{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:08:14Z","timestamp":1789668494765,"version":"4.0.1"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neonatal-Perinatal Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether intensive neonatal interventions improve survival outcomes compared with comfort-focused care in neonates with Trisomy 18.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>We conducted a systematic review and pairwise meta-analysis of observational studies reporting outcomes for neonates with Trisomy 18 receiving either intensive or comfort-focused care. Databases searched included PubMed, Embase, and Cochrane Central Register up to March 2026. Outcomes included mean survival days and 1-year survival as primary outcomes, and gestational age at delivery as a secondary exploratory outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five observational studies including 211 patients were analyzed (133 received intensive care, and 78 received comfort-focused care). Pooled analyses showed no statistically significant differences between groups for mean survival days (MD \u2212225.53\u00a0days; 95% CI \u2212776.85 to 325.79), 1-year survival (RR 1.12; 95% CI 0.90 to 1.40), or gestational age at birth (MD \u22120.28\u00a0weeks; 95% CI \u22121.69 to 1.13).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the absence of a demonstrated survival benefit of intensive neonatal interventions over non-intensive care in Trisomy 18, the findings should be interpreted cautiously given the small number of available studies, substantial clinical and statistical heterogeneity, and very low certainty of evidence. Findings highlight the importance of individualized, informed decision-making guided by prenatal counseling that integrates evidence-based outcomes and parental values. High-quality, multicenter prospective studies are needed to evaluate the impact of specific interventions and improve guidance for families and clinicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19345798261490120","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:17:55Z","timestamp":1789546675000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intensive versus comfort-focused care in neonates with trisomy 18: A systematic review and meta-analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9162-5335","authenticated-orcid":false,"given":"Laura","family":"Fonseca Queiroz","sequence":"first","affiliation":[{"name":"Division of Maternal-Fetal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Julia","family":"Lemos","sequence":"additional","affiliation":[{"name":"Redentor University Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berenice","family":"Curi-Pesantes","sequence":"additional","affiliation":[{"name":"Wellspan Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8256-5811","authenticated-orcid":false,"given":"Iaci Luisa","family":"Lopes de Mattos","sequence":"additional","affiliation":[{"name":"Universidade Federal do Estado do Rio de Janeiro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna Benigna","family":"Sales Armstrong","sequence":"additional","affiliation":[{"name":"Irmandade Santa Casa de Miseric\u00f3rdia of Sao Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Hernandez","family":"Ruano","sequence":"additional","affiliation":[{"name":"Department of Molecular Biosciences, College of Natural Sciences , University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3642-5858","authenticated-orcid":false,"given":"Rodrigo","family":"Ruano","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics &amp; Gynecology, University of Miami Miller School of Medicine, &amp; Jackson Memorial Hospital, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-7-81"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjon.2024.06.007"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.9819"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.16537"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1542\/neo.26-12-082"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1732363"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.37529"},{"issue":"3","key":"e_1_3_6_9_2","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/ajmg.c.31522","article-title":"Medical interventions and survival by gender of children with trisomy 18","volume":"172","author":"Donovan JH","year":"2016","unstructured":"Donovan JH, Krigbaum G, Bruns DA. Medical interventions and survival by gender of children with trisomy 18. Am J Med Genet C Semin Med Genet 2016; 172C(3): 253\u2013261. https:\/\/doi.org\/10.1002\/ajmg.c.31522","journal-title":"Am J Med Genet C Semin Med Genet"},{"issue":"9","key":"e_1_3_6_10_2","first-page":"865","article-title":"Management of pregnancy and survival of infants with trisomy 13 or trisomy 18","volume":"33","author":"Dotters-Katz SK","year":"2016","unstructured":"Dotters-Katz SK, Carlson LM, Johnson J, et al. Management of pregnancy and survival of infants with trisomy 13 or trisomy 18. Am J Perinatol 2016; 33(9): 865\u2013872. https:\/\/doi.org\/10.1055\/s-0036-1585580","journal-title":"Am J Perinatol"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-025-02181-7"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_6_14_2","unstructured":"Queiroz LF Lemos MJ Curi-Pesantes B et al. Aggressive versus non-aggressive care in neonates with Trisomy 18: a systematic review and meta-analysis. PROSPERO 2026 CRD420261332013. Available from: https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261332013"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1145\/2601248.2601268"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_3_6_18_2","volume-title":"Review Manager (RevMan) [Computer program]. Version 5.4","author":"The Cochrane Collaboration","year":"2020","unstructured":"The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.4. 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