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

Jessica L. Bloom; Anna Furniss; Krithika Suresh; Robert C. Fuhlbrigge; Molly M. Lamb; Sophie Rosenberg; Anastasia Edwards; Sean T. O'Leary

doi:10.1055/s-0041-1736594

American Journal of Perinatology, Table of Contents

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

¹Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

,

Anna Furniss

²Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado

,

Krithika Suresh

³Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado

,

Robert C. Fuhlbrigge

¹Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

,

Molly M. Lamb

⁴Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado

,

Sophie Rosenberg

⁵Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado

,

Anastasia Edwards

⁶Colorado Department of Public Health and Environment, Denver, Colorado

,

Sean T. O'Leary

⁷Department 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

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

Full Text

References

References
1 Saji T. Clinical characteristics of pulmonary arterial hypertension associated with Down syndrome. Pediatr Int 2014; 56 (03) 297-303
2 Ergaz-Shaltiel Z, Engel O, Erlichman I, Naveh Y, Schimmel MS, Tenenbaum A. Neonatal characteristics and perinatal complications in neonates with Down syndrome. Am J Med Genet A 2017; 173 (05) 1279-1286
3 Mann JP, Statnikov E, Modi N, Johnson N, Springett A, Morris JK. Management and outcomes of neonates with Down syndrome admitted to neonatal units. Birth Defects Res A Clin Mol Teratol 2016; 106 (06) 468-474
4 Martin T, Smith A, Breatnach CR. et al. Infants born with Down syndrome: burden of disease in the early neonatal period. J Pediatr 2018; 193: 21-26
5 McAndrew S, Acharya K, Nghiem-Rao TH, Leuthner S, Clark R, Lagatta J. NICU management and outcomes of infants with trisomy 21 without major anomalies. J Perinatol 2018; 38 (08) 1068-1073
6 Peacock AJ. ABC of oxygen: oxygen at high altitude. BMJ 1998; 317 (7165): 1063-1066
7 Penaloza D, Arias-Stella J. The heart and pulmonary circulation at high altitudes: healthy highlanders and chronic mountain sickness. Circulation 2007; 115 (09) 1132-1146
8 Bakr AF, Habib HS. Normal values of pulse oximetry in newborns at high altitude. J Trop Pediatr 2005; 51 (03) 170-173
9 Jensen KM, Sevick CJ, Seewald LAS. et al. Greater risk of hospitalization in children with Down syndrome and OSA at higher elevation. Chest 2015; 147 (05) 1344-1351
10 Posada AM, Isaza N, Panqueva P, Rondon-Sepulveda MA, Hidalgo P. High incidence of sleep-related breathing disorders in children with Down syndrome referred to a high-altitude sleep laboratory. High Alt Med Biol 2019; 20 (03) 231-235
11 Griksaitis M, Ang C. Acute altitude induced hypoxia in a child with Down's syndrome following postoperative repair of complete atrioventricular septal defect. BMJ Case Rep 2011; 2011: bcr0220113866
12 Levine RS, Salemi JL, Mejia de Grubb MC. et al. Altitude and variable effects on infant mortality in the United States. High Alt Med Biol 2018; 19 (03) 265-271
13 Dordevic D, Solevic M. The contributions of highand low altitude emission sources to the near ground concentrations of air pollutants. Atmos Res 2008; 87: 170-182
14 Ertl R, Waldhoer T, Yang L. Moderate altitude impacts birth weight: 30 years retrospective sibling analyses using record linkage data. Pediatr Res 2019; 86 (03) 403-407
15 Katz D, Shore S, Bandle B, Niermeyer S, Bol KA, Khanna A. Sudden infant death syndrome and residential altitude. Pediatrics 2015; 135 (06) e1442-e1449
16 Beall CM. Andean, Tibetan, and Ethiopian patterns of adaptation to high-altitude hypoxia. Integr Comp Biol 2006; 46 (01) 18-24
17 McDowell KM, Craven DI. Pulmonary complications of Down syndrome during childhood. J Pediatr 2011; 158 (02) 319-325
18 Cua CL, Blankenship A, North AL, Hayes J, Nelin LD. Increased incidence of idiopathic persistent pulmonary hypertension in Down syndrome neonates. Pediatr Cardiol 2007; 28 (04) 250-254
19 Fitzgerald P, Leonard H, Pikora TJ, Bourke J, Hammond G. Hospital admissions in children with Down syndrome: experience of a population-based cohort followed from birth. PLoS One 2013; 8 (08) e70401
20 Joffre C, Lesage F, Bustarret O, Hubert P, Oualha M. Children with Down syndrome: clinical course and mortality-associated factors in a French medical paediatric intensive care unit. J Paediatr Child Health 2016; 52 (06) 595-599
21 Hilton JM, Fitzgerald DA, Cooper DM. Respiratory morbidity of hospitalized children with trisomy 21. J Paediatr Child Health 1999; 35 (04) 383-386
22 Bruijn M, van der Aa LB, van Rijn RR, Bos AP, van Woensel JB. High incidence of acute lung injury in children with Down syndrome. Intensive Care Med 2007; 33 (12) 2179-2182