The Experience of Families With Children With Trisomy 13 and 18 in Social Networks

Authors

Annie Janvier, MD, PhD, Barbara Farlow, BEng, MBA, and Benjamin S. Wilfond, MD

Key Words

trisomy 13, trisomy 18, life-sustaining interventions, quality

Abstract

Background

Children with trisomy 13 and trisomy 18 (T13-18) have low survival rates and survivors have significant disabilities. For these reasons, interventions are generally not recommended by providers. After a diagnosis, parents may turn to support groups for additional information.

Methods

We surveyed parents of children with T13-18 who belong to support groups to describe their experiences and perspectives.

Results

A total of 503 invitations to participate were sent and 332 questionnaires were completed (87% response rate based on site visits, 67% on invitations sent) by parents about 272 children. Parents reported being told that their child was incompatible with life (87%), would live a life of suffering (57%), would be a vegetable (50%), or would ruin their family (23%). They were also told by some providers that their child might have a short meaningful life (60%), however. Thirty percent of parents requested “full” intervention as a plan of treatment. Seventynine of these children with full T13-18 are still living, with a median age of 4 years. Half reported that taking care of a disabled child is/was harder than they expected. Despite their severe disabilities, 97% of parents described their child as a happy child. Parents reported these children enriched their family and their couple irrespective of the length of their lives.

What's known on this subject

Trisomy 13 and 18 are conditions with 1-year survival rates of less than 10% and have traditionally been treated with palliative care. There are increasing reports of ethical dilemmas caused by parental requests for clinical interventions.

What this study adds

Parents who belong to social networks report an enriching family experience and describe surviving children as happy. Many of these parents describe challenging encounters with health care providers.

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Parents of Severely Disabled Kids Say They Enrich Their Lives

By Jenifer Goodwin

HealthDay Reporter

Filed Under: Birth Defects / Misc. | Child Development | Computers, Internet / Misc. | Family | Genetic Disorders | Grief | Infant, Child Care | Parenting | Support Groups

Posted: Monday, July 23, 2012, 10:42 AM

MONDAY, July 23 (HealthDay News) -- When Vanessa Hernandez's sixth child was born, she knew right away her daughter was different.

Hernandez's pediatrician wept as she told her the diagnosis. The baby had trisomy 13, a devastating chromosomal abnormality. Most children die before their first birthday and have serious mental and physical disabilities, including heart and breathing problems.

Hernandez's daughter, now 19 months old, hasn't had an easy time. She's had seizures, has a tracheotomy to assist her with breathing and has been fed mostly through a feeding tube.

Despite the hurdles, Isabel is a source of great joy to her family, Hernandez said. Isabel smiles and laughs frequently, and there are no indications she is in pain. Her parents celebrate small achievements. Isabel's five siblings love her fiercely. "She gets the most love in the house. They are very protective of her. Nobody leaves the room without giving her a hug and a kiss," Hernandez said.

Though many people believe that raising child with severe birth defects would be more than they could bear, many parents of children with severe disabilities say that couldn't be further from the truth.

In a new study, nearly all -- 97 percent -- of 332 parents of children with trisomy 13 or trisomy 18, another chromosomal abnormality that can cause similarly severe problems and shortened lifespans, described their child as "happy." Parents also said that no matter how short their lives, their child enriched their family.

"Despite the fact that often these children live less than a year and they are disabled, families find they are happy children. They find joy in their children. They enrich the family, enrich the couple and the child's life had meaning," said study author Dr. Annie Janvier, an associate professor of pediatrics and clinical ethics at University of Montreal. "None of the parents said they regretted not terminating the pregnancy. None said the life was unworthy of living. All of the parents reported the quality of life of their child was a good quality of life."

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Children With Trisomy 13 And 18 Are Happy Despite Popular Beliefs

By Petra Rattue

Main Category: Pediatrics / Children's Health
Also Included In: Psychology / Psychiatry
Article Date: 24 Jul 2012 - 15:00 PDT

Trisomies 13 and 18 are rare chromosome disorders, which are predominantly diagnosed prior to a child's birth and sometimes after. Children with trisomy 13 or 18 generally do not survive beyond their first year of life, and those who do are severely disabled and only live a short life. When diagnosed before birth, parents often decide to have an abortion, whilst those who continue the pregnancy often have a miscarriage.

