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Palivizumab for children with Down syndrome: is the time right for a universal recommendation?
  1. Bosco Paes1,
  2. Souvik Mitra2
  1. 1 Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
  2. 2 Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Bosco Paes, Department of Pediatrics (Neonatal Division), McMaster University, Hamilton L8S 4K1, Canada; paes{at}mcmaster.ca

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Children with Down syndrome (DS) are at increased risk for serious lower respiratory tract infections (LRTI) that are associated with significant morbidity and mortality as a result of structural variants, abnormalities both in numbers and function of innate and adaptive immunity, alveolar and pulmonary hypoplasia and congenital malformations.1–3Compared with any other birth defects in children less than 2 years, children with DS have the highest incidence rate ratio for any LRTI, bronchiolitis or pneumonia (8.0, 5.4 and 13.6) respectively.4 They also sustain more severe acute lung injury (58% vs 13%) and acute respiratory distress syndrome when admitted to intensive care (46% vs 7%) compared with children without DS.5 In the Danish database involving >450 000 subjects, of which 118 received palivizumab, the incident rate ratio for the risk of respiratory syncytial virus (RSV) hospitalisation (RSVH) and the geometric mean ratio for the duration of hospital stay in children with DS was 3.43 and 1.91, respectively, compared with children with bronchopulmonary dysplasia (2.58 and 1.36) and congenital heart disease (CHD; 1.70 and 1.25).6 LRTI and CHD remain the most important causes of mortality in children with DS of all ages. Overall, the neonatal and infant mortality in children with DS in the Netherlands is fivefold (1.65% vs 0.36%) and eightfold higher (4% vs 0.48%) than children without DS,1 while infant mortality in Chile related to DS, relative to the population without DS, is steadily rising, with an annual percentage change of 4.6%.7

Since the first report by Bloemers et al 8 on the risk of RSVH in children with DS, both with and without underlying CHD, the number of publications supporting the same findings have steadily increased. Huggard and Molloy,9 in a recent article, systematically confirmed that DS is an …

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