Flexible Bronchoscopy in Down Syndrome: Indications, Findings and Complications in Pediatric Population

Background: Down syndrome (DS) is the most common chromosomal disorder, associated with various congenital anomalies, mainly in the respiratory system.

Due to the frequency of respiratory symptoms, children with DS often undergo diagnostic procedures including flexible bronchoscopies (FB). Data regarding FB in DS patients are scarce. In the general pediatric population, the complications rate of FB is up to 7%.

Objective: to examine the indications, findings, and complications of FB in pediatric DS patients in a single tertiary center.

Methods: We conducted a retrospective study on flexible bronchoscopies performed in pediatric patients (aged 3 weeks -13 years) diagnosed with DS between the years 2004-2019 in Soroka university medical center (SUMC). Data collected included demographic information, co-morbidities, indications, findings, and complications.

Results: 67 flexible bronchoscopies were performed on 45 pediatric patients with DS, among them 91% had co-morbidities. 47.8% of procedures were performed on hospitalized patients. The most common indications were obstructive sleep apnea (40.3%), dependence on assisted ventilation (17.9%) and stridor (16.4%).

Common findings were adenoid hypertrophy (23.9%), laryngomalacia (14.9%) and tracheomalacia (14.9%). Only 13.4% had a normal examination. Complications were observed in 19.4% of procedures, including desaturation (13.4%), post-procedure fever (6%), need for intubation (3%), hospitalization in pediatric ward (4.5%) or pediatric intensive care unit (9%).

Discussion: DS patients undergoing FB have characteristic indications and a high incidence of findings and complications compared with the general pediatric population. When performing a FB in DS there is a need to be prepared for a high rate of findings and complications.