Down syndrome and ETT

[feraszaman]

Ive heard some recommendation to use smaller ETT with down syndrome babies secondary to their risk of developing subglottic stenosis . Any ideas?

[Stefan Johansson]

I spoke to a colleague now working at Guys and St Thomas hospital in London, UK, at the PICU for pediatric cardiac surgery.

He sees plenty of patients with Down syndrome and they do not routinely use smaller tubes. Although there are many referrals (i.e. long-term follow-up done somewhere else), he has not heard that tracheal stenosis would be more prevalent among Down children.

But, as you know, the pulm vascular bed can be hyperreactive and a difficult intubation might trigger pulmonary hypertension.

(Although we see not so few newborns with Down syndrome (with 10.000 inborn babies/year), we rarely need to intubate them in the neonatal period.

A personal reflection, AV commune or other complex cardiac malformation seem uncommon in the Down population I investigate with echo. I wonder if it reflects that amniocentesis is more common when the fetal screening ultrasound shows a possible cardiac malformation (week 16-18), and that fetal diagnosis of Mb Down is more common in fetuses with cardiac malformations. I.e. is VOCs less prevalent in the current population of infants with Mb Down? That could be a hypothesis worth testing in a study!)