{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:25:05Z","timestamp":1792200305890,"version":"4.4.0"},"reference-count":84,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2011,2,24]],"date-time":"2011-02-24T00:00:00Z","timestamp":1298505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,3,10]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Down syndrome (DS) is the most common genetic disease and presents with cognitive impairment, cardiac and gastrointestinal abnormalities, in addition to other miscellaneous clinical conditions. DS individuals may have a high frequency of infections, usually of the upper respiratory tract, characterized by increased severity and prolonged course of disease, which are partially attributed to defects of the immune system. The abnormalities of the immune system associated with DS include: mild to moderate T and B cell lymphopenia, with marked decrease of naive lymphocytes, impaired mitogen-induced T cell proliferation, reduced specific antibody responses to immunizations and defects of neutrophil chemotaxis. Limited evidence of genetic abnormalities secondary to trisomy of chromosome 21 and affecting the immune system is available, such as the potential consequences of gene over-expression, most significantly SOD1 and RCAN1. Secondary immunodeficiency due to metabolic or nutritional factors in DS, particularly zinc deficiency, has been postulated. Non-immunological factors, including abnormal anatomical structures (e.g. small ear canal, tracheomalacia) and gastro-oesophageal reflux, may play a role in the increased frequency of respiratory tract infections. The molecular mechanisms leading to the immune defects observed in DS individuals and the contribution of these immunological abnormalities to the increased risk of infections require further investigation. Addressing immunological and non-immunological factors involved in the pathogenesis of infectious diseases may reduce the susceptibility to infections in DS subjects.<\/jats:p>","DOI":"10.1111\/j.1365-2249.2011.04335.x","type":"journal-article","created":{"date-parts":[[2011,2,26]],"date-time":"2011-02-26T09:14:16Z","timestamp":1298711656000},"page":"9-16","source":"Crossref","is-referenced-by-count":388,"title":["Infections and immunodeficiency in Down syndrome"],"prefix":"10.1093","volume":"164","author":[{"given":"G","family":"Ram","sequence":"first","affiliation":[{"name":"Allergy and Immunology Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital. Houston, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Chinen","sequence":"additional","affiliation":[{"name":"Allergy and Immunology Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital. Houston, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2011,2,24]]},"reference":[{"key":"2021122708475358200_b1","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/S0140-6736(02)08092-3","article-title":"Mortality associated with Down's syndrome in the USA from 1983 to 1997: a population-based study","volume":"359","author":"Yang","year":"2002","journal-title":"Lancet"},{"key":"2021122708475358200_b2","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/bdra.20294","article-title":"National estimates and race\/ethnic-specific variation of selected birth defects in the United States, 1990\u20132001","volume":"76","author":"Canfield","year":"2006","journal-title":"Birth Defects Res A Clin Mol Teratol"},{"key":"2021122708475358200_b3","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1542\/peds.2006-1136","article-title":"Comorbidity, hospitalization, and medication use and their influence on mental and motor development of young infants with Down syndrome","volume":"118","author":"van Trotsenburg","year":"2006","journal-title":"Pediatrics"},{"key":"2021122708475358200_b4","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/00005176-200009000-00014","article-title":"Prevalence of celiac disease in Down syndrome in the United States","volume":"31","author":"Zachor","year":"2000","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2021122708475358200_b5","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s00431-002-1078-6","article-title":"How frequent is celiac disease in Down syndrome","volume":"161","author":"Sanchez-Albisua","year":"2002","journal-title":"Eur J Pediatr"},{"key":"2021122708475358200_b6","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1136\/adc.2003.046219","article-title":"Cancers and immune related diseases associated with Down Syndrome: a record linkage study","volume":"89","author":"Goldacre","year":"2004","journal-title":"Arch Dis Child"},{"key":"2021122708475358200_b7","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.1365-2214.1990.tb00641.x","article-title":"Health