Abstract
Objective The conventional view toward the management of infants with the trisomy 18 and trisomy
13 syndromes has been to recommend pure comfort care and the avoidance of technological
interventions. This commentary aims to address the recently raised question about
whether there has been a shift in the paradigm of the management of infants with the
two conditions.
Study Design The study design includes narrative review of the literature.
Results A body of opinion pieces and evidence has emerged indicating that there has been
a recent increase in the administration of interventions, including ventilatory support
and surgery, in the management of children with these syndromes.
Conclusion Based on the evidence in the literature, the author concludes that there has been
a type of paradigm shift described by philosopher of science, Thomas Kuhn, in the
treatment of infants with trisomy 18 and 13. More parents are being offered and choosing
technological interventions, including cardiac surgery. Future investigation of the
question whether intervention improves outcome, including the quality of life, is
crucial in addressing the unanswered questions in this dialogue.
Key Points
-
The conventional approach to the treatment of trisomy 18 and 13 has been to avoid
interventions.
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There is a growing body of evidence that this traditional view of management is changing.
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Future investigation of whether intervention improves outcome is crucial in addressing
the unanswered questions.
Keywords
trisomy 18 - trisomy 13 - pediatric palliative care - cardiac surgery - paradigm shift