A study of parent members of a trisomy 13 or 18 children support group has now revealed that although these mostly severely disabled children only have a very short life expectancy, their families nevertheless lead an overall happy and rewarding life, contrary to the medical profession's common gloomy predictions at the time of diagnosis.

The study, published in Pediatrics was conducted by Dr. Annie Janvier of the Sainte-Justine University Hospital Center and the University of Montreal with special collaboration of the study's second author, Barbara Farlow, Eng, MSc who is the mother of a child who died from trisomy 13. Both experts sometimes give joint talks on the subject of trisomies 13 and 18.

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Riscos do aborto

Riscos imediatos do aborto

Veja este post no novo site: http://ninaminhafilha.com/2012/12/29/riscos-do-aborto/

Clinical relevance of cytogenetics to pediatric practice. Postnatal findings of Patau syndrome – Review of 5 cases

Vasilica PLAIASUa, MD; Diana OCHIANAa, biol.; Gabriela MOTEIa, biol.; Ioana ANCAb, MD, PhD; Adrian GEORGESCUb, MD, PhD
aGenetics Department, IOMC “Alfred Rusescu”, Bucharest, Romania bPediatrics Department, “Carol Davila” University of Medicine and Pharmacy, IOMC “Alfred Rusescu”, Bucharest, Romania

Resumo / Abstract

Introduction: Patau syndrome (trisomy 13) is one of the most common chromosomal anomalies clinically characterized by the presence of numerous malformations with a limited survival rate for most cases. Babies are usually identified at birth and the diagnosis is confirmed with genetic testing. Materials and methods: In this review we outline the clinical and cytogenetic aspects of trisomy 13 and associated phenotypes for 5 cases analyzed in the last 3 years, referred to our Clinical Genetics Department. For each child cytogenetic analysis was performed to determine the genetic variant; also, the patients were investigated for other associated malformations (cardiac, cerebral, renal, ocular anomalies). Discussion: All 5 cases presented multiple malformations, including some but not all signs of the classical clinical triad suggestive of Patau syndrome. The cytogenetic investigation confirmed for each case the suspected diagnosis and also indicated the specific genetic variant, this being a valuable information for the genetic counselling of the families. Conclusion: The application of genetic analysis can increase diagnosis and prognosis accuracy and have an impact on clinical management.

Keywords: trisomy 13, Patau syndrome, polydactyly, cleft palate, microphthalmia, genetics

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Patau syndrome with long survival in a case of unusual mosaic trisomy 13

Giuseppina Fogu a,*, Emanuela Maserati b, Francesca Cambosu a, Maria Antonietta Moro a, Fausto Poddie a, Giovanna Soro a, Pasquale Bandiera c, Gigliola Serra d, Gianni Tusacciu d, Giuseppina Sanna d, Vittorio Mazzarello c, Andrea Montella c
a Clinical Genetics, Department of Biomedical Sciences, University of Sassari, viale San Pietro,
43/C, 07100 Sassari, Italy
b Department of Experimental and Clinical Biomedical Sciences, University of Insubria, Varese, Italy
c Anatomy and Histology Division, Department of Biomedical Sciences, University of Sassari, Italy
d Institute of Child Neuropsychiatry, University of Sassari, Italy

Received 21 January 2008; accepted 27 March 2008
Available online 9 April 2008

Abstract / Resumo
We report a 12-year-old patient with Patau syndrome, in whom two cell lines were present from birth,
one with total trisomy 13 due to isochromosome (13q), and one with partial trisomy 13. A cytogenetic re-evaluation at 9 years of age brought to light in skin fibroblasts a third cell line, partially monosomic for chromosome 13. The derivatives (13) present in the three cell lines were characterized through fluorescence in situ hybridization (FISH) experiments with suitable probes; the results suggested a sequence of rearrangements which beginning from an isochromosome (13q) could have led to the other two derivatives. We report the clinical data at birth and at the age of 12; at this age pigmentary lesions with phylloid pattern were noted. Cytogenetic findings of the chromosomal analyses on different tissues, including skin fibroblasts from differently pigmented areas, are also reported. 2008 Elsevier Masson SAS. All rights reserved.

