Do patients with Down syndrome require extra precautions when dealing with upper respiratory infections (URIs)?

From the Guidelines

Patients with Down syndrome require extra precautions when dealing with upper respiratory infections (URIs) due to their increased risk of developing severe respiratory complications, as evidenced by their higher morbidity and mortality rates for pulmonary causes 1. When a person with Down syndrome develops a URI, it is crucial to monitor them closely due to their anatomical differences, such as smaller airways, larger tongues, and increased secretions, which can lead to more severe respiratory complications 1. Key considerations for managing URIs in patients with Down syndrome include:

• Ensuring adequate hydration to prevent dehydration
• Monitoring oxygen saturation if possible to quickly identify any respiratory issues
• Seeking medical attention promptly if breathing difficulties, persistent fever above 101°F, or decreased activity levels occur
• Using acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food) for fever and discomfort
• Utilizing saline nasal drops and humidifiers to manage congestion It is also essential to be aware of the higher risk of developing secondary bacterial infections like pneumonia or otitis media in this population, and to follow up with healthcare providers if symptoms worsen or persist beyond 7-10 days 1. Preventive measures such as annual influenza vaccination, pneumococcal vaccines, and good hand hygiene are particularly important for this population to reduce the risk of respiratory infections 1.

From the Research

Precautions for URI Infections in Patients with Down's Syndrome

• Patients with Down's syndrome are at a higher risk of respiratory illnesses, including URI infections, due to various factors such as anatomical variations, comorbidities, and immune system immaturity 2, 3, 4, 5.
• Respiratory illnesses are a significant contributor to morbidity and mortality in individuals with Down's syndrome, with pneumonia being a leading cause of mortality in adults with Down's syndrome 2, 4.
• Children with Down's syndrome are more prone to lower respiratory tract infections, which are often more severe and associated with an increased need for hospitalization 5.
• The use of antibiotics in preventing hospitalizations from respiratory tract infections in children with Down's syndrome has shown mixed results, with some studies suggesting a risk reduction only in infants with Down's syndrome 6.
• Patients with Down's syndrome may require extra precautions when dealing with URI infections, including targeted monitoring and a multidisciplinary approach to management, due to the increased risk of complications and the need for higher levels of care 2, 5.
• Common comorbidities in patients with Down's syndrome, such as congenital heart disease, asthma, and dysphagia, may also impact the management of URI infections and require special consideration 2, 5.