A RETROSPECTIVE ANALYSIS OF COMORBID TRAITS AFFECTING FEEDING IN INFANTS WITH DOWN SYNDROME

Graduate School ETD Form 9 (Revised 12/07) PURDUE UNIVERSITY GRADUATE SCHOOL Thesis/Dissertation Acceptance This is to certify that the thesis/dissertation prepared By Entitled For the degree of Is approved by the final examining committee: Chair To the best of my knowledge and as understood by the student in the Research Integrity and Copyright Disclaimer (Graduate School Form 20), this thesis/dissertation adheres to the provisions of Purdue University’s “Policy on Integrity in Research” and the use of copyrighted material. Approved by Major Professor(s): ____________________________________ ____________________________________ Approved by: Head of the Graduate Program Date !"#$%&'()(*+,-&& .(/'0/%12'#0",'(-3-&41"1(%5(#%6%/7"8(0/-"01(-55'#0"39(5''8"39("3("35-301(:"0$(*%:3(1438/%6' ;-38-&&(<(;%2'/ =-0$&''3(.(>-//1 ?&&'3(.(@(A$'/3%55 ;-38-&&(<(;%2'/ !%/6-3()''1 BCDECFGDG Master of Science Graduate School Form 20 (Revised 9/10) PURDUE UNIVERSITY GRADUATE SCHOOL Research Integrity and Copyright Disclaimer Title of Thesis/Dissertation: For the degree of Choose your degree I certify that in the preparation of this thesis, I have observed the provisions of Purdue University Executive Memorandum No. C-22, September 6, 1991, Policy on Integrity in Research.* Further, I certify that this work is free of plagiarism and all materials appearing in this thesis/dissertation have been properly quoted and attributed. I certify that all copyrighted material incorporated into this thesis/dissertation is in compliance with the United States’ copyright law and that I have received written permission from the copyright owners for my use of their work, which is beyond the scope of the law. I agree to indemnify and save harmless Purdue University from any and all claims that may be asserted or that may arise from any copyright violation. ______________________________________ Printed Name and Signature of Candidate ______________________________________ Date (month/day/year) *Located at http://www.purdue.edu/policies/pages/teach_res_outreach/c_22.html A retrospective analysis of comorbid traits affecting feeding in infants with Down syndrome Master of Science Nichole L Duvall 08/19/2010 A RETROSPECTIVE ANALYSIS OF COMORBID TRAITS AFFECTING FEEDING IN INFANTS WITH DOWN SYNDROME A Thesis Submitted to the Faculty of Purdue University by Nichole L Duvall In Partial Fulfillment of the Requirements for the Degree of Master of Science December 2011 Purdue University Indianapolis, Indiana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" )0/."'K"K0,MB*/" K!E3>7" L:E7" K!E3>7"O`"$2<C>797;@!?7">7@348@"D>2<":"@!;E47"2>E:;"@=@87< IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII VT" K!E3>7"P`"K775!;E">2387"D2>":44"!;D:;8@"1!89":8"47:@8"2;7"G4!;!G"?!@!8"2?7>"8!<7 IIIIIIIIIIIIIIIII WX" K!E3>7"R`"J>7:6521;"2D"D775!;E">2387"D2>":44"!;D:;8@"1!89":8"47:@8"2;7"G4!;!G"?!@!8IIIIIIIIIII WO" K!E3>7"Q`"K775!;E">2387"D2>"!;D:;8@"1!89":8"47:@8"812"?!@!8@IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WP" K!E3>7"S`"#487>:8!2;"2D"D775!;E"@8>:87E="!;"!;D:;8@"1!89":8"47:@8"812"?!@!8@IIIIIIIIIIIIIIIIIIIIIII WR" K!E3>7"U`"/C7G!D!G"D775!;E">2387"D2>"!;D:;8@"1!89":8"47:@8"812"?!@!8@ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WQ" K!E3>7"V`"#487>75"D775!;E"@8>:87E="G2>>74:875"1!89"G:>5!:G"57D7G8@ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WS" K!E3>7"W`"#487>75"D775!;E"@8>:87E="G2>>74:875"1!89",0":F;2><:4!8!7@ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WU" K!E3>7"T`"+_@"D2>"!;D:;8@"1!89":487>75"D775!;E"@8>:87E!7@":;5":8"47:@8"812"?!