A 2 Years Child Bronchopneumonia with Down Syndrome

Introduction: Pneumonia and respiratory infections impact infants and children with Down syndrome; pneumonia is a leading cause of mortality in adults with Down syndrome. Case Presentation: A 2 years old child came to AVBRH hospital with a history of fever, cough and cold for 6 days. The patient was admitted to the pediatric ward for management. Suddenly patient started to breathlessness, increase in serum creatinine and acidotic breathing. The patient shifted to the pediatric intensive care unit. Intervention: The treatment of patients was started immediately after admission. The patient's condition was dull after the examination and patient condition inspection doctors decide to intubate the patient for further management and recovery of the patient. Conclusion: In this report, we mainly focus on expert medical management and excellent nursing care helped in managing the complicated case very nicely. The patient response was positive to conservative and nursing management. The patient was discharged without postoperative complications and satisfactory with recovery. Case Study Yelne et al.; JPRI, 33(57B): 174-177, 2021; Article no.JPRI.76809 175


INTRODUCTION
Pneumonia and respiratory infections are an important consideration inindividuals with Down syndrome (DS) at the beginning and the end oflife. Early in life, infants with DS are at an increased risk for dysphagiaand silent aspiration, both of which are risk factors for and can present pneumonia [1]. In the first year of age, pneumoniais associated with dysphagia in children with DS [2]. Down syndrome, also known as trisomy 21, is a genetic condition (abnormality in the human genome) present from conception, caused by the presence of an extra 21 chromosome¹, resulting in a total of 47 chromosomes instead of 46. In the world, 1 in 800 children is born with this syndrome. The total number of people affected globally is estimated at around 40-50 million [3].
A child with Down syndrome suffers from hypotonia, excessive joint flexibility, an increased risk for obesity, short limbs, and neurological and language development delays. Approximately 40-50% of children with Down syndrome present congenital heart defects. Individually tailored physiotherapy and psychotherapy are needed to address the problems faced by children with Down syndrome [3].
To support appropriate neurological development, physical therapy plays an important role from the first months of life. Starting physiotherapy as early as possible will determine a larger degree of independence in the future. Besides acquiring a degree of independence in children with Down syndrome, kinetic physiotherapy also aims to prevent and correct the associated disabilities [3].

Patient Information
A 2 years old child came to AVBRH hospital with a history of fever, cough and cold for 6 days. A narrated by a maternal uncle, the patient was alright before 6 days when they noticed the patient had fever with a high grade not associated with chills and rigors. The patient also had complaints of cough and cold associated with breathlessness. He was then taken to a private practitioner where he was admitted for 3 days and was later referred to AVBRH for further management. In AVBRH patient was admitted to pediatric war for management. Suddenly patient started to breathlessness, increase in serum creatinine andacidotic breathing. The patient shifted to the pediatric intensive care unit. The patient heart rate was 140/min, respiration 74/min and saturation 90%. Patient intubated with endotracheal tube no. 5 and fixed at 14cm after checking bilateral air entry. Post intubation vital is heart rate 130/min and saturation 100%. Undergone through physical examination, pathological investigation and radiological findings patient was diagnosed with bronchopneumonia with down syndrome. After 6 days, the extubated trial was given to the patient and the patient was extubated successfully. After being extubated patient was maintaining a vital sign on room air but after 2 days in the morning patient saturation suddenly down up to 70% of saturation continuously nebulization was given to the patient but saturation is not maintained after that repeat intubation was done on endotracheal tube no.4.5 and fixed at 13 cm after checking bilateral air entry. Patient on pressure-regulated volume control (PRVC) mode.

Clinical Finding
On physical examination, the patient's inspection was respiratory distress with nasal flaring, subcostal retraction, mongoloid facies are present.
On auscultation, the patient heart sound was a murmur, with rapid breathing and heart rate was an increase.
On neurological examination, the patient was conscious but irritable.

DISCUSSION
Down's syndrome is the most common chromosomal abnormality associated with several other phenotypes including learning disability, heart problems, leukemia in childhood as well as Alzheimer's disease [4]. The development of the Downs syndrome brain is associated with a reduction in neuronal number and abnormal neuronal differentiation. It has been previously reported that Down's syndrome neuron degenerates subsequently and undergo apoptosis. However, Busciglio J et al, reported that degeneration of these neurons can be prevented by treating them with free radical scavengers [5].
Bronchopneumonia is a type of pneumonia that causes inflammation in the alveoli. Someone with bronchopneumonia may have trouble breathing because their airways are constricted. Due to inflammation, their lungs may not get enough air. Symptoms of bronchopneumonia can be mild or severe [6].
Bronchopneumonia is a type of pneumonia, a condition that causes inflammation of the lungs. Symptoms can range from mild to severe and may include coughing, breathing difficulties, and fever. Causes include bacterial, viral, or fungal chest infections [7].

CONCLUSION
Pneumonia and respiratory infections are more prevalent and more severe in individuals with DS. Pneumonia is the leading cause of deathin DS. Given the possible complexity of the disease, this case study intends to raise disease awareness, highlight various therapies, and promote consultation with a doctor.

CONSENT
While preparing case reports for publication patient's informed consent has been taken from his guardian.

ETHICAL APPROVAL
It is not applicable.