Keywords: Patau syndrome; Trisomy 13; Mosaicism; FISH; Phylloid hypomelanosis

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Persistent congenital milia involving the skin of the whole body in an infant with trisomy 13 syndrome

Abstract / Resumo

Milia are tiny pearly-white cysts on the surface of the skin. In newborns, milia are usually located around the nose and eyes and generally disappear after the first several weeks of life. Trisomy 13 is a severe chromosomal disorder, with various complications. Here, we report a case of a 9-month-old female infant with trisomy 13 who had persistent congenital milia covering her entire body surface.

Multiple pearly-white cysts measuring 1 to 2 mm in diameter on: (A) back; and (B) pudendum.

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Prenatal Diagnosis and Genetic Counseling for Mosaic Trisomy 13

Chih-Ping Chen1,2,3,4,5,6*
1Department of Obstetrics and Gynecology and 2Medical Research, Mackay Memorial Hospital, Taipei, 3Department of Biotechnology, Asia University, 4School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 5Institute of Clinical and Community Health Nursing and 6Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.

Resumo / Summary

Counseling parents of a fetus with trisomy 13 mosaicism remains difficult because of the phenotypic variability associated with the condition; some patients exhibit the typical phenotype of complete trisomy 13 with neonatal death, while others have few dysmorphic features and prolonged survival. This article provides a comprehensive review of the prenatal diagnosis and genetic counseling for mosaic trisomy 13, including confined placental mosaicism 13, mosaic trisomy 13 diagnosed at amniocentesis, and phylloid hypomelanosis in association with mosaic trisomy 13. [Taiwan J Obstet Gynecol 2010;49(1):13–22]

Key Words: confined placental mosaicism, mosaicism, phylloid hypomelanosis, prenatal diagnosis, trisomy 13

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The Impact of Cardiac Surgery in Patients with Trisomy 18 and Trisomy 13 in Japan

Jun Maeda,1 Hiroyuki Yamagishi,1* Yoshiyuki Furutani,2 Mitsuhiro Kamisago,3 Tadashi Waragai,4 Shinji Oana,5 Hiroki Kajino,6 Hiroyuki Matsuura,7 Katsuhiko Mori,8 Rumiko Matsuoka,2 and Toshio Nakanishi9
1Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan 2International Research and Educational Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, Tokyo, Japan 3Department of Pediatrics, Nippon Medical School, Tokyo, Japan 4Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan 5Division of General Pediatrics, Department of Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan 6Department of Pediatrics, Asahikawa Medical School, Hokkaido, Japan 7The First Department of Pediatrics, Toho University Omori Medical Center, Tokyo. Japan 8Department of Pediatrics, Sakakibara Memorial Hospital, Tokyo. Japan 9Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan 
Received 9 December 2010; Accepted 29 July 2011

Congenital heart defects (CHD) are very common in patients with trisomy 18 (T18) and trisomy 13 (T13). The surgical indication of CHD remains controversial since the natural history of these trisomies is documented to be poor. To investigate the outcome of CHD in patients with T18 and T13, we collected and evaluated clinical data from 134 patients with T18 and 27 patients with T13 through nationwide network of Japanese Society of Pediatric Cardiology and Cardiac Surgery. In patients with T18, 23 (17%) of 134 were alive at this survey. One hundred twenty-six (94%) of 134 patients had CHDs. The most common CHD was ventricular septal defect (VSD, 59%). Sixtyfive (52%) of 126 patients with CHD developed pulmonary hypertension (PH). Thirty-two (25%) of 126 patients with CHD underwent cardiac surgery and 18 patients (56%) have survived beyond postoperative period. While palliative surgery was performed in most patients, six cases (19%) underwent intracardiac repair for VSD. Operated patients survived longer than those who did not have surgery (P<0.01). In patients with T13, 5 (19%) of 27 patients were alive during study period. Twenty-three (85%) of 27 patients had CHD and 13 (57%) of 27 patients had PH. Atrial septal defect was the most common form of CHD (22%). Cardiac surgery was done in 6 (26%) of 23 patients. In this study, approximately a quarter of patients underwent surgery for CHD in both trisomies. Cardiac surgery may improve survival in selected patients with T18. 2011 Wiley Periodicals, Inc.