@!8@IIIIIIIIIIIIII WV" K!E3>7"OX`"+_@"D2>"!;D:;8@"1!89":487>75"D775!;E"@8>:87E!7@"!;"897"C>7@7;G7"2>":F@7;G7"2D":" @7?7>7",0":F;2><:4!8=I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WW" K!E3>7"OO`"B7@348@"D>2<"D775!;E"7?:43:8!2;@"D2>"!;D:;8@"1!89"+/A":;5"C7>G7;8:E7@"2D"828:4" ;3<F7>"2D"!;D:;8@I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WT" K!E3>7"OP`"'GG3>>7;G7@"2D"G:>5!:G"57D7G8@IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII TX" K!E3>7"OR`"$2<2>F!5!8!7@"2D"812"@=@87<@"82"G2<C:>7"897"C>7@7;G7"2D":"@7?7>7"G:>5!:G" 57D7G8"1!89"897":F@7;G7"2D":"57D7G8I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII TO" K!E3>7"OQ`"#487>:8!2;"2D"D775!;E"@8>:87E!7@"2D"892@7"1!89"2>"1!8923 8"D775!;E"5!DD!G348!7@I TP" K!E3>7"OS`"'GG3>7;G7@"2D"D3;G8!2;:4":;5"@8>3G83>:4",0":F;2><:4!8!7@IIIIIIIIIIIIIIIIIIIIIIIIIIIIII TR" K!E3>7"OU`"$2<2>F!5!8!7@"2D"812"@=@87<@"82"G2<C:>7"897"C>7@7;G7"2D":",0":F;2><:4!8=" 1!89"897":F@7;G7"2D":;":F;2><:4!8=IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII TQ" K!E3>7"OV`"L>24!D7>:8!2;":@@:="2D"*OXIS"&$"D>2<"J#O@"2;7"5:=":D87>"5!@@7G8!2;IIIIIIIIIIII TU" K!E3>7"OW`"/#abE:4":G8!?!8="2D"@7;7@G7;8"G744@"ZJc"4!;7[IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII TV" viii ABSTRACT Duvall, Nichole L, M.S. Purdue University, December, 2011. A retrospective analysis of comorbid traits affecting feeding in infants with Down syndrome. Major Professor: Randall Roper. Down syndrome (DS) is the most common aneuploidy to affect humans and occurs in approximately 1 of 750 live births. Individuals with DS present with a wide range of clinical phenotypes. Common craniofacial phenotypic expressions include a small mandible, protruding tongue, and a flattened nasal bridge. These traits may affect the feeding, breathing, and swallowing of individuals with DS. Because some complications may go unnoticed for longer periods of time, we hypothesize that significant cardiac and GI defects may be indicative of feeding and airway difficulties. In order to better understand the secondary phenotypes resulting from DS, we have implemented a retrospective chart review of 137 infants between zero and six months of age who were evaluated through the Down Syndrome Program at Riley Hospital for Children from August 2005 to August 2008. Data regarding cardiac, gastrointestinal, endocrine, airway, auditory, and feeding abnormalities have been collected and incedences and comorbidites of these traits has been examined. Comprehensive results indicate cardiac abnormalities occur in 80% of infants, 60% experience gastrointestinal complications, feeding difficulties occur in 46%, and [...]... +),&*)$+7!/*'F9?LG'!.'-7:'2.33456'@:.:'F$/]2WQTX]U'B:.^#.CG'0/!.@'-7:'+$!*:$/' F4)$%#$;G'UdaKKKAKBAKBDKADADKABKBABa1d'#.;'F$:=:$/:G'Uda DKAKBABDKADAAKBKDKKBDa1dFA*nXWoDG'F6.=!-$)@:.>'D#$,/'DKG'F`!@0$:'IG5'' `)$'#'/!.@,:'$:#(-!).>'Ii'LDN'N".'^044:$'F6.=!-$)@:.G>'Q5U'*['[@D,Q'F6.=!-$)@:.G>'#.;' W5WQ'p@fpR 'A# e8?K'L),&*:$#/:'F^!),!.:> 'A# 0.-).>'[KG'%:$:'0/:;'%!-7'Q'pR')4'8?K' F#++$)"!*#-:,&'IWW'.@fpRG'!.'#'QU'p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bBG'7#/''-7:'?#-!).#,'8)%.'9&.;$)*:'L$)\:(-'... -$#./,)(#-!)./'F8KZ699O?#(%#)*+'ITT1G5' 'A7 !/'/:@*:.-#,'-$!/)*&'*);:,'7#/'#'/*#,,' -$#./,)(#-!).'(7$)*)/)*:'()*+$!/:;')4'-7:';!/-#,'$:@!).')4'[*0IX'\0/-'+$)"!*#,'-)'-7:' , #@:.:'# #(7:;'-)'-7:'(:.-$)*:$!(':.;')4'[*0IV'F8KZ699O?#(%#)*+'ITT1Y'NMMZM9#(%# )*+'ITTUG'#.;'().-#!./'#++$)"!*#-:,&'7#,4')4'-7:'J/#QI'@:.:')$-7),)@/'FJKAAON6#(%#)*+' QWWWG5' 'A/ XU8.'*!(:'/7)%'8 9a$ :,#-:;'+7:.)-&+:/'!.(,0;!.@'$:;0(:;' . the Faculty of Purdue University by Nichole L Duvall In Partial Fulfillment of the Requirements for the Degree of Master of Science December 2011 Purdue University Indianapolis, Indiana. infants with Down syndrome Master of Science Nichole L Duvall 08/19/2010 A RETROSPECTIVE ANALYSIS OF COMORBID TRAITS AFFECTING FEEDING IN INFANTS WITH DOWN SYNDROME A Thesis Submitted to the. TU" K!E3>7"OW`"/#abE:4":G8!?!8="2D"@7;7@G7;8"G744@"ZJc"4!;7[IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII TV" viii ABSTRACT Duvall, Nichole L, M.S. Purdue University, December, 2011. A retrospective analysis of comorbid traits affecting feeding