Publications by authors named "Michel E Weijerman"

17 Publications

  • Page 1 of 1

Older mothers and increased impact of prenatal screening: stable livebirth prevalence of trisomy 21 in the Netherlands for the period 2000-2013.

Eur J Hum Genet 2018 02 12;26(2):157-165. Epub 2018 Jan 12.

Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.

In the Netherlands, there is no registry system regarding the livebirth prevalence of trisomy 21 (T21). In 2007, a national screening programme was introduced for all pregnant women, which may have changed the livebirth prevalence of T21. The aim of this study is to analyse trends in factors that influence livebirth prevalence of T21 and to estimate the livebirth prevalence of T21 for the period of 2000-2013. National data sets were used on the following: (1) livebirths according to maternal age and (2) prenatal testing and termination of pregnancy (ToP) following diagnosis of T21. These data are combined in a model that uses maternal age-specific risk on T21 and correction factors for natural foetal loss to assess livebirth prevalence of T21. The proportion of mothers aged ≥ 36 years has increased from 12.2% in 2000 to 16.6% in 2009, to gradually decrease afterwards to 15.2% in 2013. The number of invasive tests performed adjusted for total livebirths decreased (5.9% in 2000 vs. 3.2% in 2013) with 0.18% a year (95% CI: -0.21 to -0.15; p   < 0.001). Following invasive testing, a higher proportion of foetuses was diagnosed with T21 (1.6% in 2000 vs. 4.8% in 2013) with a significant increase of 0.22% a year (95% CI: 0.18-0.26; p < 0.001). The proportion of ToP subsequent to T21 diagnosis was on average 85.7%, with no clear time trend. This resulted in a stable T21 livebirth prevalence of 13.6 per 10,000 livebirths (regression coefficient -0.025 (95% CI: -0.126 to 0.77; p = 0.60).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41431-017-0075-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839038PMC
February 2018

Incidence and risk factors of post-operative arrhythmias and sudden cardiac death after atrioventricular septal defect (AVSD) correction: Up to 47years of follow-up.

Int J Cardiol 2018 Feb;252:88-93

Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address:

Background: Atrioventricular septal defect (AVSD) has an incidence of 4-5.3 per 10.000 live births and is associated with Down syndrome (DS). Data on arrhythmias and sudden cardiac death (SCD) after AVSD correction is scarce.

Aim: To analyse the incidence of post-operative arrhythmias and SCD after AVSD correction and explore risk factors.

Methods: This is a retrospective multicenter study including patients after biventricular AVSD correction. Univariate and multivariate analyses were performed to explore risk factors.

Results: A total of 415 patients were included with a mean follow-up duration of 9years (range; <30days-47years). Early post-operative SVTs were documented in 33 patients (8%) and late post-operative SVTs in 15 patients (3.6%). Non-syndromic AVSD (p=0.022, HR=2.64; 95% CI=1.15-6.04) and cAVSD (p=0.005, HR=3.7; 95% CI=1.39-7.51) were independent risk factors for early post-operative SVTs and significant more late post-operative SVTs occurred in non-syndromic patients (p=0.016, HR=6.38; 95% CI=1.42-28.71) and in pAVSD (p=0.045, HR=3.703; 95% CI=1.03-13.32). Fifteen patients (3.6%) received a pacemaker. Non-syndromic AVSD (p=0.008, HR=15.82; 95% CI=2.04-122.47), pAVSD (p=0.017, HR=6.26; 95% CI=1.39-28.28) and re-operation (p=0.007, HR=4.911; 95% CI=1.54-15.64) were independent risk factors for postoperative pacemaker implantation. Late life-threatening ventricular arrhythmias and SCD occurred in 0.5% and 1.7% respectively.

Conclusion: There is good long-term survival after AVSD correction and incidence of SCD is low. Non-syndromic AVSD and cAVSD are independent risk factors for early post-operative SVTs. Non-syndromic AVSD patients have significant more early 3rd degree AVB and late post-operative SVTs. Non-syndromic patients with partial AVSD who have undergone reoperation have a significant higher risk of pacemaker implantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2017.09.209DOI Listing
February 2018

Confounding of the association between radiation exposure from CT scans and risk of leukemia and brain tumors by cancer susceptibility syndromes.

