Das Down-Syndrom als Risikofaktor für einen komplizierten Verlauf bei RSV-Infektion

Zusammenfassung

Kinder mit Down-Syndrom haben einen nicht abschließend charakterisierten humoralen und zellulären Immundefekt mit unterschiedlicher klinischer Ausprägung, der in den ersten Lebensjahren das Risiko von Atemwegsinfektionen deutlich erhöht. Einige Publikationen beschreiben das Down-Syndrom (auch ohne Frühgeburtlichkeit oder einen hämodynamisch relevanten angeborenen Herzfehler) als unabhängigen Risikofaktor für einen komplizierten Verlauf der RSV-Infektion. Dieser Beitrag stellt die aktuell verfügbaren Informationen aus der Literatur zusammen, die nahelegen, dass Kinder mit Down-Syndrom wahrscheinlich im ersten Lebensjahr von einer Prophylaxe mit Palivizumab profitieren. Die Zahl der für eine randomisierte Prüfung dieser Fragestellung erforderlichen Probanden überstiege die Zahl der in Deutschland pro Jahr geborenen Kinder mit Down-Syndrom (ein Dilemma für Mediziner, die Kinder mit seltenen Erkrankungen oder angeborenen Syndromen behandeln).

Summary

Children with Down syndrome are affected by both humoral and cellular immunodeficiency, which has not been characterized in detail to date. Infants with Down syndrome face an increased risk of respiratory tract infections. Recent studies describe Down syndrome (even without hemodynamically significant congenital heart disease or prematurity) as an independent risk factor for a complicated clinical course in RSV infected children. This article comprises the available information on this topic and comes to the conclusion that palivizumab prophylaxis would probably be beneficial in infants with Down syndrome. A randomized controlled study investigating this issue would have to include a number of infants greater than the yearly birth cohort with Down syndrome in Germany; this is a common ethical dilemma for physicians involved in the treatment of children with rare diseases or genetic syndromes.

Schlüsselwörter

Down-Syndrom - Respiratory Syncytial Virus - Palivizumab-Prophylaxe

Keywords

Down syndrome - Respiratory Syncytial Virus - palivizumab prophylaxis

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