problems in children with Down's syndrome","volume":"16","author":"Turner","year":"1990","journal-title":"Child Care Health Dev"},{"key":"2021122708475358200_b8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1440-1754.1992.tb02697.x","article-title":"Health problems and health checks in school-aged children with Down syndrome","volume":"28","author":"Selikowitz","year":"1992","journal-title":"J Pediatr Child Health"},{"key":"2021122708475358200_b9","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/eji.1830050904","article-title":"Derangements of immunoglobulin levels, phytohemagglutinin responsiveness and T and B cell markers in Down's syndrome at different ages","volume":"5","author":"Burgio","year":"1975","journal-title":"Eur J Immunol"},{"key":"2021122708475358200_b10","first-page":"298","article-title":"Immunodeficiency in Down's syndrome: T lymphocyte subset imbalance in trisomic children","volume":"33","author":"Burgio","year":"1978","journal-title":"Clin Exp Immunol"},{"key":"2021122708475358200_b11","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S1081-1206(10)60516-9","article-title":"Follow up study of immune defects in patients with dysmorphic disorders","volume":"102","author":"Cruz","year":"2009","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2021122708475358200_b12","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1046\/j.1440-1754.1999.00386.x","article-title":"Respiratory morbidity of hospitalized children with trisomy 21","volume":"35","author":"Hilton","year":"1999","journal-title":"J Pediatr Child Health"},{"key":"2021122708475358200_b13","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1542\/peds.2007-0788","article-title":"Down syndrome: a novel risk factor for respiratory syncytial virus bronchiolitis \u2013 a prospective birth-cohort study","volume":"120","author":"Bloemers","year":"2007","journal-title":"Pediatrics"},{"key":"2021122708475358200_b14","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/INF.0b013e3181b34e52","article-title":"High incidence of recurrent wheeze in children with Down syndrome with and without previous respiratory syncytial virus lower respiratory tract infection","volume":"29","author":"Bloemers","year":"2010","journal-title":"Pedatric Inf Dis J"},{"key":"2021122708475358200_b15","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/INF.0b013e3181d7ffa5","article-title":"Down syndrome and respiratory sincytial virus infection","volume":"29","author":"Megged","year":"2010","journal-title":"Pediatr Infect Dis"},{"key":"2021122708475358200_b16","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1097\/01.inf.0000136871.51792.19","article-title":"Changes in frequency and pathogens causing acute otitis media in 1995\u20132003","volume":"23","author":"Casey","year":"2004","journal-title":"Pediatr Infect Dis J"},{"key":"2021122708475358200_b17","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1111\/j.1651-2227.2010.01924.x","article-title":"Community-acquired pneumonia in children: what's old? What's new?","volume":"99","author":"Don","year":"2010","journal-title":"Acta Paediatr"},{"key":"2021122708475358200_b18","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1007\/s00134-007-0803-z","article-title":"High incidence of acute lung injury in children with Down syndrome","volume":"33","author":"Bruijn","year":"2007","journal-title":"Intens Care Med"},{"key":"2021122708475358200_b19","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/S0891-5849(98)00137-3","article-title":"Biomarkers of oxidative stress are significantly elevated in Down syndrome","volume":"25","author":"Jovanovic","year":"1998","journal-title":"Free Radic Biol Med"},{"key":"2021122708475358200_b20","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1001\/archinte.163.6.705","article-title":"Mortality and cancer incidence among individuals with Down syndrome","volume":"163","author":"Hill","year":"2003","journal-title":"Arch Intern Med"},{"key":"2021122708475358200_b21","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.jpeds.2005.06.032","article-title":"Risk of death for children with Down syndrome and sepsis","volume":"147","author":"Garrison","year":"2005","journal-title":"J Pediatr"},{"key":"2021122708475358200_b22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1111\/j.1754-4505.2007.tb00346.x","article-title":"Why is periodontal disease more prevalent and more severe in people with Down syndrome?","volume":"27","author":"Morgan","year":"2007","journal-title":"Spec Care Dentist"},{"key":"2021122708475358200_b23","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1365-2249.2009.03890.x","article-title":"Intrinsic defect of the immune system in children with