Fetal down syndrome

Facts about Down Syndrome | CDC

What is Down Syndrome?

Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.

Even though people with Down syndrome might act and look similar, each person has different abilities. People with Down syndrome usually have an IQ (a measure of intelligence) in the mildly-to-moderately low range and are slower to speak than other children.

Some common physical features of Down syndrome include:

A flattened face, especially the bridge of the nose
Almond-shaped eyes that slant up
A short neck
Small ears
A tongue that tends to stick out of the mouth
Tiny white spots on the iris (colored part) of the eye
Small hands and feet
A single line across the palm of the hand (palmar crease)
Small pinky fingers that sometimes curve toward the thumb
Poor muscle tone or loose joints
Shorter in height as children and adults

How Many Babies are Born with Down Syndrome?

Down syndrome remains the most common chromosomal condition diagnosed in the United States. Each year, about 6,000 babies born in the United States have Down syndrome. This means that Down syndrome occurs in about 1 in every 700 babies.¹

Types of Down Syndrome

There are three types of Down syndrome. People often can’t tell the difference between each type without looking at the chromosomes because the physical features and behaviors are similar.

Trisomy 21: About 95% of people with Down syndrome have Trisomy 21.² With this type of Down syndrome, each cell in the body has 3 separate copies of chromosome 21 instead of the usual 2 copies.
Translocation Down syndrome: This type accounts for a small percentage of people with Down syndrome (about 3%).² This occurs when an extra part or a whole extra chromosome 21 is present, but it is attached or “trans-located” to a different chromosome rather than being a separate chromosome 21.
Mosaic Down syndrome: This type affects about 2% of the people with Down syndrome. ² Mosaic means mixture or combination. For children with mosaic Down syndrome, some of their cells have 3 copies of chromosome 21, but other cells have the typical two copies of chromosome 21. Children with mosaic Down syndrome may have the same features as other children with Down syndrome. However, they may have fewer features of the condition due to the presence of some (or many) cells with a typical number of chromosomes.

Causes and Risk Factors

The extra chromosome 21 leads to the physical features and developmental challenges that can occur among people with Down syndrome. Researchers know that Down syndrome is caused by an extra chromosome, but no one knows for sure why Down syndrome occurs or how many different factors play a role.
One factor that increases the risk for having a baby with Down syndrome is the mother’s age. Women who are 35 years or older when they become pregnant are more likely to have a pregnancy affected by Down syndrome than women who become pregnant at a younger age. ^3-5However, the majority of babies with Down syndrome are born to mothers less than 35 years old, because there are many more births among younger women.^6,7

Diagnosis

There are two basic types of tests available to detect Down syndrome during pregnancy: screening tests and diagnostic tests. A screening test can tell a woman and her healthcare provider whether her pregnancy has a lower or higher chance of having Down syndrome. Screening tests do not provide an absolute diagnosis, but they are safer for the mother and the developing baby. Diagnostic tests can typically detect whether or not a baby will have Down syndrome, but they can be more risky for the mother and developing baby. Neither screening nor diagnostic tests can predict the full impact of Down syndrome on a baby; no one can predict this.

Screening Tests

Screening tests often include a combination of a blood test, which measures the amount of various substances in the mother’s blood (e. g., MS-AFP, Triple Screen, Quad-screen), and an ultrasound, which creates a picture of the baby. During an ultrasound, one of the things the technician looks at is the fluid behind the baby’s neck. Extra fluid in this region could indicate a genetic problem. These screening tests can help determine the baby’s risk of Down syndrome. Rarely, screening tests can give an abnormal result even when there is nothing wrong with the baby. Sometimes, the test results are normal and yet they miss a problem that does exist.

Diagnostic Tests

Diagnostic tests are usually performed after a positive screening test in order to confirm a Down syndrome diagnosis. Types of diagnostic tests include:

Chorionic villus sampling (CVS)—examines material from the placenta
Amniocentesis—examines the amniotic fluid (the fluid from the sac surrounding the baby)
Percutaneous umbilical blood sampling (PUBS)—examines blood from the umbilical cord

These tests look for changes in the chromosomes that would indicate a Down syndrome diagnosis.

