scholarly journals COVID-19 and children with Down syndrome: is there any real reason to worry? Two case reports with severe course

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ahmad Kantar ◽  
Angelo Mazza ◽  
Ezio Bonanomi ◽  
Marta Odoni ◽  
Manuela Seminara ◽  
...  

Abstract Background Down syndrome (DS) is characterized by a series of immune dysregulations, of which interferon hyperreactivity is important, as it is responsible for surging antiviral responses and the possible initiation of an amplified cytokine storm. This biological condition is attributed to immune regulators encoded in chromosome 21. Moreover, DS is also characterized by the coexistence of obesity and cardiovascular and respiratory anomalies, which are risk factors for coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case presentation A total of 55 children were admitted to the pediatric ward in Bergamo, between February and May 2020 for COVID-19. Here, we describe the cases of two children with DS and a confirmed COVID-19 diagnosis who had a severe course. In addition, both cases involved one or more comorbidities, including cardiovascular anomalies, obesity, and/or obstructive sleep apnea. Conclusions Our observations indicate that children with DS are at risk for severe COVID-19 disease course.

2020 ◽  
Author(s):  
Ahmad Kantar ◽  
Angelo Mazza ◽  
Ezio Bonanomi ◽  
Marta Odoni ◽  
Manuela Seminara ◽  
...  

Abstract Background: Down syndrome (DS) is characterised by a series of immune dysregulations, of which interferon hyperreactivity is a key one as it is responsible for surging antiviral responses and probable initiation of an amplified cytokine storm. This biological condition is attributed to immune regulators encoded in chromosome 21. Moreover, DS is characterised by the coexistence of cardiovascular and respiratory anomalies as well as obesity, which constitutes a risk factor for SARS-CoV-2 respiratory disease (COVID-19).Case presentation: Of the total number of children 55 admitted to paediatric wards in Bergamo in the period between February to May 2020 for COVID-19 infection, we present 2 children with DS and confirmed COVID-19 diagnosis that had a severe course. In addition, both cases had one or more comorbidities, being cardiovascular anomalies, obesity, and/or OSA.Conclusions: Our observations indicate the need to consider children with DS a population at a risk of severe COVID-19.


2021 ◽  
Author(s):  
Jonathan D. Santoro ◽  
Justin Del Rosario ◽  
Beth Osterbauer ◽  
Emily S. Gillett ◽  
Debra M. Don

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A240-A240
Author(s):  
Nisha Patel ◽  
Timothy Morgenthaler ◽  
Julie Baughn

Abstract Introduction Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS. Methods A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded. Results 94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis. Conclusion Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs. Support (if any):


SLEEP ◽  
2018 ◽  
Vol 41 (suppl_1) ◽  
pp. A287-A287
Author(s):  
J N Mian ◽  
B Gunaratnam ◽  
E Senthilvel

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2721-2721
Author(s):  
Paul Lee ◽  
Rahul Bhansali ◽  
Malini Rammohan ◽  
Nobuko Hijiya ◽  
Shai Izraeli ◽  
...  

