Hospital admissions in infants with Down syndrome: a record-linked population-based cohort study in Wales

Regine Angela Esperanza, Annette Evans, David Tucker, Shantini Paranjothy, Lisa Hurt* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Despite recent advances, mortality in children with Down syndrome remains times higher than in the general population. This study aims to describe the burden, patterns and causes of hospital admissions in infants with Down syndrome, and compare this with children without Down Syndrome in a population-based cohort.

Methods: This study used data from the Wales Electronic Cohort for Children, a cohort of all children born in Wales between 1990 and 2012. The cohort was generated from routine administrative data, linked to create an anonymised dataset within the Secure Anonymised Information Linkage databank. This analysis is based on all infants born between January 2003 and January 2012 who were followed to their first birthday, a move out of Wales, death, or until October 31st 24 2012 (end of follow-up). Infants with Down syndrome were
identified using the Congenital Anomaly Register and Information Service in Wales.
Multivariable Cox regression was used to compare the time to first hospital admission. Admission codes were used to identify the commonest indications for hospitalisation and to determine the presence of other congenital anomalies.

Results: We included 324,060 children, 356 of whom had Down syndrome. 80.3% of infants with Down syndrome had at least 1 hospital inpatient admission during the first year of life, compared with 32.9% of infants without Down syndrome. These first admissions were earlier (median of 6 days (IQR 3, 72) compared with 45 days (IQR 6, 166)) and longer (median of 4 days (IQR 1, 15) compared with 1 day (IQR 0, 3)) than in infants without Down syndrome. The most common causes of admissions were congenital abnormalities, respiratory diseases, conditions originating in the perinatal period and infectious diseases.
The presence of other congenital abnormalities increased hospitalisations in all infants, but more so in infants with Down Syndrome who spent a median of 21 days in hospital (IQR 11, 47) during their first year of life.

Conclusion: Infants with Down syndrome are at high risk for early, more frequent and longer hospital admissions. Congenital heart disease and respiratory infections remain a major burden in this population. More research is needed to understand how to better manage these conditions particularly in the first month of life when most admissions occur.
Original languageEnglish
Pages (from-to)225-239
Number of pages15
JournalJournal of Intellectual Disability Research
Issue number3
Early online date3 Dec 2021
Publication statusPublished - Mar 2022


  • Down syndrome
  • infants
  • children
  • hospitalisation
  • co-morbidity


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