Respiratory problems in children with Down syndrome

Pandit, Chetan; Fitzgerald, Dominic A.

doi:10.1111/j.1440-1754.2011.02077.x

Cited by 63 publications

(76 citation statements)

References 49 publications

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“…As infecções respiratórias agudas em geral representam um grande espectro, incluindo rinofaringites, sinusites, otites e pneumonias [3]. Essas enfermidades podem ter diferentes agentes etiológicos, principalmente vírus e bactérias, e são mais frequentes em crianças com SD [5].…”

Section: Discussionunclassified

“…Além de diferentes conformações nas vias aéreas superiores, pessoas com SD apresentam alterações morfológicas das vias aéreas inferiores e do parênquima pulmonar [16], que também podem contribuir para a maior suscetibilidade a infecções. Ainda existe um baixo índice de sucesso ao se utilizarem os instrumentos de avaliação da função pulmonar em crianças com SD, o que dificulta o entendimento e o esclarecimento do papel dessas alterações morfofuncionais [3]. Por outro lado, muitos estudos têm sugerido uma importante interferência dos fatores imunológicos.…”

Section: Discussionunclassified

“…Essa síndrome apresenta uma variedade de características dismórficas e malformações congênitas, associadas frequentemente com deficiências imunológicas [2] e infecções concomitantes [3]. A incidência descrita para a SD é de um a cada 600 a 800 nascidos vivos [4].…”

Section: Introductionunclassified

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Avaliação da migração de neutrófilos e da frequência relativa de linfócitos CD4+/CD8+ em crianças com síndrome de Down e controles

Filho

Klein

Tavares

et al. 2015

Sci Med

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Este artigo é resultante da Dissertação apresentada pelo autor Artur Kautzmann Filho ao Programa de Pós-Graduação em Pediatria e Saúde da ABSTRACT Aims:To evaluate neutrophil migration and the relative frequency of CD4+/CD8+ lymphocytes in children with Down syndrome and in healthy controls. Methods: This was a case-control study carried out at the Institute of Biomedical Research, affiliated with São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul (PUCRS). Patients with Down syndrome were selected by convenience sampling, including all children with Down syndrome aged 3 to 13 years treated at the Pediatric and Otolaryngology Outpatient Clinics of São Lucas Hospital and at KinderCenter for Children with Special Needs, in Porto Alegre, State of Rio Grande do Sul, Brazil, between January and December 2012. Healthy children without Down syndrome, participants in another ongoing study conducted by Institute of Biomedical Research, were recruited to the control group. Those patients with the largest volume of cells stored in cryotubes were selected. A neutrophil chemotaxis assay and immunophenotyping of CD4+ and CD8+ T cells were performed to evaluate the functionality of the immune response. Associations were assessed by the chi-squared test, Student's t test, or Mann-Whitney's test. All tests were bidirectional, and p values less than 0.05 were regarded as statistically significant. Results: This study included 19 patients (13 with Down syndrome and six controls), with a mean age of 8.13 and 9.83 years, respectively. No significant changes concerning neutrophil migration were observed in the Down syndrome group. However, patients with Down syndrome tended to have a lower rate of CD4+ T cells and a higher rate of CD8+ T cells. The CD4+/CD8+ ratio revealed significant difference between the groups, being lower in patients with Down syndrome. Conclusions: This study suggests that patients with Down syndrome show a decreased CD4+/CD8+ ratio, which may contribute to the frequent and recurrent infections in these children.KEY WORDS: down syndrome; immunity; CD4-CD8 ratio; child; infection. Scientia Medica Artigo originAlOpen Access 2015;25(1):ID19235 ISSN 1980ISSN -6108 : http://dx.doi.org/10.15448/1980ISSN -6108.2015 Recebido: novembro,

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Section: Discussionunclassified

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Avaliação da migração de neutrófilos e da frequência relativa de linfócitos CD4+/CD8+ em crianças com síndrome de Down e controles