J Radiol Prot 2016 Dec 28;36(4):953-974. Epub 2016 Nov 28.

Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.

Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of pediatric CT scans. We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk. Since empirical evidence is lacking in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about patterns of CT scans among CSS patients. We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome and other CSS. Moreover, tuberous sclerosis complex, von Hippel-Lindau disease, neurofibromatosis type 1 and other CSS do not meaningfully confound RRs for brain tumors. Empirical data on the use of CT scans among CSS patients is urgently needed. Our assessment indicates that associations with radiation exposure from pediatric CT scans and leukemia or brain tumors reported in previous studies are unlikely to be substantially confounded by unmeasured CSS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/0952-4746/36/4/953DOI Listing
December 2016

Confounding of the Association between Radiation Exposure from CT Scans and Risk of Leukemia and Brain Tumors by Cancer Susceptibility Syndromes.

Cancer Epidemiol Biomarkers Prev 2016 Jan 23;25(1):114-26. Epub 2015 Nov 23.

Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands.

Background: Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of CT scans performed in children.

Methods: We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk estimates. Because there is virtually no empirical evidence in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about the current and previous patterns of CT scans among CSS patients.

Results: We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome, or other CSS. In contrast, RRs for brain tumors may be overestimated due to confounding by tuberous sclerosis complex (TSC) while von Hippel-Lindau disease, neurofibromatosis type 1, or other CSS do not meaningfully confound. Empirical data on the use of CT scans among CSS patients are urgently needed.

Conclusions: Our assessment indicates that associations with leukemia reported in previous studies are unlikely to be substantially confounded by unmeasured CSS, whereas brain tumor risks might have been overestimated due to confounding by TSC.

Impact: Future studies should identify TSC patients in order to avoid overestimation of brain tumor risks due to radiation exposure from CT scans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1158/1055-9965.EPI-15-0636DOI Listing
January 2016

Increased production of interleukin-10 in children with Down syndrome upon ex vivo stimulation with Streptococcus pneumoniae.

Pediatr Res 2014 Jan 14;75(1-1):109-13. Epub 2013 Oct 14.

Department of Pediatric Infectious Diseases, Immunology and Rheumatology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.

Background: Children with Down syndrome (DS) have an increased susceptibility to infections, due to altered humoral and/or cellular immunity. The aim of the study was to determine the cytokine production in whole blood of children with DS upon stimulation with heat-killed Streptococcus pneumoniae and lipopolysaccharide (LPS), in comparison with their healthy siblings.

Methods: Whole blood of 61 children with DS and 57 of their healthy siblings was stimulated with 200 ng/ml LPS and 4 × 10(7) colony-forming units/ml S. pneumoniae during 6, 24, and 48 h. Concentrations of pro- and anti-inflammatory cytokines, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-12p70, and IL-10 were determined at all time points.

Results: Children with DS show an increased IL-10 production upon stimulation with S. pneumoniae compared to their healthy siblings. At most time points, no significant differences were seen in cytokine production upon stimulation with LPS.

Conclusion: Children with DS may be prone to a severe course of pneumococcal pneumonia, because of an increased anti-inflammatory response.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/pr.2013.173DOI Listing
January 2014

[New insights into the support of children with Down syndrome].

Ned Tijdschr Geneeskd 2013 ;157(6):A5330

Rijnland ziekenhuis, afd. Kindergeneeskunde, Leiderdorp, the Netherlands.