Down syndrome: a review","volume":"156","author":"Kusters","year":"2009","journal-title":"Clin Exp Immunol"},{"key":"2021122708475358200_b24","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.jpeds.2005.07.022","article-title":"Intrinsic abnormalities of lymphocyte counts in children with Down syndrome","volume":"147","author":"de Hingh","year":"2005","journal-title":"J Pediatr"},{"key":"2021122708475358200_b25","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1111\/j.1651-2227.2007.00459.x","article-title":"Immunological patterns in young children with Down syndrome: is there a temporal trend?","volume":"96","author":"Cocchi","year":"2007","journal-title":"Acta Paediatr"},{"key":"2021122708475358200_b26","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/0090-1229(90)90131-9","article-title":"Down syndrome (trisomy 21) thymuses have a decreased proportion of cells expressing high levels of TCR alpha, beta and CD3","volume":"55","author":"Murphy","year":"1990","journal-title":"Clin Immunol Immunopathol"},{"key":"2021122708475358200_b27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/0090-1229(92)90079-4","article-title":"Down syndrome peripheral blood contains phenotypically mature CD3 TCR alpha beta cells but abnormal proportions of TCR gamma delta, TCR alpha beta and CD4+45RA+ cells: evidence for an inefficient release of mature T cells by DS thymus","volume":"62","author":"Murphy","year":"1992","journal-title":"Clin Immunol Immunopathol"},{"key":"2021122708475358200_b28","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1365-3083.1993.tb01733.x","article-title":"Imbalance of the CD4 subpopulations expressing CD45RA and CD29 antigens in the peripheral blood of adults and children with Down syndrome","volume":"38","author":"Barrena","year":"1993","journal-title":"Scand J Immunol"},{"key":"2021122708475358200_b29","first-page":"1","article-title":"Direct analysis of thymic function in children with Down syndrome","volume":"2","author":"Prada","year":"2005","journal-title":"Immun Aging"},{"key":"2021122708475358200_b30","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1203\/PDR.0b013e3181d4eca3","article-title":"Both normal memory counts and decreased na\u00efve cells favor intrinsic defect over early senescence of Down syndrome lymphocytes","volume":"67","author":"Kusters","year":"2010","journal-title":"Pediatr Res"},{"key":"2021122708475358200_b31","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1203\/PDR.0b013e3181d4ecc1","article-title":"Down syndrome B-lymphocyte populations, intrinsic defect or decreased T lymphocyte help","volume":"67","author":"Verstegen","year":"2010","journal-title":"Pediatr Res"},{"key":"2021122708475358200_b32","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1159\/000230384","article-title":"Impaired in vitro response of circulating lymphocytes to phytohemagglutinin in Down's syndrome: dose and time\u2013response curves and relation to cellular immunity","volume":"39","author":"Rigas","year":"1970","journal-title":"Int Allergy Immunol"},{"key":"2021122708475358200_b33","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1744-313X.2010.00914.x","article-title":"Analysis of peripheral blood T cell subset, natural killer cells and serum levels of cytokines in children with Down syndrome","volume":"37","author":"Cetiner","year":"2010","journal-title":"Int J Immunogenet"},{"key":"2021122708475358200_b34","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/00006454-199008000-00004","article-title":"Immunoglobulin G subclass deficiency and predisposition to infection in Down's syndrome","volume":"9","author":"Loh","year":"1990","journal-title":"Pediatr Infect Dis J"},{"key":"2021122708475358200_b35","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/0022-510X(93)90172-U","article-title":"Immunoglobulin G subclasses in older persons with Down syndrome","volume":"117","author":"Mehta","year":"1993","journal-title":"J Neurol Sci"},{"key":"2021122708475358200_b36","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.archoralbio.2007.06.002","article-title":"Age-dependent deficiency in saliva and salivary antibodies secretion in Down's syndrome","volume":"52","author":"Chaushu","year":"2007","journal-title":"Arch Oral Biol"},{"key":"2021122708475358200_b37","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0022-3476(75)80469-0","article-title":"Defective antibody response to bacteriophage phi 174 in Down syndrome","volume":"86","author":"Lopez","year":"1975","journal-title":"J Pediatr"},{"key":"2021122708475358200_b38","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1017\/S0022172400026978","article-title":"The response of institutionalized Down's syndrome subjects to enterovirus