Key words: trisomy 18; trisomy 13; cardiac surgery

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The Risk of Fetal Loss Following a Prenatal Diagnosis of Trisomy 13 or Trisomy 18

Joan K. Morris1* and George M. Savva2

1Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St. Bartholomew’s and the London, Queen Mary’s School of Medicine and Dentistry, Charterhouse Square, London, UK

2Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

Received 12 July 2007; Accepted 23 November 2007

The objective of this study is to determine the risk of fetal loss (spontaneous abortion or stillbirth) following a prenatal diagnosis of trisomy 13 (T13; Patau syndrome) or trisomy 18 (T18; Edwards syndrome). Five regional congenital anomaly registers in England and Wales provided details on the outcomes of 198 pregnancies prenatally diagnosed with T13 and 538 prenatally diagnosed with T18. For each pregnancy the time from prenatal diagnosis until birth, miscarriage or termination occurred was calculated and these times were analyzed using Kaplan–Meier survival functions. Our results showed that between 12 weeks gestation and term an estimated 49% (95% CI: 29–73%) of pregnancies diagnosed with T13 and 72% (61–81%) of pregnancies diagnosed with T18 ended in a miscarriage or stillbirth. Between 18 weeks and term the proportions were 42% (18–72%) for T13 and 65% (57–79%) for T18 and between 24 weeks and term the proportions were 35% (5–70%) for T13 and 59% (49–77%) for T18. Male fetuses with T18 appeared to be more likely to be lost than female fetuses. These are the most precise estimates currently available for the risk of loss in a general population. These estimates should be useful in counseling women who are carrying an affected fetus and knowing the risk of fetal loss is essential to compare the performance of prenatal screening programs occurring in the first and second trimester.
2008 Wiley-Liss, Inc.

Key words: trisomy 13; trisomy 18; spontaneous fetal loss

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Trisomy 13 (Patau Syndrome) and Craniosynostosis

By Rafael F.M. Rosa,1,2 Rosana C.M. Rosa,2 Jos e A.M. Flores,3 Daniel T. Chazan,4 Cristine Dietrich,5 Mariana B. de Barth,5 Vanessa F. Carpes,5 Andr e C. da Cunha,5 Carla Graziadio,2,6 and Paulo R.G. Zen2,6*
1Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), RS, Brazil
2Graduate Program in Pathology, Universidade Federal de Ci^encias da Sa ude de Porto Alegre (UFCSPA), RS, Brazil
3Pediatric Radiology Service, Hospital da Crianc¸a Santo Ant^onio (HCSA)/Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil
4Pediatrics Service, HMIPV, RS, Brazil
5Fetal Medicine Service, HMIPV, RS, Brazil
6Clinical Genetics, UFCSPA and CHSCPA, RS, Brazil

Received 18 March 2011; Accepted 6 April 2011

Trisomy 13 or Patau syndrome is considered a rare chromosomal disease. It was first described by Patau et al. [1960] and its prevalence ranges from 1 to 5,000–12,000 births. It is clinical characterized by multiple malformations, involving especially the face, heart, and limbs, besides a very limited survival [Jones, 2006; Pont et al., 2006; Carey, 2010]. Despite the great variability of the clinical picture presented by the syndrome, craniosysnostosis seems to be a feature uncommonly described among these patients [Mankinen and Sears, 1976; Sullivan et al., 1990; Unal et al., 2009; Aypar et al., 2011].

We report on two patients with trisomy 13 presenting craniosynostosis who show involvement of different sutures. The first was a 1-day-old Caucasian girl, the fourth child of nonconsanguineous parents aged 44 years (mother) and 26 years (father). The child was born through vaginal delivery, prematurely at 36 weeks and 3 days of gestation, weighing 2,640 g (10–50th centile), measuring 46 cm (10–50th centile), with head circumference of 32 cm (10–50th centile), and Apgar score of 5 at first minute and 6 at fifth minute. The mother had chronic hypertension and used the angiotensin-converting enzyme inhibitor captropril during the first 2 months of gestation. Later, she was changed to methyldopa. She denied the use of other drugs or smoking. She drank occasionally (beer) during the pregnancy. During the pregnancy she had an ultrasound at 36 weeks, which showed the fetus had a keel shaped skull (trigonocephaly) (Fig. 1), long bones at 10th centile, and bilateral pyelocalicial dilatation. This last feature was confirmed postnatally through an abdominal ultrasound.

