Flexible bronchoscopy in pediatric patients with Down syndrome: A case-control study of the indications, findings, and complications

Noga Arwas, Aviv Goldbart, Micha Aviram, Yotam Dizitzer, Itay Pansky, Inbal Golan-Tripto

Research output: Contribution to journalArticlepeer-review


Background: Children with Down syndrome (DS) often undergo flexible bronchoscopies (FB) due to common respiratory symptoms. Objective: To examine the indications, findings, and complications of FB in pediatric DS patients. Methods: A retrospective case-control study on FB performed in DS pediatric patients between 2004 and 2021 in a tertiary center. DS patients were matched to controls (1:3) based on age, gender, and ethnicity. Data collected included demographics, comorbidities, indications, findings, and complications. Results: Fifty DS patients (median age 1.36 years, 56% males) and 150 controls (median age 1.27 years, 56% males), were included. Evaluation for obstructive sleep apnea and oxygen dependence were more common indications among DS (38% vs. 8%, 22% vs. 4%, p < 0.01, respectively). Normal bronchoscopy was less frequent in DS compared with controls (8% vs. 28%, p = 0.01). Soft palate incompetence and tracheal bronchus were more frequent in DS (12% vs. 3.3%, p = 0.024, 8% vs. 0.7%, p = 0.02, respectively). Complications were more frequent in DS (22% vs. 9.3%, incidence rate ratio [IRR] 2.36, p = 0.028). In DS, cardiac anomalies (IRR 3.96, p < 0.01), pulmonary hypertension (IRR 3.76, p = 0.006), and pediatric intensive care unit (PICU) hospitalization before the procedure (IRR 4.2, p < 0.001) were associated with higher complication rates. In a multivariate regression model, history of cardiac disease and PICU hospitalization before the procedure, but not DS, were independent risk factors for complications with an IRR of 4 and 3.1, respectively (p = 0.006, p = 0.05). Conclusion: DS pediatric patients undergoing FB are a unique population with specific indications and findings. DS pediatric patients with cardiac anomalies and pulmonary hypertension are at the highest risk for complications.

Original languageEnglish
Pages (from-to)1658-1664
Number of pages7
JournalPediatric Pulmonology
Issue number6
StatePublished - 1 Jun 2023


  • Down syndrome
  • Trisomy 21
  • children
  • flexible bronchoscopy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Pediatrics, Perinatology, and Child Health


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