The prevalence of Down syndrome (DS) in the Netherlands is 14/10,000 live births; this is almost 1.5 times higher than during the 1980s and 90 s. In the Netherlands the uptake of prenatal screening is lower than in the rest of Europe and the percentage of pregnant women > 36 years has increased. The early diagnosis and treatment of congenital heart abnormalities means that mortality among DS children has fallen. Although their life expectancy has increased greatly, other comorbidities have come to the fore. Wheezing is reported in 1/3 of the children with DS; it seems unrelated to asthma and atopy. The percentage of mothers who start breastfeeding a child with Down syndrome is low (48%), despite the preventive effect on celiac disease and infections and its therapeutic value for speech and language development. Children with DS score lower on quality of life for the domains of lung and stomach problems, motor function and communication. Medical support and screening addressing specific comorbidities (heart, thyroid, lungs, hearing, vision) and special support for cognitive, motor and speech development in children with Down syndrome is worthwhile.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2013

Frequency of lower respiratory tract infections in relation to adaptive immunity in children with Down syndrome compared to their healthy siblings.

Acta Paediatr 2012 Aug 2;101(8):862-7. Epub 2012 May 2.

Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.

Aim: Children with Down syndrome (DS) experience respiratory tract infections (RTIs) more frequently than healthy children. We investigated whether this is related to different immunological characteristics associated with DS.

Methods: The study group consisted of 22 children with DS and 22 of their healthy, age-range matched siblings. Data were collected on infections and hospitalizations because of lower RTIs. Immunoglobulin and IgG subclass levels in blood, as well as lymphocyte and T cell (subset) counts, were determined.

Results: The children with DS had a significantly higher frequency of lower RTIs and related hospitalization than their siblings. We also found significantly reduced IgG2 levels as well as significantly lower counts of total lymphocytes, CD4(+) T lymphocytes, CD4(+) invariant natural killer (iNKT) cells and regulatory T cells in the DS group.

Conclusion: In children with DS, reduced levels of IgG2, total lymphocytes, T lymphocytes, iNKT cells and regulatory T cells might contribute to their higher susceptibility to lower RTIs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1651-2227.2012.02696.xDOI Listing
August 2012

Testicular volume and testicular microlithiasis in boys with Down syndrome.

J Urol 2012 Mar 20;187(3):1012-7. Epub 2012 Jan 20.

Department of Pediatrics, Medical Center Alkmaar, Alkmaar, The Netherlands.

Purpose: Studies have suggested that testicular microlithiasis and Down syndrome are linked, yet a correlation remains unclear. We investigated the prevalence of testicular microlithiasis in patients with Down syndrome. We hypothesized that testicular microlithiasis is present at a higher rate in these patients. We further hypothesized that patients with Down syndrome have lower testicular volumes than normal age matched boys. We tested our hypothesis by ultrasound investigation in boys 0 to 18 years old with Down syndrome.

Materials And Methods: Testicular ultrasound was performed in 79 boys with Down syndrome. Mean patient age was 8.8 years (range 0.4 to 18.3). Testicular microlithiasis was assessed and testicular volume was measured according to the formula, π/6 × length × width × height.

Results: Testicular microlithiasis was present in 18 boys (22.8%). It was diagnosed in 6 of 28 boys younger than 7 years (21.4%), in 6 of 28 boys 7 to 12 years (21.4%) and in 6 of 23 boys 12 years or older (26.1%). No significant difference was found in the prevalence of testicular microlithiasis between these 3 groups. Mean testicular volumes in patients with Down syndrome (2.19 ml) were significantly smaller than the normative values.

Conclusions: This study demonstrated a 22.8% prevalence of testicular microlithiasis in boys with Down syndrome, which is significantly increased compared to normative values. In addition, testis volume is significantly smaller in boys with Down syndrome compared to normative values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.juro.2011.10.167DOI Listing
March 2012

Increased pro-inflammatory cytokine production in Down Syndrome children upon stimulation with live influenza A virus.

J Clin Immunol 2012 Apr 15;32(2):323-9. Epub 2011 Dec 15.

Department of Pediatrics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.

Purpose: Children with down syndrome (DS) have an increased susceptibility to infections, due to altered humoral and/or cellular immunity. The aim of this study was to determine the cytokine production in whole blood of children with DS upon stimulation with live influenza A virus.

Methods: Whole blood of 61 children with DS and 57 of their healthy siblings was stimulated with 2.5 × 10(4) TCID50/ml influenza A virus during 6, 24, and 48 h. TNF-α, IL-1β, IL-6, IL-8, IL-10, IL-12p70, IFN-α, IFN-γ concentrations, and viral load were measured at all time points.

