Pediatric Comorbidities and Medical Complications Identified in Children with Down Syndrome

Abstract

Objective: Children with Down syndrome (DS) have an increased risk of neonatal complications and comorbidities compared to the general population; however, the incidence, optimal screening intervals and outcomes in this population are uncertain. The purpose of this study is to phenotypically define this population of children with DS using a large multi-age and ethnic sample and current American Academy of Pediatrics (AAP) Guidelines testing practices.Method: This is a retrospective review of a large cohort of 1,108 children with DS (male=602; mean age at initial contact: 5.72 years, SD ± 5.51) who received care at the Sie Center for Down Syndrome (SCDS) at The Children's Hospital Colorado from 2011 and 2016. Clinical data were collected from a prospective patient clinic database. Clinical details were collected, which included demographics, prenatal and birth history and complications, comorbidities, procedures, treatment plans and outcomes.Results: Medical complications requiring admission to the neonatal intensive care unit were identified in 70.6% of children with DS. Frequent causes for these neonatal admissions included: Required oxygen (60.7%), feeding problem (48.2%), Respiratory Distress Syndrome (21.4%) and pulmonary hypertension (14.7%). Incidence of medical comorbidities in our population with DS included cardiac defects (64.3%), abnormal sleep study (71.1%), abnormal thyroid study (29.1%), pulmonary aspiration (12.2%), celiac disease (5.0%) and pulmonary arterial hypertension (28.3%). Conclusion:Clinical data provides results from one of the largest investigations at a single pediatric hospital for children and young adults with DS in the US. This study describes the comorbidities affecting individuals with DS more accurately by applying AAP guidelines in studying a larger population than previously defined. This result improves our understanding of the incidence and identification of medical conditions in children with DS and reinforces recommendations on medical care screening for individuals with DS.

Medical problems in children with Down syndrome

“…GI abnormalities occur in approximately 12% of patients. 11 Duodenal atresia or stenosis, Hirschsprung disease, tracheoesophageal fistula, Meckel diverticulum, imperforate anus, and omphalocele are observed. Gastroesophageal reflux is commonly seen in children with Down syndrome and can be severe enough to result in aspiration of stomach contents, resulting in respiratory symptoms such as persistent coughing, wheezing, and pneumonia.…”

A schedule of gross motor development for children with Down syndrome

“…Data results indicate that clinic patients capture approximately 50.3% of the state of Colorado's population of children with DS and provide support of a population‐based representation (Hickey et al . ). The second paediatric hospital has similar demographic representation of the community.…”

Infantile Spasms in Children With Down Syndrome: Identification and Treatment Response

“…Results indicate that SCDS clinic patients capture approximately 50.3% of the state of Colorado’s population of children with Down syndrome and provides support for a population-based representation. 26 Because we tested infantile spasms diagnosis differences separately for each of the 5 medical comorbidities and complications, we used the Benjamini and Hochberg false discovery rate to control for potential Type I errors. 27 Fisher’s exact tests were conducted between ACTH, vigabatrin, oral steroids, and other treatments with (1) regression of skills at spasms onset, (2) cessation of spasms at 2 weeks (n = 32), and (3) cessation of spasms at 3 months (n = 34).…”