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Question 1: Palivizumab for all children with Down syndrome?
  1. Dean Huggard1,
  2. Eleanor J Molloy1,2,3,4
  1. 1 Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland
  2. 2 Neonatology, Our Lady’s Children’s Hospital, Dublin, Ireland
  3. 3 Paediatrics, Tallaght Hospital, Dublin, Ireland
  4. 4 Neonatology, Coombe Women & Infants University Hospital, Dublin, Ireland
  1. Correspondence to Dr Dean Huggard, Department of Paediatrics, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland; dean.huggard{at}gmail.com

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Scenario

Structured clinical question

A 4-month-old boy with Down syndrome (DS) attended the general paediatric clinic for routine follow-up. With winter approaching the registrar asked, as children with DS are at increased risk of respiratory tract infections (RTIs), should this baby receive palivizumab prophylaxis, even if there is no congenital heart disease (CHD)?

Should children with DS without CHD or prematurity (population) receive palivizumab prophylaxis (intervention) to improve outcome (outcome)?

Search strategy

Primary sources

MEDLINE was searched via PubMed up to July 2018; the advanced search mode was used including the terms ‘Down syndrome’ or ‘Trisomy 21’ and ‘pavilizumab’ or ‘synagis’ or ‘pavilizumab vaccination’ or ‘pavilizumab immunisation’ or ‘synagis vaccine’ or ‘synagis immunisation’ or ‘pavilizumab prophylaxis’ or ‘synagis prophylaxis’. The articles were selected based on the ‘most relevant’ search mode.

Secondary sources

A search of the Cochrane Library using the search terms ‘Down syndrome’, ‘Trisomy 21’, ‘pavilizumab’ and ‘synagis’ was performed. No significant results were found.

Comments

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and is responsible for significant morbidity and mortality worldwide. It primarily affects infants, and approximately 1% of children of this age in Europe and the USA will be hospitalised over the bronchiolitis season, which typically runs from November to March.1 2 Palivizumab is a humanised monoclonal antibody which provides passive immunity to the recipient, and although not a cure for RSV has shown to be effective in reducing hospitalisation rates (by 55%–72%) in high-risk groups.3 It is usually given prophylactically, with a maximum of five doses 1 month apart starting in the autumn to those considered at greater risk: infants who are ex-premature <29 weeks, evidence of chronic lung disease (CLD), CHD, pulmonary abnormality, neuromuscular disease and significant immunosuppression.4

Children with DS may receive palivizumab prophylaxis due to a congenital heart lesion, prematurity or another risk factor, but they are …

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