Results: At most of the time points, TNF-α, IL-1β, IL-6, and IL-8 concentrations were significantly higher in children with DS following stimulation with live influenza A virus. IFN-α and IFN-γ levels were also significantly higher in the DS group. Viral clearance, however, was equal in both groups.

Conclusions: Children with DS have an altered immune response to influenza A virus. The production of higher levels of pro-inflammatory cytokines may be responsible for a more severe clinical course of viral disease in these children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10875-011-9625-4DOI Listing
April 2012

Recurrent wheeze in children with Down syndrome: is it asthma?

Acta Paediatr 2011 Nov 16;100(11):e194-7. Epub 2011 Jun 16.

Department of Paediatrics, VU University Medical Centre, Amsterdam, the Netherlands.

Aim: To compare the prevalence of current wheeze in children with Down syndrome (DS), their siblings, and nonrelated population controls.

Methods: This was a case-control study in which the International Study of Asthma and Allergy in Childhood questionnaire for respiratory symptoms was completed by parents for 130 children with DS, 167 of their siblings, and for 119 age- and sex-matched control subjects from the general population.

Results: Both wheeze ever and wheeze during the last 12 months was more commonly reported in DS than in their siblings or controls. The relative risk (RR) of current wheeze in DS was 2.8 (95% CI, 1.42-5.51) compared with siblings, and 2.75 (95% CI, 1.28-5.88) compared with controls. A doctor's diagnosis of asthma was found in 3.1% in children with DS, in 4.2% in siblings and in 6.7% in controls. During 4-years follow-up, the diagnosis of asthma could not be confirmed in the 24 DS children with current wheeze, and atopy was found in none of them.

Conclusion: Wheeze is common in children with DS. This is likely to be related to the factors specific for DS and probably unrelated to asthma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1651-2227.2011.02367.xDOI Listing
November 2011

Increased risk of respiratory tract infections in children with Down syndrome: the consequence of an altered immune system.

Microbes Infect 2010 Oct 2;12(11):799-808. Epub 2010 Jun 2.

Department of Pediatrics, Division of Infectious Diseases, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.

Down syndrome (DS) is the most common chromosomal abnormality among live-born infants. Respiratory tract infections are the most important cause of mortality in individuals with DS at all ages. In recent decades several studies have been performed to elucidate abnormalities of the immune system in DS. However, the influence of the immune system on the occurrence of respiratory tract infections in these children has never been reviewed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.micinf.2010.05.007DOI Listing
October 2010

Clinical practice. The care of children with Down syndrome.

Eur J Pediatr 2010 Dec 15;169(12):1445-52. Epub 2010 Jul 15.

Department of Pediatrics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.

Down syndrome (DS) is one of the most common chromosomal abnormalities. Because of medical advances and improvements in overall medical care, the median survival of individuals with DS has increased considerably. This longer life expectancy requires giving the necessary care to the individual with DS over their total longer lifespan. DS medical guidelines are designed for the optimal care of the child in whom a diagnosis of DS has been confirmed. We present an overview of the most important issues related to children with DS based on the most relevant literature currently available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-010-1253-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2962780PMC
December 2010

Intestinal barrier gene variants may not explain the increased levels of antigliadin antibodies, suggesting other mechanisms than altered permeability.

Hum Immunol 2010 Apr 4;71(4):392-6. Epub 2010 Feb 4.

Department of Pediatric Gastroenterology, UMC Utrecht, Utrecht, The Netherlands.

