G503(P) Acute medical presentations in children with down's syndrome: do they need a different approach. (May 2019)

• Record Type: Journal Article
• Authors: Baicher, VJS; Marder, E; Walton, L
• Is Part Of: Archives of disease in childhood. Volume 104:Supplement 2(2019)
• Page Start: A203
• Page End: A203
• Publication Date: 2019-05
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2019-rcpch.487
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Children with Down syndrome are known to have increased susceptibility to infections and have more serious subsequent illness than typically developing children. Recent high profile cases of sepsis in children with Down syndrome have shone a light on the vulnerability of these children. Early recognition of serious illness is paramount and can be more challenging in children with Down syndrome because of physiological and behavioural differences causing atypical presentations and possible rapid deterioration. Previous work in the region reviewing causes of death in children with Down syndrome showed a predominance towards respiratory aetiologies. We wanted to develop local guidance for the management of acute presentations of medical illness in children with Down syndrome with a more cautious approach, a lower threshold for considering sepsis and to assess the feasibility of mandatory senior paediatric review in the emergency department. This audit is a first step in that process. Aim: Audit the number and type of attendances to our emergency department by children with Down syndrome. Methods: The local database of all children with Down syndrome born between January 1999 and January 2018 living in our health community was accessed and their attendances to the city's tertiary centre emergency department from 2008–2018 reviewed. Attendances were then classified by type eg medical, surgical or injury. Results: 231 children with Down syndrome met the above criteria. Of these, 175 had attended the emergency department at least once over the 10 year period. The attendance count by patient ranged from 29 to 0. The majority of medical attendances were with respiratory complaints. There were 5 deaths and 9 other episodes of serious illness which also showed a predominance towards respiratory complaints. Conclusion: Recent high profile cases of serious illness in children with Down syndrome have increased the focus on the management of medical illness in this group. Our data shows that when children with Down syndrome present acutely, the chief medical complaints were of respiratory origin. Data from this study will be used to inform children's hospital guidance on management of illness in children with Down syndrome.