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Am J Perinatol 2024; 41(S 01): e2666-e2673
DOI: 10.1055/s-0043-1772748
Clinical Opinion

Structured Framework for Multidisciplinary Parent Counseling and Medical Interventions for Fetuses and Infants with Trisomy 13 or Trisomy 18

Amanda J.H. Kim
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Mayme Marshall   #
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Ladawna Gievers
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Tyler Tate
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Sara Taub
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Stephanie Dukhovny
2   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
Christina Ronai   *   #
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Erin J. Madriago   *
1   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
› Author Affiliations Funding None.
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Abstract

Objective Trisomy 13 (T13) and 18 (T18) are aneuploidies associated with multiple structural congenital anomalies and high rates of fetal demise and neonatal mortality. Historically, patients with either one of these diagnoses have been treated similarly with exclusive comfort care rather than invasive interventions or intensive care, despite a wide phenotypic variation and substantial variations in survival length. However, surgical interventions have been on the rise in this population in recent years without clearly elucidated selection criterion. Our objective was to create a standardized approach to counseling expectant persons and parents of newborns with T13/T18 in order to provide collaborative and consistent counseling and thoughtful approach to interventions such as surgery.

Study Design This article describes our process and presents our resulting clinical care guideline.

Results We formed a multi- and interdisciplinary committee. We used published literature when available and otherwise expert opinion to develop an approach to care featuring individualized assessment of the patient to estimate qualitative mortality risk and potential to benefit from intensive care and/or surgeries centered within an ethical framework.

Conclusion Through multidisciplinary collaboration, we successfully created a patient-centered approach for counseling families facing a diagnosis of T13/T18. Other institutions may use our approach as a model for developing their own standardized approach.

Key Points

  • Trisomy 13 and trisomy 18 are associated with high but variable morbidity and mortality.

  • Research on which patients are most likely to benefit from surgery is lacking.

  • We present our institution's framework to counsel families with fetal/neonatal T13/T18.

Keywords

trisomy 13 - trisomy 18 - antenatal counseling - shared decision-making

Data Availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.


Ethics Review

No subject research was conducted, and therefore, institutional ethics' board review was not indicated.


* co-senior authors.


# Current affiliations: M.M. is at Department of Pediatric Cardiology, Cleveland Clinic Children's; C.R. is at Department of Cardiology, Boston Children's Hospital.




Publication History

Received: 07 June 2023

Accepted: 25 July 2023

Article published online:
24 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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