Onphysical exam, the proposita presented with a keel shape skull (trigonocephaly); upslanting palpebral fissures; broad nose; anteverted nares; micrognathia; small, dysplastic, and low set ears; and postaxial polydactyly of the right hand. The images of the patient at age of 16 days can be seen in Figure 2. Skull radiographies confirmed the finding of premature closure of the metopic suture. Ophthalmologic assessment disclosed a bilateral cataract. The echocardiographic study showed a heart deviatedto the right presenting a small atrial septal defect of ostium secundum type and a tinny patent ductus arteriosus. Karyotype with GTG-Banding showed 47,XX,þ13[15]. The child developed seizures and episodes of apnea and cyanosis, and died at 20 days of life.

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Variable Expressivity in Patau Syndrome is Not All Related to Trisomy 13 Mosaicism

By Hui-Fang Hsu1 and Jia-Woei Hou
Department of Pediatrics, Chang Gung Children’s Hospital, Taoyuan, Taiwan
Chang Gung Institute of Technology, Taoyuan, Taiwan
Received 17 April 2006; Accepted 13 March 2007

Patau syndrome (trisomy 13) is very rare in live-born babies. Individuals with this chromosomal syndrome have a short lifespan and are rarely seen beyond infancy. This study is aimed at the clinical spectrum, natural history, and survival of patients with trisomy 13. We reviewed the detailed data of 13 Patau syndrome live-born babies. Among them two individuals were delivered from continuation of pregnancy even after prenatal diagnosis. The remaining 11 patients were born to younger mothers who did not undergo amniocentesis because no major anomalies except for cleft lip/palate were found on prenatal sonograms. The common features of Patau syndrome including the clinical triad (microphthalmia, cleft lip/palate, and polydactyly) and non-cyanotic heart defects were always found in our series. However, certain serious central defects (holoprosencephaly, omphalocele, and single umbilical artery), which are easily recognized from prenatal sonogram, occurred less frequently than those stated in the literature. The median survival time was 95 days and was longer than that previously reported. There were two infants with trisomic mosaicism with different outcomes in both clinical spectrum and survival. Otherwise, we also found the increased recurrence risks of aneuploidy in two individuals, and the longest survivor (84 months) of nonmosaic trisomy 13 in Taiwan. We thus suggest that longterm survival in our series is strongly correlated with different expressivity after prenatal selection, in addition to cytogenetic mosaicism. Less associated anomalies such as polyhydramnios, oligohydramnios, intrauterine growth retardation, single umbilical artery, eye defects, holoprosencephaly, omphalocele, and polycystic kidney may contribute to their clinical courses. 2007 Wiley-Liss, Inc.

Key words: Patau syndrome; trisomy 13; recurrent aneuploidy; mosaicism; long-term survival

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Patau syndrome with a long survival: a case report

By: A.C. Duarte, A.I.C. Menezes, E.S. Devens, J.M. Roth, G.L. Garcias and M.G. Martino-Roth

Genetics and Molecular Research 3 (2): 288-292 (2004)

ABSTRACT

Trisomy 13 is a clinically severe entity; 85% of the patients do not survive beyond one year, and most children die before completing six months of age. We report a female child, 28 months old, white, the fourth child of a non-consanguineous couple, who presented trisomy 13. The child was born at term, from a vaginal delivery, weighing 2600 g. At birth, she was cyanotic, icteric, spastic, and cried weakly. The initial clinical examination detected polydactyly in the left hand, congenital clubfoot and convex soles, ocular hypertelorism, a low nasal bridge, numerous hemangiomas distributed throughout the body, cardiomegaly, and perimembranous inter-ventricular communication. There was no cleft lip or palate. On physical examination at 18 months old, the child weighed 6,900 g, had a cephalic perimeter of 41 cm, a thoracic perimeter of 43 cm and was 76 cm tall. At 28 months, she weighed 10,760 g and was 88.5 cm tall. Neuropsychomotor development retardation was evident from birth and, according to the psychologist and the social assistant of APAE (Handicapped Parents and Friends Association) in Canguçu, Rio Grande do Sul, there was a noticeable improvement after physiotherapy and recreational sessions.

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Can rationing possibly be rational?

2011 Canadian Medical Association or its licensors

CMAJ 2011. DOI:10.1503/cmaj.109-3932

Annie Farlow was just short of three months old when she died in an Ontario hospital of what her parents believe might have been a treatable respiratory condition.

Born with the chromosome disorder Trisomy 13, Annie had little chance of surviving to her teens, but her parents, Barbara and Tim Farlow, took comfort in the hospital’s assurance that her disorder wouldn’t preclude her from receiving the same level of care as any other child with a medical condition.