Treatments

Down syndrome is a lifelong condition. Services early in life will often help babies and children with Down syndrome to improve their physical and intellectual abilities. Most of these services focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapy, and they are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school, although many children are included in regular classes.

Other Resources

The views of these organizations are their own and do not reflect the official position of CDC.

Down Syndrome Research Foundation (DSRF)
DSRF initiates research studies to better understand the learning styles of those with Down syndrome.
Global Down Syndrome Foundation
This foundation is dedicated to significantly improving the lives of people with Down syndrome through research, medical care, education and advocacy.
National Association for Down Syndrome
The National Association for Down Syndrome supports all persons with Down syndrome in achieving their full potential. They seek to help families, educate the public, address social issues and challenges, and facilitate active participation.
National Down Syndrome Society (NDSS)
NDSS seeks to increase awareness and acceptance of those with Down syndrome.

References

Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research. 2019; 111(18): 1420-1435.
Shin M, Siffel C, Correa A. Survival of children with mosaic Down syndrome. Am J Med Genet A. 2010;152A:800-1.
Allen EG, Freeman SB, Druschel C, et al. Maternal age and risk for trisomy 21 assessed by the origin of chromosome nondisjunction: a report from the Atlanta and National Down Syndrome Projects. Hum Genet. 2009 Feb;125(1):41-52.
Ghosh S, Feingold E, Dey SK. Etiology of Down syndrome: Evidence for consistent association among altered meiotic recombination, nondisjunction, and maternal age across populations. Am J Med Genet A. 2009 Jul;149A(7):1415-20.
Sherman SL, Allen EG, Bean LH, Freeman SB. Epidemiology of Down syndrome. Ment Retard Dev Disabil Res Rev. 2007;13(3):221-7.
Adams MM, Erickson JD, Layde PM, Oakley GP. Down’s syndrome. Recent trends in the United States. JAMA. 1981 Aug 14;246(7):758-60.
Olsen CL, Cross PK, Gensburg LJ, Hughes JP. The effects of prenatal diagnosis, population ageing, and changing fertility rates on the live birth prevalence of Down syndrome in New York State, 1983-1992. Prenat Diagn. 1996 Nov;16(11):991-1002.
Bull MJ, the Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2011;128:393-406.

What are Congenital Heart Defects?

Congenital heart defects (CHDs) are the most common type of birth defect. As medical care and treatment have advanced, babies with a CHD are living longer and healthier lives. Learn more facts about CHDs below.

What are Congenital Heart Defects (CHDs)?

CHDs are present at birth and can affect the structure of a baby’s heart and the way it works. They can affect how blood flows through the heart and out to the rest of the body. CHDs can vary from mild (such as a small hole in the heart) to severe (such as missing or poorly formed parts of the heart).

About 1 in 4 babies born with a heart defect has a critical CHD (also known as critical congenital heart defect).¹ Babies with a critical CHD need surgery or other procedures in the first year of life.

Piper was born with a congenital heart defect (CHD). Read her story as well as other stories from families affected by a congenital heart defect »

Types

Listed below are examples of different types of CHDs. The types marked with a star (*) are considered critical CHDs.

Atrial Septal Defect
Atrioventricular Septal Defect
Coarctation of the Aorta*
Double-outlet Right Ventricle*
d-Transposition of the Great Arteries*
Ebstein Anomaly*
Hypoplastic Left Heart Syndrome*
Interrupted Aortic Arch*
Pulmonary Atresia*
Single Ventricle*
Tetralogy of Fallot*
Total Anomalous Pulmonary Venous Return*
Tricuspid Atresia*
Truncus Arteriosus*
Ventricular Septal Defect

Signs and Symptoms

Signs and symptoms for CHDs depend on the type and severity of the particular defect. Some defects might have few or no signs or symptoms. Others might cause a baby to have the following symptoms:

Blue-tinted nails or lips
Fast or troubled breathing
Tiredness when feeding
Sleepiness

Diagnosis

Some CHDs may be diagnosed during pregnancy using a special type of ultrasound called a fetal echocardiogram, which creates ultrasound pictures of the heart of the developing baby. However, some CHDs are not detected until after birth or later in life, during childhood or adulthood. If a healthcare provider suspects a CHD may be present, the baby can get several tests (such as an echocardiogram) to confirm the diagnosis.