Various genes may influence intestinal barrier function, including MAGI2, MYO9B, and PARD3, which are associated with celiac disease. Because direct measurement of intestinal permeability is difficult, antibodies against gliadin (AGA) and Baker's yeast (anti-Saccharomyces cerevisiae antibodies [ASCA]) can be used as an indirect test. The objective of this study was to investigate whether intestinal permeability, represented by AGA, was correlated with MAGI2, MYO9B, and PARD3. Analyses were performed in patients with Down syndrome, a population with suspected increased intestinal permeability. Correlations between AGA and ASCA were investigated. Patients with Down syndrome (n = 126) were genotyped for six single-nucleotide polymorphisms in MAGI2 (rs1496770, rs6962966, rs9640699), MYO9B (rs1457092, rs2305764), and PARD3 (rs10763976). An allele dosage association of these risk genes and AGA levels was performed. The correlation between AGA and ASCA was studied. A strong correlation was found between AGA and ASCA (p < 0.01). The patient group with one or more risk genotypes had lower mean AGA levels (trend test p = 0.007) and consisted of a larger number of patients with normal AGA levels (p = 9.3 x 10(-5)). Celiac-associated risk genotypes are associated with lower AGA values instead of elevated ones. Thus, other immunologic phenomena play a role in the increased prevalence of elevated AGA in patients with Down syndrome, possibly involving altered induction and/or maintenance of tolerance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.humimm.2010.01.016DOI Listing
April 2010

High incidence of recurrent wheeze in children with down syndrome with and without previous respiratory syncytial virus lower respiratory tract infection.

Pediatr Infect Dis J 2010 Jan;29(1):39-42

Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht 3508 AB, The Netherlands.

Background: Respiratory syncytial virus (RSV)-induced lower respiratory tract infection (LRTI) is associated with the subsequent development of recurrent wheeze. In a recent study, we found a high incidence (9.9%) of hospitalization for RSV-induced LRTI among children with Down syndrome (DS), indicating DS as a new risk factor for RSV-induced LRTI. In the current study we aimed to investigate the development of long-term airway morbidity in children with DS after hospitalization for RSV-induced LRTI.

Methods: A combined retrospective cohort and prospective birth cohort of children with DS with a history of hospitalization for RSV-induced LRTI was studied (n = 53). Three control populations were included: children with DS without hospitalization for RSV-induced LRTI (n = 110), children without DS but with hospitalization for RSV-induced LRTI (n = 48), and healthy siblings of the previous 3 groups mentioned (n = 49). The primary outcome was physician-diagnosed wheeze up to 2 years of age.

Results: The incidence of physician-diagnosed recurrent wheeze in children with DS with a history of hospitalization for RSV-induced LRTI was 36%. Unexpectedly, up to 30% of children with DS without a history of RSV-induced LRTI had physician-diagnosed recurrent wheeze (no significant difference). In children without DS physician-diagnosed wheeze was found more frequently in children hospitalized for RSV-induced LRTI than healthy controls (31% vs. 8%, P = 0.004).

Conclusions: In this combined retrospective/prospective cohort study RSV-induced LRTI did not significantly contribute to the risk of recurrent wheeze in children with DS. An unexpected finding was that recurrent wheeze was very common among children with DS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0b013e3181b34e52DOI Listing
January 2010

Prospective human leukocyte antigen, endomysium immunoglobulin A antibodies, and transglutaminase antibodies testing for celiac disease in children with Down syndrome.

J Pediatr 2009 Feb 25;154(2):239-42. Epub 2008 Sep 25.

Department of Pediatrics and Infectious Diseases, VU University Medical Center, Amsterdam, The Netherlands.

Objective: To assess the effect of a prospective screening strategy for the early diagnosis of celiac disease (CD) in children with Down syndrome (DS).

Study Design: Blood samples were taken from 155 children with DS. Buccal swabs were also taken from 9 of these children for determination of human leukocyte antigen (HLA)-DQ2 or HLA-DQ8 positivity. Independently, immunoglobulin A anti-endomysium-(EMA) and anti-tissue transglutaminase antibodies (TGA) were tested. An intestinal biopsy was performed to confirm the diagnosis of CD.

Results: Sixty-three children (40.6%) had test results that were positive for HLA-DQ2 or HLA-DQ8. Results of HLA DQ-typing of DNA isolated from blood and buccal swabs were identical. Eight of the children in whom test results were positive for HLA-DQ2/8 also had positive test results for EMA and TGA. CD was confirmed in 7 of these children with an intestinal biopsy, and in 1 child, CD was suggested with improvement on a gluten-free diet.

