than that described in the literature. CONCLUSIONS Data indicate presence of common presenting physical and medical characteristics and varied medical assistance to newborns with full t18.
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Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol 2008; 28:275-81. [PMID: 18200025 DOI: 10.1038/sj.jp.7211916] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Upper and lower reference limits for blood neutrophil concentrations of neonates were reported by Manroe, Rosenfeld and co-workers in 1979 and by Mouzinho, Rosenfeld and co-workers in 1994. Studies by Carballo and co-workers and Maynard and co-workers suggested that at high altitude a much higher upper limit of values occurs, and that neutrophilia is often diagnosed inappropriately, at high altitude, if the Manroe and Mouzinho charts are used. STUDY DESIGN We revisited the Manroe and Mouzinho charts using modern cell counting instrumentation and very large sample sizes. This was accomplished with data from an 18-hospital health-care system, at hospitals averaging 4,800 feet above sea level. Data were obtained from neonates in the first 10 days following birth, using tests performed on a single type of automated blood cell counter (Beckman Coulter LH 750, Fullerton, CA, USA). To obtain a description of 'expected values,' patients with the following diagnoses, known to have a high proportion of abnormal neutrophil counts, were excluded from the analysis; (1) maternal pregnancy-induced hypertension, (2) early-onset bacterial sepsis, (3) a discharge diagnosis of congenital neutropenia and (4) trisomy 21, 18 or 13. RESULT Blood neutrophil concentrations were tabulated from 30 354 tests performed on neonates of 23 to 42 weeks gestation, with dates of birth between 1 January 2004 and 31 May 2007. The reference range charts generated from these data have much higher upper value limits than do the Manroe and Mouzinho charts, and are similar to the high-altitude reports of Carballo and co-workers and Maynard and co-workers. Neonates whose mothers labored before delivery had significantly higher neutrophil counts (averaging 3,500 neutrophils per mul higher, P<0.0001; comparing cesarean section deliveries with vs without labor). Females had significantly higher counts (averaging 2,000 neutrophils per mul higher) than males (P<0.0001). Counts did not differ on the basis of racial/ethnic group. CONCLUSION The figures of this report describe the expected ranges for blood neutrophil concentrations over the first 10 days of life among neonates of 23 to 42 weeks gestation at high altitude.
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