Treatment

Treatment for CHDs depends on the type and severity of the defect present. Some affected infants and children might need one or more surgeries to repair the heart or blood vessels. Some can be treated without surgery using a procedure called cardiac catheterization. A long tube, called a catheter, is threaded through the blood vessels into the heart, where a doctor can take measurements and pictures, do tests, or repair the problem. Sometimes the heart defect can’t be fully repaired, but these procedures can improve blood flow and the way the heart works. It is important to note that even if their heart defect has been repaired, many people with CHDs are not cured. See more information about living with a CHD below.

Causes

The causes of CHDs among most babies are unknown. Some babies have heart defects because of changes in their individual genes or chromosomes. CHDs also are thought to be caused by a combination of genes and other factors, such as things in the environment, the mother’s diet, the mother’s health conditions, or the mother’s medication use during pregnancy. For example, certain conditions a mother has, like pre-existing diabetes or obesity, have been linked to heart defects in the baby.^2,3 Smoking during pregnancy as well as taking certain medications have also been linked to heart defects.^2,3

Learn more about research on CHDs »

Living with a CHD

As medical care and treatment have advanced, infants with CHDs are living longer and healthier lives. Many children with CHDs are now living into adulthood. It is estimated that more than two million individuals in the United States are living with a CHD. Many people with a CHD lead independent lives with little or no difficulty. Others might develop disability over time. Some people with a CHD have genetic problems or other health conditions that increase their risk for disability.

Even with improved treatments, many people with a CHD are not cured, even if their heart defect has been repaired. People with a CHD can develop other health problems over time, depending on their specific heart defect, the number of heart defects they have, and the severity of their heart defect. For example, some other health problems that might develop include irregular heart beat (arrhythmias), increased risk of infection in the heart muscle (infective endocarditis), or weakness in the heart (cardiomyopathy). People with a CHD need routine checkups with a cardiologist (heart doctor) to stay as healthy as possible. They also might need further operations after initial childhood surgeries. It is important for people with a CHD to visit their doctor on a regular basis and discuss their health, including their specific heart condition, with their doctor.

Learn more about living with a CHD »

References

Oster M, Lee K, Honein M, Colarusso T, Shin M, Correa A. Temporal trends in survival for infants with critical congenital heart defects. Pediatrics. 2013;131(5):e1502-8.
Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL. Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007;115(23):2995-3014.
Patel SS, Burns TL. Nongenetic risk factors and congenital heart defects. Pediatr Cardiol. 2013;34(7):1535-55.

Screening tests for Down syndrome in the first 24 weeks of pregnancy

Relevance
Down syndrome (also known as Down syndrome or Trisomy 21) is an incurable genetic disorder that causes significant physical and mental health problems and disability. However, there is great variation in how Trisomy Down affects people. Some individuals have severe suffering, while others have little problems and are able to lead relatively normal lives. There is no way to predict how badly each child may be affected. nine0006

Parents-to-be are given the option of having a Down test during pregnancy to help them make decisions. If a pregnant woman is carrying a child with Down syndrome, then a decision must be made whether to terminate or continue the pregnancy. This information offers parents the opportunity to plan for life with a Down child.