infections","volume":"84","author":"Hawkes","year":"1980","journal-title":"J Hyg"},{"key":"2021122708475358200_b39","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/BF00819505","article-title":"Safety and effectiveness of an acellular pertussis vaccine in subjects with Down's syndrome","volume":"12","author":"Li Volti","year":"1996","journal-title":"Child Nerv Syst"},{"key":"2021122708475358200_b40","first-page":"163","article-title":"Abnormalities in the immune response to influenza antigen in Down syndrome (trisomy 21)","volume":"246","author":"Epstein","year":"1987","journal-title":"Prog Clin Biol Res"},{"key":"2021122708475358200_b41","first-page":"231","article-title":"Humoral immunodeficiency in Down syndrome: serum IgG subclass and antibody response to hepatitis B vaccine","volume":"7","author":"Avanzini","year":"1990","journal-title":"Am J Med Genet"},{"key":"2021122708475358200_b42","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/00005176-200410000-00007","article-title":"Immunogenicity and safety of an inactivated hepatitis A vaccine in children with Down syndrome","volume":"39","author":"Ferreira","year":"2004","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2021122708475358200_b43","first-page":"485","article-title":"Antibody response to pneumococcal vaccine in patients with trisomy-21 (Down's syndrome)","volume":"48","author":"Nurmi","year":"1982","journal-title":"Clin Exp Immunol"},{"key":"2021122708475358200_b44","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1590\/S0100-879X2006001200010","article-title":"Antibody response to pneumococcal capsular polysaccharide vaccine in Down syndrome patients","volume":"39","author":"Costa-Carvalho","year":"2006","journal-title":"Braz J Med Biol Res"},{"key":"2021122708475358200_b45","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S0022-3476(75)80077-1","article-title":"Defective neutrophil chemotaxis in patients with Down syndrome","volume":"87","author":"Khan","year":"1975","journal-title":"J Pediatr"},{"key":"2021122708475358200_b46","first-page":"243","article-title":"Phagocytic function in Down syndrome \u2013 I. Chemotaxis","volume":"24","author":"Barkin","year":"1980","journal-title":"J Ment Defic Res"},{"key":"2021122708475358200_b47","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1203\/00006450-198304000-00013","article-title":"Defective monocyte chemotaxis in children with Down's syndrome","volume":"17","author":"Barroeta","year":"1983","journal-title":"Pediatr Res"},{"key":"2021122708475358200_b48","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/j.1399-0004.1976.tb01619.x","article-title":"White cell function in Down's syndrome","volume":"9","author":"Costello","year":"1976","journal-title":"Clin Genet"},{"key":"2021122708475358200_b49","first-page":"251","article-title":"Phagocytic function in Down syndrome \u2013 II. Bactericidal activity and phagocytosis","volume":"24","author":"Barkin","year":"1980","journal-title":"J Ment Defic Res"},{"key":"2021122708475358200_b50","first-page":"451","article-title":"Down's syndrome lymphoid cell lines exhibit increased adhesion due to the over-expression of lymphocyte function-associated antigen (LFA-1)","volume":"64","author":"Taylor","year":"1988","journal-title":"Immunology"},{"key":"2021122708475358200_b51","first-page":"169","article-title":"Monoclonal antibodies to CD18 and CD11a distinguish Down's syndrome (trisomy 21) from normal lymphoblastoid cells","volume":"7","author":"Robson","year":"1989","journal-title":"Dis Markers"},{"key":"2021122708475358200_b52","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1002\/ajmg.1320460408","article-title":"Nonspecific immunity in Down syndrome: a study of chemotaxis, phagocytosis, oxidative metabolism, and cell surface expression of polymorphonuclear cells","volume":"46","author":"Novo","year":"1983","journal-title":"Am J Med Genet"},{"key":"2021122708475358200_b53","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1365-2249.1992.tb03036.x","article-title":"Differential expression of lymphocyte function-associated antigen (LFA-1) on peripheral blood leucocytes from individuals with Down's syndrome","volume":"88","author":"Barrena","year":"1992","journal-title":"Clin Exp Immunol"},{"key":"2021122708475358200_b54","first-page":"563","article-title":"Dosage effects for superoxide dismutase-1 in nucleated cells aneuploid for chromosome 21.Am","volume":"29","author":"Feaster","year":"1977","journal-title":"J Hum Genet"},{"key":"2021122708475358200_b55","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1182\/blood.V77.6.1263.1263","article-title":"Age-related expansion of functionally inefficient cells with markers of natural killer cells activity in