Background: Diagnosis and treatment of obstructive sleep apnea (OSA) in infants and young children is challenging because of its clinical heterogeneity and lack of age-specific guidelines. Aim: We report the management and treatment outcome of OSA in children below two years of age. Treatment decisions were based upon the pattern of upper airway (UA) obstruction, clinical presentation and OSA severity. Methods: Retrospective, non-randomized observational cohort study at a tertiary center. Children with OSA who underwent an UA evaluation (drug-induced sleep endoscopy or direct laryngoscopy) were included. Results: The study population comprised 100 patients, 57 boys and 43 girls, with a median age of 0.72 years (range 0.0-2.0) and OSA confirmed by polysomnography. Multilevel UA collapse was present in 26%, (adeno)tonsillar hypertrophy in 31% and 21% had laryngomalacia. Laryngomalacia was more common in children below six months of age and adenotonsillar hypertrophy was observed mainly in children older than 1.5 year of age. Treatment improved OSA severity in the entire study population with a significant reduction in obstructive apnea/hypopnea index from 10.8/h (range 2.1-99.1) to 1.7/h (range 0.0-73.0) (p<0.001), an improvement in mean oxygen saturation from 96.9% (range 88.9-98.4) to 97.4% (range 92.3-99.0) (p<0.001) and in minimal oxygen saturation from 85.4% (range 37.0-96.0) to 88.8% (range 51.0-95.5) (p<0.001). Conclusion: Multidisciplinary management of young children with OSA guided by the pattern of UA obstruction and OSA severity, results in favorable treatment outcomes. The pattern of UA obstruction changes in the first two years of life from a dynamic collapse to structural abnormalities.

As we know life expectancy in CP can improve by both preventive measurements as initiation of early therapy concerning respiratory morbidity. The prevalence of PA in this prospective study of children with CP is low, gram-negative bacteria were most commonly found. Therefore, it is recommended to repeat and expand this study since the prevalence of respiratory tract infections is again increasing in the post-covid era.

Introduction: Children with Down syndrome (DS) often present with chronic or recurrent respiratory symptoms. This can be caused by anatomical and/or immunological predisposition. With this study, we aim to evaluate the differences in microbiota in the lower airways of patients with DS versus controls. Methods: All endoscopic procedures under general anesthesia in patients with DS were reviewed retrospectively. We compared the microbiological data from BAL samples (when available) to a cohort of children with chronic respiratory symptoms but without any other relevant medical history. Results: Endoscopic data were available for 65 DS patients, microbiological data for 47 out of 65 patients (72%). The control group consisted of 150 children without significant underlying disease, who were matched for age and sex. Microbiological data were available for 135 out of 150 patients (90%). Microorganisms were categorized and compared in both groups, with no statistical differences. Mostly present were typical bacteria such as H. influenzae, Moraxella catarrhalis, Streptococci and Staphylococci. Conclusion: There were no significant differences in presence of pathogens in the lower airways of children with DS and chronic respiratory symptoms, compared to controls with similar symptomatology.