The most accurate tests to detect Down include testing of amniotic fluid (fluid around the fetus, amniocentesis required) or placental tissue (chorionic villus biopsy (CVS)) for abnormal chromosomes associated with Down. Both tests require the insertion of a needle into the mother's abdomen and increase the risk of miscarriage. Thus, the tests are not suitable to be given to all pregnant women. Instead, screening uses tests that measure markers in the mother's blood, urine, or baby's ultrasound. These screening tests are not perfect, they can miss cases of Down and also give a "high risk" result to some women whose children do not have Down. Thus, pregnancies identified as Down's "high risk" pregnancies using these screening tests require further testing by amniocentesis or CVS to confirm a Down's diagnosis. nine0006

What we did
The aim of this review was to find out which of the screening tests done during the first 24 weeks of pregnancy are most accurate in predicting the risk of Down pregnancy. We studied 7 different urinary markers that can be used alone, in ratios, or in combination, taken up to 24 weeks of gestation. This cumulatively creates 24 screening tests for Down. We found 19 studies involving 18,013 pregnant women, of which 527 were pregnancies with Down syndrome. nine0005

What we found
Evidence does not support the use of urine tests to screen for Down syndrome during the first 24 weeks of pregnancy. The amount of evidence is limited. These tests are not offered in routine clinical practice.

Other important information to consider
Urine testing itself has no side effects for the woman. However, some women who have a "high-risk" screening test result and who are undergoing amniocentesis or CVS are at risk of having a non-Down's syndrome non-parous baby (healthy miscarriage). Parents will need to weigh this risk when deciding whether or not to have an amniocentesis or CVS after receiving a "high risk" screening test result. nine0006

Translation notes:

Translation: Kong Hong Han. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: lezign@gmail. com

Down syndrome - causes, symptoms, diagnosis and treatment

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IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes. nine0006

Down syndrome: causes, symptoms, diagnosis and treatment.

Definition

Down's syndrome is a congenital chromosomal anomaly, consisting in the presence of an extra chromosome in the 21st pair (trisomy of the 21st pair of chromosomes). A person has 23 pairs of chromosomes, so an ordinary child has 46 chromosomes, and a child with Down syndrome has 47. Down syndrome is characterized by a special appearance of the patient and a decrease in intellectual abilities. The frequency of this chromosomal anomaly in the population is 1:800 and does not depend on gender, race, family standard of living, or the presence or absence of bad habits in parents. nine0006

In Russia, 2,500 children with Down syndrome are born annually.

Causes of Down syndrome

The risk of having a child with Down syndrome for a woman increases from the age of 35 and reaches 1% by the age of 39. Of the total number of newborns with Down's disease, more than 20% are born to mothers over 35 years of age. In addition, risk factors are the presence of hepatitis B or C in the mother, tuberculosis, rubella, Botkin's disease, the father's age is over 45 years, the mother's age is too young (up to 18 years), and closely related marriages. nine0006

Classification of Down syndrome

There are three types of Down syndrome:

trisomy is the most common form of Down syndrome, which is characterized by complete tripling of 21 chromosomes in all cells of the body; this form accounts for 94-95% of all cases of the disease;
displacement (translocation) of 21 pairs of chromosomes to other chromosomes - occurs in 4% of cases;
mosaic Down's syndrome (about 2% of cases), when only some cells of the body contain tripled chromosome 21. Patients themselves, as a rule, are no different from healthy ones, but have a high risk of having a child with Down syndrome. nine0037

Symptoms of Down syndrome

A child with Down syndrome has wide-set eyes with a Mongoloid incision, light pigment spots can be observed on the iris, epicanthus is often present - a vertical fold located between the upper and lower eyelids, partially covering the inner canthus . In addition, the distinguishing features are a short nose, a flat bridge of the nose, small auricles, brachycephaly (short and wide, almost round, head), a flat nape, an arched palate. Children often have anomalies of the dentition, underdevelopment of the lower jaw. nine0006

The body and limbs are disproportionately formed - the figure is squat, the shoulders are lowered, the limbs are short, there is a skin fold on the neck, the fingers may be shortened due to underdevelopment of the middle phalanges. Children with Down syndrome have a unique pattern of fingers and palms, this does not affect development in any way, but is a diagnostic feature. The feet are normal, but with an increased gap between the first and second toes, the sole often has a deep crease in this place. Most people with Down syndrome have flat feet. Muscle tone is significantly reduced, which affects movements. nine0006

Malformations of various organs and systems are diagnosed - the heart, the gastrointestinal tract, hypoplasia of the genital organs, keeled (the sternum protrudes) or funnel-shaped (the sternum is depressed) deformity of the chest.

