P198 Management of Children with Down Syndrome

Down Syndrome is a chromosomal anomaly that occurs in one in every 546 live births in Ireland.1 Children with Down Syndrome require surveillance and support as they may have complex needs, including cognitive impairment, audiological issues, obstructive sleep apnoea, ophthalmic disease, cardiac defects, neurologic dysfunction, gastrointestinal disease, hip dislocation, thyroid disease, and haematological disorders.2 We reviewed the management of children with Down Syndrome attending the Mullingar, Co Westmeath Early Intervention Clinic in March 2017. Patients’ charts and investigations were reviewed to determine if management was consistent with national guidelines.3 We also reviewed management in the context of the more extensive American Academy of Pediatrics Guidelines. There were 10 patients (4 males and 6 females) attending the Early Intervention Team ranging from 3 months to 5 years of age. Eight patients were diagnosed with Down Syndrome postnatally, one was diagnosed antenatally, and one was unspecified. We identified four main areas where we were not meeting the national guidelines. First, 20% of children waited over 6 months for an echocardiogram, and 80% of children never had an electrocardiogram performed. Second, dental advice or infective endocarditis advice was not documented at any visit. Third, there was a delay in referral for ophthalmology assessment for two patients at their 18 – 24 months visit. Fourth, referrals to audiology services were variable and delayed up to 3 years of age. Lastly, the AAP advise a more comprehensive assessment of children at their routine appointments.4 While half of patients had a coeliac screen organised, patients rarely had an FBC, CRP, or ferritin performed. Vaccinations, including RSV prophylaxis and influenza vaccine, were discussed with two patients. Families were not given c-spine advice, or asked about neurological dysfunction or obstructive sleep apnoea. Our local practice would be improved with dentition review, and early referrals to and reviews by cardiology, ophthalmology, and audiology. We would suggest the introduction of a clinical template to guide appointments, and a review of the AAP guidelines, with a view to consider including their recommendations into Irish practice. References Irish Health. http://www.irishhealth.com/article.html?con=64. 2006. Bull MJ, and the Committee on Genetics. Clinical Report—Health Supervision of Children With Down Syndrome. American Academy of Pediatrics. PediatricsVolume 128 (2): 393–406, 2011. Down Syndrome Ireland. Suggested Schedule of Health Checks. https://downsyndrome.ie/wp-content/uploads/2017/01/Medical-Management-Guidelines-Suggested-Schedule-of-Health-Checks.pdf. 2017. Voigt RG, Macias MM, and Myers SM. AAP Developmental and Behavioural Paediatrics. American Academy of Pediatrics, 2011.