Objective: Airway lesions are an important complication in Down syndrome because airway lesions exacerbate respiratory infection, which is one of the top causes of death in Down syndrome. The purpose of this study was to investigate the features of airway lesions in Down syndrome.

Methods: We retrospectively reviewed 20 patients with Down syndrome who were admitted to our neonatal intensive care unit. The median gestational age (GA) was 38.0 weeks, and the median birth body weight (BBW) was 2,879 g. We performed laryngo-tracheo-broncho fiberscopy (BF) in cases involving suspected findings of airway lesions such as stridor, depression in the oxygen saturation, suckling disorder, and suspicious image findings. We investigated the groups with and without airway lesions.

Results: Six cases (30%) involved complications of airway lesions. Five patients required mechanical ventilation, and the median length of mechanical ventilation was 87 days. On comparison of the 2 groups, there were no significant differences in GA, BBW, presence of hypotonia, and complication of congenital heart disease. Significant differences were found in the presence of suspected findings of airway lesions, length of hospital stay, and the need for surgical operation for congenital heart disease.

Conclusion: The complication rate of airway lesions in Down syndrome is high, and most patients require long durations of mechanical ventilation. It is important that patients with suspected findings of airway lesions or severe congenital heart disease should undergo BF for early diagnosis.

We report the clinical course of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in two Japanese teenagers.

Patient 1: :A 17-year-old girl complained of a fever, sore throat, and back pain for 2 days. A nasopharyngeal swab polymerase chain reaction (PCR) test for SARS-CoV-2 revealed positivity on the 17th day after the onset of symptoms. There was no remarkable change in complete blood count (CBC) and biochemical data. The virus tested negative on day 23. Patient 2: A 14-year-old girl, the sister of patient 1, complained of cough alone, and a nasopharyngeal swab PCR test revealed positivity for SARS-CoV-2 on the first day of the onset of symptoms. Her symptoms improved 3 days later. There were no remarkable changes in CBC and biochemical data on a blood test or findings of chest X-ray screening. The virus tested negative on day 10.

Both patients exhibited mild symptoms for only a few days. Neither of the patients developed severe pneumonia or acute respiratory distress syndrome. However, it took 23 days for patient 1 and 10 days for patient 2 from the onset of the first symptoms for the virus to test negative on nasopharyngeal swab PCR testing. These cases indicate that patients with mild symptoms may spread the SARS-CoV-2 for the same duration as that of symptomatic patients. Hence, infection control among asymptomatic patients is very important to avoid human-to-human transmission in families or communities.