The child with trisomy 21 is at risk for other abnormalities and complications. The most common is congenital heart disease, typically a VSD although endocardial cushion defects are also common in Down syndrome. Cardiac defects require SBE prophylaxis for dental work or other invasive procedures. An echocardiogram is recommended for all infants with Down syndrome. The presence of Down syndrome per se does not adversely affect the outcome of surgery in the absence of pulmonary hypertension.
Hypotonia can lead to poor suck as well as constipation.
Genitourinary involvement can include renal malformations, hypospadias, micropenis and undescended testes. Neonatal leukemoid reactions are common. Children should be referred for an ophthalmologic examination by 9 months of age. Therefore, all children should have formal audiograms by 6 months of age and hearing should be monitored at each office visit. In addition to otitis media, there is also a higher incidence of sinusitis and obstructive sleep apnea.