But months after Annie’s death, the Farlows discovered that physicians had not initiated emergency resuscitation measures with the same alacrity as in other cases. They also learned that a physician had placed a “do not resuscitate” order on Annie’s chart without their consent. Subsequently, their daughter received an undisclosed quantity of narcotics that, in their opinion, may have caused her “unexplained, rapid” decline.

The circumstances surrounding Annie’s death have the Farlows asking questions that plague Canadian patient advocates, health care workers, ethicists and policy-makers faced with a growing scarcity of resources: When is it appropriate to limit or withdraw potentially beneficial treatment? How should decisions be made? Who should make them?

“I never took the position that my daughter had a right to any and all treatments, but the unilateral decisions we believe the doctors made should have been made transparently. We have a right to know and appeal the limits of the system and be provided with whatever care is possible within its confines,” Barbara Farlow says. “Not only do I believe my daughter was denied a chance to prolong her life, the secrecy in which decisions seem to have been made also meant she was denied timely palliative care, and she suffered greatly at the end.”

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You can also see this article at cmaj.ca

Natural Outcome of Trisomy 13, Trisomy 18, and Triploidy After Prenatal Diagnosis

Introduction

Trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome) are, along with trisomy 21 (Down syndrome), the most common autosomal aneuploidies in the newborn, with a prevalence at birth of between one in 3,000 and one in 15,000 [Smith, 1964; Carter et al., 1985; Baty et al., 1994; Hasslod and Hunt, 2001].

Triploidy belongs to the polyploid types, and is estimated to occur in 1–2% of recognized human conceptuses. Most pregnancies with triploidy, however, are aborted spontaneously in early gestation so that the prevalence at birth of triploidy is rare: approximately one in 50,000 newborns [Doshi et al., 1983; McFadden and Kalousek, 1991].

All these chromosomal abnormalities belong to disorders which are compatible with life, but which are also associated with a high rate of spontaneous abortion, intrauterine death, and a short life span. [O’Connor, 2008].

Over the last 30 years, prenatal diagnosis of these disorders has improved due to the increasing use of fetal ultrasound screening methods in the first and second trimesters, and invasive diagnostic methods such as amniocenteses. In Austria, as in many other countries, parents are given the opportunity to terminate a pregnancy (artificially induced abortion) if a severe fetal disorder has been diagnosed. Only a few parents, therefore, decide to continue with a pregnancy after a prenatal diagnosis of trisomy 13, trisomy 18, or triploidy.

[...]


The aim of this study was to analyze the outcome of continued pregnancies after prenatal chromosomal diagnosis of trisomy 13, trisomy 18, or triploidy. These new data are aimed at improving the consulting process for parents who are confronted with prenatal diagnoses of these chromosomal abnormalities.

Birth History, Physical Characteristics, and Medical Conditions in Long-Term Survivors With Full Trisomy 13

Por Deborah Bruns
Department of Educational Psychology and Special Education, Southern Illinois University Carbondale, Carbondale, Illinois
Received 7 April 2011; Accepted 29 July 2011

The purpose of the study is to provide data about long-term survivors with full trisomy 13 (t13). Mothers of 30 long-term survivors with full t13 completed an online survey. Survey data were downloaded into an SPSS database. Descriptive statistics were used to analyze survey data. Tracking Rare Incidence Syndrome (TRIS) Survey data on survival, birth information including maternal and paternal age at conception, physical characteristics, and medical conditions were compared. Data indicate longer mean survival rates (48.4 months for those living at the time of data collection, 40.8 months for those who died prior) than described in the literature. Means for gestations age, birth weight, and lengthare 38.11 weeks, 2,789.34 g and 48.45 cm, respectively. Long-term survivors presented with syndromerelated physical characteristics (e.g., low-set ears, cleft lip and palate) and medical conditions (e.g., ventricular septal defect (VSD), feeding difficulties). We conclude that data indicate longer survival and a range in birth information (gestational age, birth weight, and length) along with presence of common presenting physical characteristics and medical conditions of long-term survivors with full t13. (Leia mais / Keep reading it.)

Patau Syndrome: A Case Report

Aijaz Nanjiani, M.D.

Ashgar Hossain, M.D.

