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Am J Perinatol 2023; 40(14): 1515-1520
DOI: 10.1055/s-0041-1736594
Original Article

The Impact of Altitude at Birth on Perinatal Respiratory Support for Neonates with Trisomy 21

Jessica L. Bloom 
1   Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Anna Furniss
2   Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Krithika Suresh
3   Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
,
Robert C. Fuhlbrigge
1   Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Molly M. Lamb
4   Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
,
Sophie Rosenberg
5   Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
,
Anastasia Edwards
6   Colorado Department of Public Health and Environment, Denver, Colorado
,
Sean T. O'Leary
7   Department of Pediatrics, Section of Infectious Disease, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
› Author Affiliations Funding NIH/NCATS Colorado CTSI, grant number: UL1 TR002535; NIH T32 Research Training in Rheumatology, grant number: AR007534.
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Abstract

Objective Both high altitude and trisomy 21 (T21) status can negatively impact respiratory outcomes. The objective of this study was to examine the association between altitude and perinatal respiratory support in neonates with T21 compared with those without T21.

Study Design This retrospective cohort study used the United States all-county natality files that included live, singleton, in-hospital births from 2015 to 2019. Descriptive statistics for neonates with and without the primary outcome of sustained assisted ventilation (>6 hours) were compared using t-tests and Chi-squared analyses. Multivariable logistic regression was used to determine the association between respiratory support and the presence of T21, and included an interaction term to determine whether the association between respiratory support and the presence of T21 was modified by elevation at delivery.

Results A total of 17,939,006 neonates, 4,059 (0.02%) with T21 and 17,934,947 (99.98%) without, were included in the study. The odds of requiring sustained respiratory support following delivery were 5.95 (95% confidence interval [CI]: 5.31, 6.66), 4.06 (95% CI: 2.39, 6.89), 2.36 (95% CI: 1.64, 3.40), and 5.04 (95% CI: 1.54, 16.54) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevations, respectively. The odds of requiring immediate ventilation support following delivery were 5.01 (95% CI: 4.59, 5.46), 5.90 (95% CI: 4.16, 8.36), 2.86 (95% CI: 2.15, 3.80), and 12.08 (95% CI: 6.78, 21.51) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevation, respectively.

Conclusion Neonates with T21 have increased odds of requiring respiratory support following delivery when compared with neonates without T21 at all categories of altitude. However, the odds ratios did not increase monotonically with altitude which indicates additional research is critical in understanding the effects of altitude on neonates with T21.

Key Points

  • Neonates with T21 have an increased need for perinatal respiratory support at all altitudes.

  • The odds of needing perinatal respiratory support did not increase monotonically with elevation.

  • Additional research is critical to understanding the effects of altitude on neonates with T21.

Keywords

trisomy 21 - Down syndrome - altitude - elevation - respiratory support - neonate


Publication History

Received: 30 July 2021

Accepted: 14 September 2021

Article published online:
21 October 2021

© 2021. Thieme. All rights reserved.

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