Limited Evidence on the Management of Respiratory Tract Infections in Down's Syndrome: A Systematic Review.

AIMS: To systematically review the effectiveness of preventative and therapeutic interventions for RTIs in children with Down Syndrome. METHODS: Databases were searched for published and ongoing studies of respiratory tract diseases, cardiovascular diseases and obstructive sleep apnoea to provide a broad overview of the existing evidence base. These databases were searched for controlled trials, cohort studies and controlled before-after (CBA) studies. Trial registries were searched for ongoing studies. Initially, all study types were included to provide a broad overview of the existing evidence base. However, those with a critical risk of bias were excluded using the Cochrane risk of bias tool. RESULTS: A total of 13,575 records were identified from which 5 studies fulfilled the eligibility criteria and three fulfilled our criteria for data extraction.One randomized controlled trial (RCT) of moderate risk of bias compared zinc therapy with placebo. Outcome data were only reported for 50 (78%) children who presented with extreme symptoms; no benefit of zinc therapy was found. One non-RCT with serious risk of bias included 26 children and compared pidotimod (an immunostimulant) with no treatment; pidotimod was associated with fewer upper RTI recurrences compared with no treatment (1.43 vs. 3.82). A prospective cohort study with moderate risk of bias compared 532 palivizumab treated children with 233 untreated children and found that children treated with palivizumab had fewer RSV-related hospitalisation (23 untreated, 8 treated) but the same number of overall RTI-related hospitalisations (73 untreated, 74 treated) in the first two years of life. CONCLUSIONS: The evidence base for the management of RTIs in people with Down syndrome is incomplete. Methodologic rigorous studies are warranted to guide clinicians in how best to prevent and treat RTIs in children with Down syndrome.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.