Bergen Regional Medical Center, Paramus, NJ

Nahla Mahgoub, M.D.

Beth Israel Medical Center,

New York, NY

SIR: Patau syndrome is a congenital disorder which was reported by Dr. Klaus Patau in 1960.1 The syndrome is caused by presence of an extra copy of chromosome 13. Other changes in chromosome 13, such as translocation, can also result in the characteristics classified as Patau syndrome. The syndrome causes serious physical and mental abnormalities, including neurological impairment, structural facial defects, heart defects, and mental retardation.

The incidence of Patau syndrome is approximately one per 12,000 live births.2–4 The median survival age for children with the syndrome is 2.5 days. The most common cause of death is cardiopulmonary complications. Forty-five percent of the patients die within the first month of life and 70% die by 1 year of age. Survival to adulthood is extremely rare.

Case Report

We would like to report a 51-year old Caucasian woman with Patau syndrome. Her chromosomal analysis showed partial translocation of chromosome 13 (unbalanced rearrangement between chromosome 13 and chromosome 14). 

She had had 17 siblings in all. Eight of them died within the first few weeks of life. Another five died between the ages of 10 and 34 as a result of the medical complications of the syndrome; these siblings had mental retardation and psychosis. One living sibling, a 30-year-old man, suffered from mental retardation and psychosis. Three other siblings, two men and one woman, had no chromosomal abnormalities and are healthy.

The patient was born at full term with six toes on each foot, a small head, small eyes, low-set ears, and a cleft lip. Although all of her developmental milestones were delayed, she graduated from a special education high school. Her Wechsler Intelligence Scale for Children at 4 years old showed an IQ of 61 and moderate mental retardation. Her Wechsler Adult Intelligence Scale (WAIS) at 18 years old showed an IQ of 74 and educatable mental retardation while Rorschach testing showed severe immaturity. Her WAIS at 34 years old showed an IQ of 72 and borderline intellectual capabilities. The Halstead-Reitan Neurophysiological Battery showed serious neurological impairment. Her EEG showed complex partial seizures, and her computed tomography (CT) scan showed blunting of the frontal horns of the ventricular system.

Comment

What makes this case noteworthy, apart from the rarity of the syndrome and survival to adulthood, is the evolution of the psychosis, which is not a feature of Patau syndrome. The patient started to develop auditory hallucinations at the age of 15, for which she had multiple admissions and received different antipsychotic medications.

She started to decompensate after her antipsychotic medication was changed because of questionable seizures. She presented in the emergency room with agitated behavior. She was observed conversing with God, the devil, and her deceased siblings. She was delusional; she believed that people were taking her strength. The patient was medicated and admitted to the psychiatric floor. She was put on a regimen of valproic acid, 500 mg twice daily, aripiprazole, 20 mg daily, and olanzapine, 20 mg daily.

She was discharged to an assisted living facility after she stabilized. Since then, she has not had any hospitalization.

References

1. Patau K, Smith DW, Therman E, et al: Multiple congenital anomaly caused by an extra autosome. Lancet 1960; 1:790

2. Baty BJ, Brent L, Cary JC, et al: Natural history of trisomy 18 and trisomy 13, I: growth, physical assessment, medical histories, survival, and recurrence risk. Am J Med Genet 1994; 49:175–187

3. Baty BJ, Brent L, Cary JC, et al: Natural history of trisomy 18 and trisomy 13, II: psychomotor development. Am J Med Genet 1994; 49:189–194

4. Delatycki M, Garder R: Three cases of trisomy 13 mosaicism and a review of the literature. Clin Genet 1997; June:403–407

Research Letter Patau Syndrome With a Long Survival (146 Months): A Clinical Report and Review of Literature

American Journal of Medical Genetics 140A:92 – 93 (2006) 

Trisomy 13 is a clinically severe condition first described by Patau in 1960 [Smith et al., 1960]. The frequency of this syndrome is 1:3,000 live births [Tunca et al., 2001]. It is the third most frequent trisomy among live births [Phatak et al., 2004] after trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome). Eighty-five percent of liveborns do not survive beyond 1 year of life, and most die before the age of 6 months [Duarte et al., 2004]. Trisomy 13 is characterized by multiple malformations of the cardiac, central nervous, and urogenital systems [Phatak et al., 2004]. There have only been five cases of patients with trisomy 13 previously reported, who had survived past the first decade [Redheendran et al., 1981; Singh, 1990; Zoll et al., 1993; Tunca et al., 2001]. In this report, we present a newborn with trisomy 13, the fourth longest described in the literature and the longest survival (146 months) reported in Greece. (Keep reading it...)