Conclusions: We found a prevalence of CD in children with DS of 5.2% (10 times higher than the general Dutch population). We recommend HLA-DQ2/8 typing from buccal swabs in the first year of life and initiating serologic screening of children with DS in whom test results are positive for HLA-DQ2 or DQ8 at age 3 years. Early knowledge of negative HLA-DQ2/8 status can reassure most parents that their children do not have a CD risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2008.08.007DOI Listing
February 2009

Prevalence, neonatal characteristics, and first-year mortality of Down syndrome: a national study.

J Pediatr 2008 Jan 19;152(1):15-9. Epub 2007 Nov 19.

Department of Pediatrics and Infectious Diseases, VU University Medical Center, Amsterdam, The Netherlands.

Objective: To determine the prevalence, neonatal characteristics, and first-year mortality in Down syndrome (DS) among children in The Netherlands.

Study Design: The number of DS births registered by the Dutch Paediatric Surveillance Unit (DPSU) in 2003 was compared with total live births (reference population) and perinatal registrations.

Results: The prevalence of DS was 16 per 10,000 live births. Compared with the reference population, the 182 children with trisomy 21 had a gestational age of 38 weeks versus 39.1 weeks (P < .001), a birth weight of 3119 g versus 3525 g in males (P < .001) and 2901 g versus 3389 g in females (P < .001), and mothers with a parity of > or = 4.17% versus 5% (P < .001) and a mean age of 33.6 years versus 31 years (P < .001) and 33% (n = 54) > or = 36 years). The mean age of DS diagnosis was 10.2 days in nonhospital deliveries and 1.8 days in hospital deliveries (P < .001). Children with DS were less often breast-fed (P < .05), and 86% (n = 156) were hospitalized after birth. Neonatal and infant mortality were higher in DS, 1.65% versus 0.36% (P < .02) and 4% versus 0.48% (P < 0.001), respectively.

Conclusions: The prevalence of DS in The Netherlands exceeds previously reported levels and is influenced by the mother's age. Neonatal and infant DS mortality have declined, but still exceed those in the reference population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2007.09.045DOI Listing
January 2008

Down syndrome: a novel risk factor for respiratory syncytial virus bronchiolitis--a prospective birth-cohort study.

Pediatrics 2007 Oct;120(4):e1076-81

Division of Infectious Diseases, University Medical Centre Utrecht, Department of Pediatrics, 3508 AB, Utrecht, The Netherlands.

Objectives: Respiratory syncytial virus is the single-most important cause of lower respiratory tract infections in children. Preterm birth and congenital heart disease are known risk factors for severe respiratory syncytial virus infections. Although Down syndrome is associated with a high risk of respiratory tract infections, little is known about the incidence of respiratory syncytial virus infections in this group. The aim of our study was to determine the incidence of respiratory syncytial virus lower respiratory tract infection-associated hospitalization among children with Down syndrome.

Patients And Methods: We performed a retrospective observational study and a prospective nationwide birth-cohort study of children with Down syndrome. The retrospective cohort comprised 176 children with Down syndrome. A birth cohort of 219 children with Down syndrome was prospectively followed until 2 years of age. All 276 siblings of the birth cohort were used as controls.

Results: Of the 395 patients with Down syndrome, 180 (45.6%) had a known risk factor for severe respiratory syncytial virus infections; 39 (9.9%) of these were hospitalized for respiratory syncytial virus lower respiratory tract infections. Two control children (0.7%) versus 9 term children with Down syndrome without congenital heart disease (7.6%) were hospitalized for respiratory syncytial virus lower respiratory tract infections. The median duration of hospitalization was 10 days; mechanical ventilation was required for 5 children (12.8%).

Conclusions: This is the first study, to our knowledge, to demonstrate that Down syndrome is a novel independent risk factor for severe respiratory syncytial virus lower respiratory tract infections. These findings should prompt studies to investigate possible mechanisms that underlie severe respiratory syncytial virus lower respiratory tract infections in children with Down syndrome. The effect of respiratory syncytial virus prophylaxis in this specific population needs to be established.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2007-0788DOI Listing
October 2007