LAUSR

BACKGROUND Children with Down syndrome (DS) often undergo flexible bronchoscopies (FB) due to common respiratory symptoms. OBJECTIVE To examine the indications, findings, and complications of FB in pediatric DS patients. METHODS A retrospective case-control study on FB performed in DS pediatric patients between 2004-2021 in a tertiary center. DS patients were matched to controls (1:3) based on age, gender, and ethnicity. Data collected included demographics, comorbidities, indications, findings, and complications. RESULTS Fifty DS patients (median age 1.36 years, 56% males) and 150 controls (median age 1.27 years, 56% males), were included. Evaluation for obstructive sleep apnea and oxygen dependence were more common indications among DS (38% vs. 8%, 22% vs. 4%, p<0.01, respectively). Normal bronchoscopy was less frequent in DS compared with controls (8% vs. 28%, p=0.01). Soft palate incompetence and tracheal bronchus were more frequent in DS (12% vs. 3.3%, p=0.024, 8% vs. 0.7%, p=0.02, respectively). Complications were more frequent in DS (22% vs.9.3%, IRR 2.36, p=0.028). In DS, cardiac anomalies (IRR 3.96, p<0.01), pulmonary hypertension (IRR 3.76, p=0.006), and PICU hospitalization before the procedure (IRR 4.2, p<0.001) were associated with higher complication rates. In a multivariate regression model, history of cardiac disease and PICU hospitalization before the procedure, but not DS, were independent risk factors for complications with an IRR of 4 and 3.1, respectively (p=0.006, p=0.05). CONCLUSION DS pediatric patients undergoing FB are a unique population with specific indications and findings. DS pediatric patients with cardiac anomalies and pulmonary hypertension are at the highest risk for complications. This article is protected by copyright. All rights reserved.