Trisomy 13 and 18 and Quality of Life: Treading ‘‘Softly’’

By Lawrence J. Fenton

Not too long ago I was privileged to speak at an annual international conference of the Support Organization For Trisomy 18, 13 and Related Disorders (SOFT). I learned much more than I taught. There were over 200 families there. Approximately half of the families were bereaved parents of a child with Trisomy 13 or 18. (Keep reading it...)

O que é a síndrome de Patau?

 A síndrome de Patau é uma anomalia cromossômica causada pela trissomia do cromossoma 13. Foi descoberta em 1960 por Klaus Patau observando um caso de malformações múltiplas em um neonato, sendo trissômico para o cromossomo 13.[1]

A Síndrome de Patau também é conhecida pelo nome de Síndrome Bartholin-Patau, já que o dinamarquês Thomas Bartholin descreveu em 1656 o quadro clínico de crianças apresentando tal deficiência.[2]

Tem como principal causa a não disjunção dos cromossomos durante a anáfase 1 da meiose, gerando gametas com 24 cromátides. Neste caso, o gameta possui um par de cromossomos 13, que juntando com o cromossomo 13 do gameta do parceiro forma um ovo com trissomia. Cerca de 20% dos casos resultam de uma translocação não balanceada. Ocorre na maioria das vezes com mulheres com idade avançada 35 anos acima.

O fenótipo inclui malformações graves do sistema nervoso central como arrinencefalia. Um retardamento mental acentuado está presente. Em geral há defeitos cardíacos congênitos e defeitos urogenitais incluindo criptorquidia nos meninos, útero bicornado e ovários hipoplásticos nas meninas gerando inviabilidade, e rins policísticos. Com frequência encontram-se fendas labial e palato fendido, os punhos cerrados e as plantas arqueadas. A fronte é oblíqua, há hipertelorismo ocular e microftalmia bilateral, podendo chegar a anoftalmia, coloboma da íris, olhos são pequenos extremamente afastados ou ausentes. As orelhas são malformadas e baixamente implantadas. As mãos e pés podem mostrar sexto dedo (polidactilia) e/ou o quinto dedo sobrepondo-se ao terceiro e quarto, como na Síndrome de Edwards (trissomia do 18).

A expectativa de vida é muito curta (cerca de seis meses), porém existem casos na literatura médica de sobrevida maior que dez anos.[3] 

Fonte: Wikipedia

Características
O fenótipo inclui malformações graves do sistema nervoso central como arrinencefalia. Um retardamento mental acentuado está presente. Em geral há defeitos cardíacos congênitos e defeitos urigenitais incluindo criptorquidia nos meninos, útero bicornado e ovários hipoplásticos nas meninas gerando inviabilidade, e rins policísticos. Com freqüência encontram-se fendas labial e palato fendido, os punhos cerrados e as plantas arqueadas. A fronte é oblíqua, há hipertelorismo ocular e microftalmia bilateral, podendo chegar a anoftalmia, coloboma da íris, olhos são pequenos extremamente afastados ou ausentes. As orelhas são malformadas e baixamente implantadas. As mãos e pés podem mostrar quinto dedo (polidactilia) sobrepondo-se ao terceiro e quarto, como na trissomia do 18.

Fonte: ghente.org

O artigo da Wikipedia em inglês é bem mais rico. Caso você saiba ler em inglês, clique aqui.

Referências

    ↑ K. Patau, D. W. Smith, E. Therman, S. L. Inhorn, H. P. Wagner: Multiple congenital anomaly caused by an extra autosome.The Lancet, 1960, I: 790.
    ↑ Bartholin-Patau syndrome (Thomas Bartholin), <http://www.whonamedit.com/synd.cfm/1024.html>. Acesso em: 20 de maio de 2008
    ↑ European Journal of Medical Genetics Volume 51, Issue 4, July-August 2008, Pages 303-314, "Patau syndrome with long survival in a case of unusual mosaic trisomy 13"
    ↑ Trantado de Medicina Cadiovascular, por Braunwald, Zipes e Libby, editora Roca, p.2058