Filho

Klein

Tavares

et al. 2015

Sci Med

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“…In addition, gastroesophageal reflux, immunologic dysfunction, tracheal bronchus, airway malacia, CHD, and pulmonary hypoplasia cause recurrent lower airway diseases. 11 Cooney and Thurlbeck showed that 6 of 7 patients with DS had hypoplastic lungs, and 5 had CHD. 12 Patients with DS have a decreased number of alveoli in relation to acini, enlarged alveoli and alveolar ducts, and a smaller alveolar surface area, which can lead to exacerbation of pulmonary hypertension in DS.…”

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“…Pandit et al suggest there are many respiratory problems in both the upper and lower airways of children with DS. 11 Anatomic characteristics in DS such as large tongue, small hypopharynx, pharyngeal hypotonia, tonsils and adenoid enlargement, laryngomalacia, and tracheomalacia cause upper airway problems. In addition, gastroesophageal reflux, immunologic dysfunction, tracheal bronchus, airway malacia, CHD, and pulmonary hypoplasia cause recurrent lower airway diseases.…”

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What Causes Pulmonary Arterial Hypertension in Down Syndrome With Congenital Heart Disease?

Hosokawa

Vanderpool

Ishii

et al. 2018

Circ J

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H-E classification and IPVD score. Furthermore, earlier progression of histopathological changes in pulmonary arteriopathy could not be proved in patients with DS despite accounting for age in the histological findings. Previous papers have reported no difference in the incidence of PAH between patients with DS and those without DS. Vázquez-Antona et al showed that results of a hemodynamic study of pulmonary hypertension and vasodilation test with oxygen were similar for patients with DS and those without the chromosomal abnormality, 10 though they did not examine histological findings.Cohort selection, other types of respiratory problems and anatomic variability are other reasons that could explain the results in the current study by Masaki et al. Patients who had undergone pulmonary artery banding were excluded from this study, which might cause underestimation of the severity of pulmonary arteriopathy in the group of patients with DS. Other factors could be contributing to the pathogenesis of PAH in patients with DS. Pandit et al suggest there are many respiratory problems in both the upper and lower airways of children with DS. 11 Anatomic characteristics in DS such as large tongue, small hypopharynx, pharyngeal hypotonia, tonsils and adenoid enlargement, laryngomalacia, and tracheomalacia cause upper airway problems. In addition, gastroesophageal reflux, immunologic dysfunction, tracheal bronchus, airway malacia, CHD, and pulmonary hypoplasia cause recurrent lower airway diseases. 11 Cooney and Thurlbeck showed that 6 of 7 patients with DS had hypoplastic lungs, and 5 had CHD. 12 Patients with DS have a decreased number of alveoli in relation to acini, enlarged alveoli and alveolar ducts, and a smaller alveolar surface area, which can lead to exacerbation of pulmonary hypertension in DS. 12 Bush et al investigated the histologic features of impaired development of the lung vasculature and alveoli and the presence of intrapulmonary bronchopulmonary anastomoses (IBA) in patients with DS using specimens obtained from autopsy. 13 These patients had frequent histologic evidence of impaired lung alveolar and vascular development, D own syndrome (DS) is the most common chromosomal abnormality. A recent study showed that its incidence is 1 in 319-1,000 live births. 1 Approximately half of all newborns with DS have congenital heart disease (CHD): 2 atrioventricular septal defect (AVSD: 45%), ventricular septal defect (VSD: 35%), secundum atrial septal defect (8%), and tetralogy of Fallot (4%). 3 DS strongly associates with pulmonary arterial hypertension (PAH). Patients with DS and CHD are thought to develop PAH more rapidly than non-DS patients with CHD. 4 In patients with DS and severe pulmonary hypertension, cardiologists need to determine whether there are surgical indications when they perform the cardiac catheterizations. In those cases, the Heath-Edwards (H-E) classification, and in Japan the index of pulmonary vascular disease (IPVD) 5 proposed by Yamaki and Tezuka, 6 determined from a lung biopsy play an im...

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