Down's syndrome","volume":"77","author":"Cossarizza","year":"1991","journal-title":"Blood"},{"key":"2021122708475358200_b56","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1352\/2009.114.100-109","article-title":"T lymphocyte maturation is impaired in healthy young individuals carrying trisomy 21 (Down syndrome)","volume":"114","author":"Guazzarotti","year":"2009","journal-title":"Am J Intellect Dev Disabil"},{"key":"2021122708475358200_b57","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.humimm.2009.09.361","article-title":"Mannan-binding lectin deficiency increases the risk of recurrent infections in children with Down's syndrome","volume":"71","author":"Nisihara","year":"2010","journal-title":"Hum Immunol"},{"key":"2021122708475358200_b58","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1038\/nature04678","article-title":"NFAT dysregulation by increased dosage of DSCR1 and DYRK1A on chromosome 21","volume":"441","author":"Arron","year":"2006","journal-title":"Nature"},{"key":"2021122708475358200_b59","doi-asserted-by":"crossref","first-page":"39051","DOI":"10.1074\/jbc.M604659200","article-title":"Down syndrome candidate region 1 increases the stability of the IkappaBalpha protein: implications for its anti-inflammatory effects","volume":"281","author":"Kim","year":"2006","journal-title":"J Biol Chem"},{"key":"2021122708475358200_b60","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1749-6632.1982.tb26840.x","article-title":"Down syndrome, aging and Alzheimer's disease: a clinical review","volume":"396","author":"Lott","year":"1982","journal-title":"Ann NY Acad Sci"},{"key":"2021122708475358200_b61","first-page":"213","article-title":"Precocious aging of the immune system in Down syndrome: alteration of B-lymphocyte, T lymphocytes subsets, and cells with natural killer markers","volume":"7","author":"Cossariza","year":"1990","journal-title":"Am J Med Genet Suppl"},{"key":"2021122708475358200_b62","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1006\/clin.1996.0031","article-title":"Immune dysfunction in Down's syndrome: primary immune deficiency or early senescence of the immune system?","volume":"78","author":"Cuadrado","year":"1996","journal-title":"Clin Immunol Immunopathol"},{"key":"2021122708475358200_b63","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1365-2788.1994.tb00370.x","article-title":"Oral zinc supplementation in Down's syndrome subjects decreased infections and normalized some humoral and cellular immune parameters","volume":"38","author":"Licastro","year":"1994","journal-title":"J Intellect Disabil Res"},{"key":"2021122708475358200_b64","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/0090-1229(91)90137-Y","article-title":"Immunodeficiency and plasma zinc levels in children with Down's syndrome: a long-term follow-up of oral zinc supplementation","volume":"58","author":"Stabile","year":"1991","journal-title":"Clin Immunol Immunopathol"},{"key":"2021122708475358200_b65","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S0022-3476(89)80136-2","article-title":"Infection and immunity in Down syndrome: a trial of long-term low oral doses of zinc","volume":"114","author":"Lockitch","year":"1989","journal-title":"J Pediatr"},{"key":"2021122708475358200_b66","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S1081-1206(10)60082-8","article-title":"Prevalence of positive skin prick test results in children with Down syndrome: a case\u2013control study","volume":"102","author":"Mannan","year":"2009","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2021122708475358200_b67","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ppul.10332","article-title":"Airway anomalies in children with Down syndrome: endoscopic findings","volume":"36","author":"Bertrand","year":"2003","journal-title":"Pediatr Pulmonol"},{"key":"2021122708475358200_b68","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1056\/NEJM198211043071902","article-title":"Pulmonary hypoplasia in Down's syndrome","volume":"307","author":"Cooney","year":"1982","journal-title":"N Engl J Med"},{"key":"2021122708475358200_b69","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/0046-8177(91)90183-P","article-title":"Down syndrome: patterns of disturbed lung growth","volume":"22","author":"Schloo","year":"1991","journal-title":"Hum Pathol"},{"key":"2021122708475358200_b70","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1001\/archpedi.157.7.655","article-title":"Prospective polysomnographic analysis of obstructive sleep apnea in Down syndrome","volume":"257","author":"Dyken","year":"2003","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021122708475358200_b71","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1542\/peds.88.1.132","article-title":"Obstructive