Development of an Implementation Blueprint to Scale-Up Contraception Care for Adolescents with Psychiatric Conditions in a Pediatric Hospital.

Down syndrome, or Trisomy 21, is a chromosomal abnormality due to the complete or partial presence of a third copy of chromosome 21 []. In the United States, it occurs at a rate of roughly 1 in 700–800 live births, with more than 200,000 individuals currently living with Down syndrome [, ]. Prevalence has increased in the 21st century, largely due to the increased life span of individuals with Down syndrome: in 2010, a mean of 53 years and a median of 58 years as compared to 26 years and 4 years, respectively, in 1950 []. Much of this trend has been driven by advances in medical and surgical interventions for neonatal and pediatric individuals with Down syndrome. As recently as 1973, epidemiological studies in Sweden and the UK suggested that around half of individuals born with Down Syndrome were expected to survive the neonatal period; in 2010, the survival rate had increased to 95% [, ]. Down syndrome manifests with significant phenotypic variation, although the reasons behind the heterogeneic presentation are elusive. One common hypothesis is that genetic variants in 200-protein coding genes on the extra copy of chromosome 21 may have different cis and trans effects [, ]. In recent years, this multi-organ multi-system syndrome has sparked a burgeoning literature describing associated comorbidities. Among individuals with Down syndrome, roughly 50% present with congenital heart defects (commonly atrial and ventricular septal defects), more than half present with obstructive sleep apnea, more than half of neonates with Down syndrome present with abnormal thyroid tests, and about 8% of pediatric individuals with Down syndrome present with epilepsy. Additionally, individuals present with both conductive and sensorineural hearing loss, with ophthalmoplegias (commonly congenital and developmental cataracts and refractive errors), with atlantoaxial instability, with mental health disorders (such as anxiety and depressive disorders), with intellectual disability, and with early-onset Alzheimer’s disease [, , ].