Trisomy Disorders

Trisomy 18

Posted on: October 30, 2008

Alternative names   

Edwards syndrome

Definition   

Trisomy 18 is a syndrome associated with the presence of a third (extra) number 18 chromosome.

Causes, incidence, and risk factors   

Trisomy 18 is a relatively common syndrome affecting approximately 1 out of 3,000 live births and affecting girls more than three times as often as boys. Multiple abnormalities are associated with the presence of an extra number 18 chromosome. Many of these abnormalities are not compatible with more than a few months of life. Few infants survive beyond the first year. low birth weight, mental retardation, low-set ears, malformed ears, small jaw (micrognathia), hand abnormalities, congenital heart disease,hernias, and undescended testicle (cryptorchidism). There may be many other abnormalities noted.

Common findings include

Symptoms   

 

Signs and tests   

Examination of the pregnant woman may show polyhydramnios (extra amniotic fluid). At the birth of the child, an unusually small placenta may be noted.

Physical examination may show an excess of arched type finger print patterns. X-rays may reveal a short breast bone (sternum). Chromosome studies show trisomy 18, partial trisomy, or translocation.

 

Treatment   

Treatment is supportive, but life-sustaining measures are not recommended.

Support Groups   

Support Organization for Trisomy 18, 13 and Related Disorders (SOFT)
2982 S Union St
Rochester, NY 14624
716-594-4621
800-716-7638
www.trisomy.org

Trisomy 18 Support Foundation, Inc.
4301 Connecticut Ave. N.W. Suite 404
Washington, D.C. 20008-2369
757-464-5905
www.trisomy18support.org

 

Expectations (prognosis)   

The abnormalities of trisomy 18 are generally not compatible with more than a few months of life. Fifty percent of the affected infants do not survive beyond the first week of life. More than 10 children have survived to teenage years, but usually with marked handicaps.

Complications   

Complications depend on the specific abnormalities that affect the infant.

Calling your health care provider   

Call your health care provider and genetic counselor if you have had a child with Trisomy 18 and you plan to have another child.

Prevention   

Prenatal diagnosis of trisomy 18 ispossible with an amniocentesis and chromosome studies on amniotic cells. Parents who have a child with translocational trisomy 18 should have chromosome studies, because they are at increased risk for another child with trisomy 18.

Update Date: 8/19/2003

Updated by: Douglas R. Stewart, M.D., Division of Medical Genetics, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

http://www.nlm.nih.gov/medlineplus/ency/article/001661.htm

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Trisomy 18 Disorders Menu

http://neuro-www.mgh.harvard.edu/forum/Trisomy18DisordersMenu.html

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Trisomy On-Line

http://www.trisomyonline.org/

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Trisomy 18

http://www.emedicine.com/ped/topic652.htm

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T18moms.com

http://www.t18moms.com/

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Trisomy 18 Support

http://www.trisomy18support.org/

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What is Trisomy 18?

Trisomy 18 is a rare chromosome abnormality, affecting about one in every 3,000 to 4,000babies, which involves severe mental retardation as well as physical birth defects. Most babies with this condition do not live longer than a few days, weeks, or months; about 70% of fetuses conceived with Trisomy 18 die before birth. Those who do survive are usually small for their age and have a poor suck and weak cry. They have feeding problems, since it is difficult for them to coordinate breathing, sucking, and swallowing. Only about 10% are alive at the time of their first birthday, although some children do live for years. Children with Trisomy 18 who survive past infancy usually do not walk, but some have learned a few words or signs to use in communicating. Some children with Trisomy 18 smile responsively and interact with family members.

In addition to mental retardation, babies with Trisomy 18 have various birth defects. The most common of these are heart defects, a cleft lip (when the upper lip does not form properly), and kidney problems. The babies are often born with their fists clenched; this is due to abnormalities in the nervous system which prevent the hand muscles from receiving proper instructions to move normally. 

What causes Trisomy 18?

The problems with Trisomy 18 are caused by anextra chromosome — specifically a third copy of chromosome number 18. Chromosomes, which normally come in pairs – one in each pair from the mother and one from the father — are the packages of genetic material which give the baby the instructions for growth and development. The extra genetic material that a baby with Trisomy 18 receives interferes with these instructions and causes abnormalities in many organs of the body. The extra copy of chromosome 18 was present in either the sperm or the egg which went to form the baby, and this mistake occurred either prior to or just at conception. Many parents wonder why Trisomy 18 occurred, but we know of nothing that either parent could have done that would have caused or prevented this from happening. 

If I had one baby with Trisomy 18, will I have another?

It is very unusual for a family to have a second child with Trisomy 18. If you were under 30 years old when pregnant with your baby with Trisomy 18, then there is approximately a 1% chance for another baby to have Trisomy 18. If you were over 30, then your risk is not increased; it is simply the same as that of any other woman your age. Prenatal diagnosis is an option for you in a future pregnancy, even though the risk of recurrence is low. 

Mosaic Trisomy 18

Occasionally Trisomy 18 is present in only some of the baby’s cells; this is known as mosaic Trisomy 18; in these cases the outlook is often better than for those babies with full Trisomy 18. 

How is Trisomy 18 diagnosed?

Trisomy 18 can be diagnosed prenatally through CVS or amniocentesis (See CVS/Amnio section) ; it is also one of the conditions screened for in the XAFP program (See XAFP section). Sometimes ultrasound findings provide the first indication that the baby has a problem.

In other cases a baby with Trisomy 18 may be diagnosed shortly after birth. If facial features, a heart defect, or other problems raise the possibility of Trisomy 18, a blood chromosome study will be done to confirm the diagnosis. If a baby is born with Trisomy 18, decisions about care and interventions (such as heart surgery) will have to be made and should be discussed with your baby’s doctor.

If you have just learned during your pregnancy that your baby has Trisomy 18 and are trying to decide whether or not to continue your pregnancy, you will probably not find many sources of information on this condition. There is an organization called SOFT (Support Organization for Trisomy 18, 13, and Related Disorders) which is a group composed of parents who have children with Trisomy 18 and other related conditions, as well as professionals who have an interest in caring for children with those conditions. These parents are strong advocates for their children and emphasize the positive aspects involved in raising a child with Trisomy 18. Parents who continue a pregnancy with a baby with Trisomy 18 or who have a baby born unexpectedly with this condition have found this group to be a great support. Their website can be found at

http://www.trisomy.org.

http://www.dor.kaiser.org/genetics/OurServices/Trisomy18Main.html

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