Utilization of medical care among children with Down's syndrome.

BACKGROUND: The present authors have previously found an increased mortality rate in children with Down's syndrome (DS) and a congenital heart defect (CHD). The aim of the present study was to investigate the utilization of medical care in relation to congenital malformations in DS.
METHOD: Retrospectively, 211 children with DS born between 1973 and 1980 in the northern part of Sweden were followed up for at least 17 years (1973-1997). The duration of neonatal care was compared with that of children with DS born between 1995 and 1998 in the same region.
RESULTS: Neonatal care was reduced over time. Almost 50% of the children had CHD, and before 10 years of age, these subjects were admitted for inpatient care twice as often as children with DS who did not have malformations, and had more than 12 times as many inpatient days per month. The existence of a gastrointestinal or other malformation increased inpatient days per month four and two times, respectively, compared to healthy children with DS. During the first 10 years of life, children with DS and a CHD accounted for 71% of all inpatient days caused by infections. No gender differences were observed.
CONCLUSIONS: At a group level, the presence of a CHD was the most important congenital abnormality in determining utilization of medical care and the burden of infections in the population of children with DS.