Children with Down syndrome have mental retardation of varying severity. All children with Down syndrome lag behind in psychomotor development - they have reduced emotional activity, they begin to sit, walk, talk later than their peers, their speech is underdeveloped, their vocabulary is poor. nine0006

Speech disorders are associated not only with insufficiency of intelligence, but also with frequent hearing impairments and reduced muscle tone.

Despite the lag in intellectual and psycho-emotional development, children with Down syndrome are teachable, although they need more time to master certain knowledge than their peers. They can attend pre-school and school institutions, receive vocational education, be creative, lead a normal life and start families. nine0006

Such patients may show affection, benevolence, and curiosity.

Diagnosis of Down syndrome

During pregnancy, a woman can be diagnosed with Down syndrome. Primary (screening) diagnosis includes ultrasound and markers such as free beta hCG and PAPP-A (pregnancy-associated protein A) between the 11th and 13th weeks of pregnancy.

Screening ultrasound 1st trimester of pregnancy (11-13 weeks 6 days)

Investigation necessary to monitor the growth and development of the fetus in the first trimester of pregnancy.

RUB 2,790 Sign up

1st trimester prenatal screening for trisomies, PRISCA-1 (1st trimester biochemical screening - 1st trimester “double test”, risk calculation using PRISCA software)

Synonyms: Prenatal Screening Markers for Down Syndrome; PRISCA-1. Brief description of the study "Prenatal screening for trisomies of the 1st trimester of pregnancy, PRISCA-1)" Test run...

Up to 1 business day

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2 040 RUB

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If, according to the results of the research, there is a suspicion of Down's syndrome in the fetus, an invasive procedure is possible - a chorionic villus biopsy, or amniocentesis, when a sample of amniotic fluid is taken. nine0006

The decision to conduct an invasive study is made individually in each case, since the procedure is uncomfortable for the mother and has a risk of spontaneous abortion.

There is another screening diagnostic method - non-invasive prenatal testing (NIPT), which allows you to determine the chromosomal abnormalities of the fetus by the mother's blood, due to the detection of DNA fragments of her child in the woman's blood. If a fetus is at high risk of having Down syndrome after NIPT, an invasive examination is still required to confirm the diagnosis. nine0006

The second screening is done at 18-20 weeks of gestation and includes an ultrasound and a blood test if not previously done.

Screening ultrasound of the 2nd trimester of pregnancy (18-21 weeks) with Doppler evaluation of blood flow parameters

Study to monitor the course of multiple pregnancies, growth and development of fetuses and viability of blood circulation.

RUB 3,890 Sign up nine0006

2nd trimester prenatal trisomy screening, PRISCA-2 (2nd trimester biochemical screening, 2nd trimester “triple test”, risk calculation using PRISCA software)

Synonyms: Triple test of the second trimester of pregnancy. Maternal Screen, Second Trimester; Prenatal Screening II, PRISCA II, Prenatal Risk Calculation. Attention! For this study, you must have ...

Up to 1 business day

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2 120 RUB

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Third ultrasound screening performed at 30-34 weeks.

Screening ultrasound of the 3rd trimester of pregnancy (30-34 weeks) with Doppler evaluation of blood flow parameters

Ultrasound examination for functional assessment of intrauterine development of the fetus, its estimated height and weight, as well as blood circulation. nine0006

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Which doctors to contact

Prenatal diagnosis of fetal Down syndrome is done by a doctor – obstetrician-gynecologist.

