Airway anomalies in children with Down syndrome: endoscopic findings

Abstract

Down syndrome (DS) is the most common chromosomal anomaly in humans. Numerous congenital malformations associated with DS have been described. However, there are insufficient data available about airway anomalies. Our objective was to characterize the clinical presentation, frequency, and type of airway anomalies in a population of patients with DS. A retrospective evaluation of flexible bronchoscopies performed in 24 DS patients due to significant respiratory morbidity was compared to the findings in 324 non-DS patients during the same time period. The procedure was carried out under sedation, using an Olympus BF3C20 bronchoscope. The main indications for the procedure were atelectasis of the right upper lobe (12/24) and stridor (7/24). The most common associated conditions were congenital heart disease (12/24) and reactive airways disease (12/24). The most important endoscopic findings were: laryngomalacia (12/24), tracheomalacia (8/24), tracheal bronchus (5/24), and bronchomalacia (5/24). Only six patients had a normal examination. Multiple airway anomalies (>/=2) were a common finding in this series. We conclude that patients with DS and respiratory symptoms have a high incidence of airway anomalies compared to non-DS patients. The clinician should have a high index of suspicion for airway anomalies in DS patients with respiratory symptoms.

Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

“…[33]. Only 25% of the cases had normal airway structure, with most having more than two abnormalities These upper airway abnormalities were again highlighted in an MRI study in which children with DS but without OSA had more narrow airways, with mid facial and mandibular hypoplasia, and increased fat content in the tongue, soft palate and parapharyngeal area compared to children without DS [90].…”

What people with Down Syndrome can teach us about cardiopulmonary disease

“…The upper respiratory tract in persons with Down syndrome is often narrow due to congenital and associated conditions [23][24][25]. The trachea is often smaller in children with Down syndrome [26], and tracheal bronchus contributes to recurrent pneumonia [27,28]. Airway malacia causes obstruction in >50% of children with Down syndrome, with other causes more prevalent in adults [29,30].…”

El niño con Síndrome de Down en la Unidad de Cuidados Intensivos

“…21 , realizado en nuestro país, en una población de 24 pacientes con SD que presentaban síntomas respiratorios recurrentes y que fueron evaluados con fibrobroncoscopia, describió que, dentro de las alteraciones en la vía aérea superior, la laringomalacia fue el hallazgo endoscópico más frecuente (50%) 21 . Sin embargo, en una cohorte de 239 pacientes 22 el porcentaje fue menor (6%).…”