Pulmonary complications in children with Down syndrome: a scoping review

Abstract Context: Down syndrome (DS) is a prevalent chromosomal disorder associated with a wide range of congenital anomalies and other health problems. Objectives To give a scoping overview of encountered lower airway problems (both infectious and non-infectious) in DS children. Data sources : We systematically searched the MEDLINE and PubMed databases for relevant publications. Study selection: Studies were eligible if they were original studies about pediatric airway problems in DS and were evaluated by the PRISMA guidelines. Data extraction: Data concerning patient characteristics, study methods and outcomes were critically reviewed. Results Sixty papers were included. These were reviewed and summarized by topic, i.e. airway anomalies, dysphagia and aspiration, lower respiratory tract infections (and bronchiolitis in particular), pulmonary hypertension and other. Respiratory problems are proven to be a frequent and a major health burden in DS children. Airway anomalies (both single and multiple) are more prevalent and require a specific approach. A large proportion of DS children have (often silent) aspiration, resulting in protracted and difficult-to-treat symptoms. Respiratory tract infections are usually more severe and associated with an increased need for (prolonged) hospitalization. Pulmonary hypertension, wheeze and some other rare conditions are more commonly encountered in DS. Limitations: Large number of studies and high levels of study heterogeneity. Conclusions Several lower airway problems are more frequent and more complex in children with DS. These findings emphasize the need for a multidisciplinary approach by an experienced team allowing for a prompt diagnosis, proper management and improved long term outcome.