The child is watching pediatrician, if necessary, genetic testing is carried out with a consultation of a geneticist. Further, a patient with Down syndrome should be observed by an ophthalmologist, cardiologist, neurologist, dentist, orthopedist-traumatologist, gynecologist, ENT doctor. nine0006

Treatment for Down syndrome

There is no cure for Down syndrome. Patients with Down syndrome usually have a sufficient number of medical problems and conditions that may require care immediately after birth, intermittent treatment, or long-term treatment throughout life. Concomitant malformations are often an indication for surgical treatment.

Children need constant attention and care, physical (exercise) and psychological rehabilitation. Physiotherapy is prescribed to increase muscle strength, improve posture and balance. Speech therapist helps to solve problems with speech. Many patients are forced to resort to the use of hearing aids, glasses for vision correction, orthodontic constructions, bandages that help move, wear orthopedic shoes. Patients with Down syndrome are prone to obesity, so great attention should be paid to sufficient physical activity and a balanced diet. nine0006

Nootropic drugs are used to correct speech development disorders and related learning difficulties. Hyperactivity, impulsivity problems, and irritability may be indications for the prescription of psychotropic drugs. In addition, drugs are used to improve metabolic processes and motor activity.

In each age period, the attention of parents and doctors should be directed to the correction of certain conditions. nine0006

In the neonatal period (up to 1 month) and in the first year of life, the presence of malformations of the cardiovascular system and the gastrointestinal tract, as well as thyroid function, is assessed. At the age of 1-5 years, control requires sleep disturbances, constipation, instability of the cervical spine, delayed development of motor skills due to reduced muscle tone. At an older age (5-13 years), sleep disorders, constipation, skin lesions, behavioral disorders, learning difficulties, memory development, communication need correction, the period of sexual development begins. Puberty is accompanied by behavioral problems, deficits or delays in cognitive skills and communication, sexual behavior issues, and behavioral changes. In adulthood, sleep problems, constipation, visual and hearing impairments also persist. nine0006

Complications

Approximately half of children with Down syndrome are diagnosed with heart defects, the most common are ventricular septal defect, open common atrioventricular canal, tetralogy of Fallot and fibroelastosis. Narrowing of the nasopharynx and oropharynx, Eustachian tube, external auditory canal due to the underdevelopment of the middle part of the face leads to the fact that many children with Down syndrome experience apnea - episodes of complete or partial cessation of breathing during sleep, accompanied by impaired ventilation and a decrease in oxygen levels in blood. nine0006

Digestive organs are characterized by regurgitation, bloating, and constipation.

Very high risk of infections, especially of the respiratory tract. The syndrome is often accompanied by eye diseases - congenital cataracts, nystagmus, strabismus, glaucoma, keratoconus, blepharitis and insufficiency of the nasolacrimal ducts. Insufficiency or obstruction of the nasolacrimal canal increases the risk of developing conjunctivitis, lacrimation. Due to frequent otitis media, the outflow of fluid from the middle ear is difficult, which increases the risk of hearing loss. Repeated otitis causes conductive hearing loss and, as a result, impaired speech function. nine0006

Children with Down syndrome may develop scoliosis, hip dysplasia, subluxation or dislocation of the hip, and instability of the patella. Due to the abnormal structure of collagen fibers, weakness of the ligamentous apparatus is observed, leading to hypermobility, instability of the joints, and their excessive mobility.

Prevention of Down syndrome

There is no prevention of Down syndrome. Couples planning to have a baby are advised not to delay pregnancy until a later age, to undergo prenatal screening and genetic counseling. nine0006

Sources:

Grigoriev K.I. Down syndrome: comorbidity and program goals in the work of a pediatrician with such children // Difficult patient. - 2017. - No. 1–2. – T 15.
Sapozhnikova T.V. Psychological and pedagogical support for children with Down syndrome and their families in a rehabilitation center: a teaching aid / T.V. Sapozhnikova, N.A. Pershina, N.A. Shchigreva. - Biysk, 2019. - 311 p.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor. nine0005 For a correct assessment of the results of your analyzes over time, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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