Abstract Children with Down syndrome have a spectrum of associated disorders including a 20-fold increased incidence of B-cell acute lymphoblastic leukemia (DS-ALL). Although a number of genetic alterations have been found in this ALL subtype, such as activating mutations in JAK2 and overexpression of CRLF2, the mechanisms by which trisomy 21 promotes the leukemia are largely unknown. Previous studies have implicated chromosome 21 genes HMGN1 and DYRK1A in both malignant and normal lymphopoiesis. DYRK1A is a member of the dual-specificity tyrosine phosphorylation-regulated kinase family that has been well studied in non-hematopoietic tissues. Its targets include proteins that regulate multiple pathways including cell signaling, cell cycle, and brain development. We have previously shown that DYRK1A is a megakaryoblastic leukemia-promoting gene through its negative regulation of NFAT transcription factors. Furthermore, in studies with a conditional Dyrk1a knock-out mouse, we found that the kinase is required for lymphoid, but not myeloid cell development. In developing lymphocytes, Dyrk1a regulates the cell cycle by destabilizing cyclin D3. Consequently, loss of Dyrk1a resulted in the failure of these cells to switch from a proliferative to quiescent phase for subsequent maturation (Thompson et al. J. Exp. Med. 2015 212:953-70). Despite this deficiency in exiting the cell cycle, Dyrk1a-deficient lymphocytes also exhibit impaired proliferation before undergoing apoptosis. These data reveal a critical role for DYRK1A in lymphopoiesis and suggest that it may be a target for therapeutic intervention. We assayed the activity of the highly selective and potent DYRK1 inhibitor, EHT 1610, in multiple ALL cell lines. EHT 1610 inhibited the growth of Jurkat and MHH-CALL-4 cells with EC50s of 0.83mM and 0.49mM, respectively. Next, we treated primary human ALL blasts with EHT 1610 and the less selective DYRK1A inhibitor harmine. Growth of 16 out of 30 specimens, which included DS-ALL, pre-B ALL, and T-ALL, was sensitive to DYRK1A inhibition at doses between 0.5 and 10mM. Of note, growth of 9 of the 11 of the DS-ALL samples was inhibited by EHT 1610. This result indicates that the increased dosage of DYRK1A in DS samples sensitizes the cells to DYRK1A inhibition. To further study the contributions of DYRK1A to normal and malignant lymphopoiesis, we performed phosphoproteomic analysis on primary murine pre-B cells treated with EHT 1610. After 2 hours of EHT 1610 treatment, the cells were collected and analyzed for changes in the phosphoproteome. Phosphorylation of 36 proteins was significantly altered. Bioinformatics analysis led to the identification of a number of notable pathways that appear to be regulated by DYRK1A including cell cycle, cell division and mitosis, RNA metabolism, and JAK-STAT signaling. Differentially phosphorylated proteins included geminin, which is important in cell division and whose loss enhances megakaryopoiesis, and POLR2M, which is intriguing because DYRK1A phosphorylates the CTD of RNA Pol II and binds chromatin at specific sites in glioblastoma cells. Another interesting target is STAT3, which is phosphorylated by DYRK1A on Ser727, a residue whose phosphorylation is required for maximal STAT3 activation. Treatment of murine pre-B cells with EHT 1610 significantly reduced the level of phosphorylation of Ser727 and Tyr705, suggesting that DYRK1A may provide a priming event for STAT3 activation similar to its priming effect on GSK3b phosphorylation. Consistent with a role for JAK/STAT signaling and STAT3 activity, B-ALL cells were highly sensitive to ruxolitinib therapy. Taken together, our study suggests that DYRK1A is a therapeutic target in DS-ALL and likely functions in part by enhancing JAK/STAT signaling. Disclosures No relevant conflicts of interest to declare.


2018 ◽  
Vol 104 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Magnus von Lukowicz ◽  
Nina Herzog ◽  
Sebastian Ruthardt ◽  
Mirja Quante ◽  
Gabriele Iven ◽  
...  

BackgroundObstructive sleep apnoea (OSA) is common in children with Down syndrome (DS), yet difficult to treat. As muscular hypotonia of the upper airway may cause OSA and is also common in DS, we tested whether intense myofunctional therapy improves OSA in children with DS.Patients and methodsForty-two children underwent cardiorespiratory sleep studies immediately before and after a 1-week intensive training camp consisting of three daily 45 min sessions of myofunctional exercises according to Padovan. Primary outcome was the mixed-obstructive-apnoea/hypopnoea index (MOAHI), secondary outcomes the ≤3% oxygen desaturation index (DI3), the ≤90% desaturation index (DI90) and the lowest pulse oximeter saturation (SpO2nadir).ResultsEighteen recordings had ≥3 hours of artefact-free recording in both the pretreatment and post-treatment sleep study and were therefore included in the analysis. Mean age was 6.3 years (SD 2.5); 83% had OSA prior to intervention. Mean MOAHI was 6.4 (SD 8.6) before and 6.4 (SD 10.8) after the intervention (p>0.05); the DI3 and SpO2nadir also did not change. Only the DI90 decreased significantly from 2.7 (SD 4.5) to 2.1 (SD 3.7) (p<0.05).ConclusionThe 1-week intense myofunctional training camp evaluated here in children with DS had only a marginal effect on OSA. Whether a longer follow-up period or duration of intervention would yield stronger effects remains to be determined.


PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 132-139
Author(s):  
Carole L. Marcus ◽  
Thomas G. Keens ◽  
Daisy B. Bautista ◽  
Walter S. von Pechmann ◽  
Sally L. Davidson Ward

Children with Down syndrome have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), yet the type and severity of OSAS in this population has not been characterized. Fifty-three subjects with Down syndrome (mean age 7.4 ± 1.2 [SE] years; range 2 weeks to 51 years) were studied. Chest wall movement, heart rate, electrooculogram, end-tidal Po2 and Pco2, transcutaneous Po2 and Pco2, and arterial oxygen saturation were measured during a daytime nap polysomnogram. Sixteen of these children also underwent overnight polysomnography. Nap polysomnograms were abnormal in 77% of children; 45% had obstructive sleep apnea (OSA), 4% had central apnea, and 6% had mixed apneas; 66% had hypoventilation (end-tidal Pco2, &gt;45 mm Hg) and 32% desaturation (arterial oxygen saturation &lt;90%). Overnight studies were abnormal in 100% of children, with OSA in 63%, hypoventilation in 81%, and desaturation in 56%. Nap studies significantly underestimated the presence of abnormalities when compared to overnight polysomnograms. Seventeen (32%) of the children were referred for testing because OSAS was clinically suspected, but there was no clinical suspicion of OSAS in 36 (68%) children. Neither age, obesity, nor the presence of congenital heart disease affected the incidence of OSA, desaturation, or hypoventilation. Polysomnograms improved in all 8 children who underwent tonsilletomy and adenoidectomy, but they normalized in only 3. It is concluded that children with Down syndrome frequently have OSAS, with OSA, hypoxemia, and hypoventilation. Obstructive sleep apnea syndrome is seen frequently in those children in whom it is not clinically suspected. It is speculated that OSAS may contribute to the unexplained pulmonary hypertension seen in children with Down syndrome.


2020 ◽  
pp. 019459982095483
Author(s):  
Philip D. Knollman ◽  
Christine H. Heubi ◽  
Susan Wiley ◽  
David F. Smith ◽  
Sally R. Shott ◽  
...  

Objectives To compare the demographic and clinical characteristics of children with Down syndrome who did and did not receive polysomnography to evaluate for obstructive sleep apnea after publication of the American Academy of Pediatrics’ guidelines recommending universal screening by age 4 years. Study Design Retrospective cohort study. Setting Single tertiary pediatric hospital. Methods Review was conducted of children with Down syndrome born between 2007 and 2012. Children who obtained polysomnography were compared with children who did not, regarding demographic data, socioeconomic status, and comorbidities. Results We included 460 children with Down syndrome; 273 (59.3%) received at least 1 polysomnogram, with a median age of 3.6 years (range, 0.1-8.9 years). There was no difference in the distribution of sex, insurance status, or socioeconomic status between children who received polysomnography and those who did not. There was a significant difference in race distribution ( P = .0004) and distance from home to the medical center ( P < .0001) between groups. Among multiple medical comorbidities, only children with a history of hypothyroidism ( P = .003) or pulmonary aspiration ( P = .01) were significantly more likely to have obtained polysomnography. Conclusions Overall, 60% of children with Down syndrome obtained a polysomnogram. There was no difference between groups by payer status or socioeconomic status. A significant difference in race distribution was noted. Proximity to the medical center and increased medical need appear to be associated with increased likelihood of obtaining a polysomnogram. This study illustrates the need for improvement initiatives to increase the proportion of patients receiving guideline-based screening.


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