sleep apnea in children with Down syndrome","volume":"88","author":"Marcus","year":"1992","journal-title":"Pediatrics"},{"key":"2021122708475358200_b72","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1001\/archotol.1996.01890210025007","article-title":"Upper airway obstruction in children with Down syndrome","volume":"122","author":"Jacobs","year":"1996","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"2021122708475358200_b73","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1378\/chest.120.4.1190","article-title":"Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants","volume":"120","author":"Sheikh","year":"2001","journal-title":"Chest"},{"key":"2021122708475358200_b74","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/(SICI)1099-0496(199909)28:3<181::AID-PPUL4>3.0.CO;2-S","article-title":"Gastroesophageal reflux in infants with wheezing","volume":"28","author":"Sheikh","year":"1999","journal-title":"Pediatr Pulmonol"},{"key":"2021122708475358200_b75","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1017\/S0012162299000729","article-title":"Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability","volume":"41","author":"Morton","year":"1999","journal-title":"Dev Med Child Neurol"},{"key":"2021122708475358200_b76","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1469-8749.1996.tb12139.x","article-title":"Swallow function in children with Down syndrome: a retrospective study","volume":"38","author":"Frazier","year":"1996","journal-title":"Dev Med Child Neurol"},{"key":"2021122708475358200_b77","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/00008480-200204000-00015","article-title":"Persistent silent aspiration in a child with trisomy 21","volume":"14","author":"Brumbaugh","year":"2002","journal-title":"Curr Opin Pediatr"},{"key":"2021122708475358200_b78","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1002\/ppul.20687","article-title":"Oropharyngeal aspiration and pneumonia in children","volume":"42","author":"Weir","year":"2007","journal-title":"Pediatr Pulmonol"},{"key":"2021122708475358200_b79","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1111\/j.1572-0241.2001.03864.x","article-title":"Prospective evaluation of esophageal motor dysfunction in Down syndrome","volume":"96","author":"Zarate","year":"2001","journal-title":"Am J Gastroentrol"},{"key":"2021122708475358200_b80","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1469-8749.1996.tb12139.x","article-title":"Swallow function in children with Down syndrome: a retrospective study","volume":"38","author":"Frazier","year":"1996","journal-title":"Dev Med Child Neurol"},{"key":"2021122708475358200_b81","first-page":"1581","article-title":"Down syndrome \u2013 a modern otorhinolaryngological perspective","volume":"41","author":"Strome","year":"1982","journal-title":"Layngoscope"},{"key":"2021122708475358200_b82","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/ajmg.c.30095","article-title":"Down syndrome: common otolaryngoloic manifestations","volume":"142","author":"Shott","year":"2006","journal-title":"Am J Med Genet Part C Semin Med Genet"},{"key":"2021122708475358200_b83","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1177\/000348948909800709","article-title":"Congenital anomalies of the Eustachian tube in children with Down syndrome","volume":"98","author":"Shibahara","year":"1989","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2021122708475358200_b84","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1177\/019459987908700317","article-title":"Ossicular abnormalities in Down's syndrome","volume":"87","author":"Balkany","year":"1979","journal-title":"Otolaryngol Head Neck Surg"}],"container-title":["Clinical and Experimental Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-2249.2011.04335.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/cei\/article-pdf\/164\/1\/9\/41909648\/j.1365-2249.2011.04335.x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cei\/article-pdf\/164\/1\/9\/41909648\/j.1365-2249.2011.04335.x.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T11:23:16Z","timestamp":1641036196000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cei\/article\/164\/1\/9\/6428940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,2,24]]},"references-count":84,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2011,2,24]]},"published-print":{"date-parts":[[2011,3,10]]}},"URL":"https:\/\/doi.org\/10.1111\/j.1365-2249.2011.04335.x","relation":{},"ISSN":["0009-9104","1365-2249"],"issn-type":[{"value":"0009-9104","type":"print"},{"value":"1365-2249","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2011,4]]},"published":{"date-parts":[[2011,2,24]]}}}