A cross sectional study on the prevalence and associated risk factors of pulmonary arterial hypertension in children with Down’s Syndrome at Kenyatta National Hospital

Abstract

Background: Pulmonary arterial hypertension is a significant cause of morbidity and mortality and is associated with several risk factors  in children with Down’s syndrome.

Objectives: To determine the prevalence and associated risk factors of pulmonary arterial hypertension in children with Down’s  syndrome aged 0- 12 years seen at Kenyatta National Hospital.

Methods: This was a cross-sectional study done over a 3-month period at KNH paediatric wards and outpatient clinics. Children with  Down’s syndrome aged 0-12 years were recruited into the study. Echocardiography was done on all children to assess for pulmonary  arterial hypertension and congenital heart defects. Questionnaires and X-rays were used to assess for other risk factors such as adenoid  hypertrophy, reflux and lung disease.

Results: 81 children with Down’s were enrolled in the study. The prevalence of pulmonary arterial hypertension in these children was  32.1% with 95% CI (21.0- 42.0). The prevalence of congenital heart defects was 59.3%, adenoid hypertrophy: 33.3 %, pulmonary  manifestations: 35.8 % and reflux disease 9.9%. The risk factors with significant association with PAH were female sex OR= 3.3 with 95% CI  (1.1-10.2) and congenital heart disease OR 8.3 with 95% CI (1.9-35.8). In univariate analysis lung disease and upper airway obstruction  were not associated with PAH.

Conclusion and Recommendations: The prevalence of pulmonary arterial hypertension in children with  Down’s syndrome was 32% and was significantly associated with female gender and CHD. Early screening for pulmonary arterial hypertension and congenital heart defects is recommended in all children with Down’s syndrome.