Background
Trisomy 18 was independently described by Edwards et al and Smith et al in 1960. [1, 2]
Among liveborn children, trisomy 18 is the second most common autosomal trisomy after trisomy 21.
The disorder is characterized by severe psychomotor and growth retardation, microcephaly, microphthalmia, malformed ears, micrognathia or retrognathia, microstomia, distinctively clenched fingers, and other congenital malformations. [3] See the images below.
Note the microphthalmia, micrognathia/retrognathia, microstomia, low-set/malformed ears, short sternum, and abnormally clenched fingers in an infant with trisomy 18 (Edwards syndrome).
Note the characteristic clenched hand of trisomy 18 (Edwards syndrome) with the index finger overriding the middle finger and the fifth finger overriding the fourth finger.
Note the rocker-bottom foot with a prominent calcaneus in an infant with trisomy 18 (Edwards syndrome).
This photo shows the hands of a fetus with trisomy 18 (Edwards syndrome). Note that hands typically present with overlapping digits, in which the second and fifth fingers override the third and fourth fingers, respectively. The overall posturing of the wrists and fingers in this fetus is suggestive of contractures.
Pathophysiology
See the list below:
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Trisomy 18 severely affects all organ systems.
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In translocations that result in partial trisomy or in cases of mosaic trisomy 18, clinical expression is less severe, and survival is usually longer.
Epidemiology
Frequency
United States
Prevalence is approximately 1 in 6,000-8,000 live births.
At the time of first trimester screening, the incidence of trisomy 18 is 1 in 400, but due to high spontaneous loss, the birth prevalence is 1 in 6,500.
Mortality/Morbidity
Approximately 95% of conceptuses with trisomy 18 die as embryos or fetuses; 5-10% of affected children survive beyond the first year of life.
For liveborn infants with trisomy 18, the estimated probability of survival to age 1 month was 38.6% and to age 1 year was 8.4%. Median survival time was 14.5 days (population based study). [4] Nonetheless, in a multistate study of 1113 children with trisomy 18, Meyer et al found a 5-year survival rate of 12.3%. In the study, gestational age had the greatest impact on mortality, while the lowest mortality rates were found among females and the children of non-Hispanic black mothers. [5] Long-term survival up to age 27 years has been reported. [6, 7, 8]
The high mortality rate in trisomy 18 is usually due to the presence of cardiac and renal malformations, feeding difficulties, sepsis, and apnea caused by CNS defects. Severe psychomotor and growth retardation are invariably present in those who survive beyond infancy.
Race
Trisomy 18 has no racial predilection.
Sex
Approximately 80% of trisomy 18 cases occur in females. The preponderance of females with trisomy 18 among liveborn infants [4, 9] (sex ratio, 0.63) compared with fetuses with prenatal diagnoses (sex ratio, 0.90) indicates a prenatal selection against males with trisomy 18 after the time of amniocentesis. [10, 11, 12]
Age
Trisomy 18 is detectable during the prenatal and newborn periods.
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Note the microphthalmia, micrognathia/retrognathia, microstomia, low-set/malformed ears, short sternum, and abnormally clenched fingers in an infant with trisomy 18 (Edwards syndrome).
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This photo depicts the elongated skull, prominent occiput, low-set ear, micrognathia/retrognathia, short neck, and characteristic finger-grasping pattern in an infant with trisomy 18 (Edwards syndrome).
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Note the characteristic clenched hand of trisomy 18 (Edwards syndrome) with the index finger overriding the middle finger and the fifth finger overriding the fourth finger.
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This photo demonstrates a G-banded karyotype showing 47,XY,+18.
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Note the rocker-bottom foot with a prominent calcaneus in an infant with trisomy 18 (Edwards syndrome).
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This photo shows the hands of a fetus with trisomy 18 (Edwards syndrome). Note that hands typically present with overlapping digits, in which the second and fifth fingers override the third and fourth fingers, respectively. The overall posturing of the wrists and fingers in this fetus is suggestive of contractures.
