Palivizumab for children with Down syndrome: is the time right for a universal recommendation?
Bibliographic record
Abstract
Children with Down syndrome (DS) are at increased risk for serious lower respiratory tract infections (LRTI) that are associated with significant morbidity and mortality as a result of structural variants, abnormalities both in numbers and function of innate and adaptive immunity, alveolar and pulmonary hypoplasia and congenital malformations.1–3Compared with any other birth defects in children less than 2 years, children with DS have the highest incidence rate ratio for any LRTI, bronchiolitis or pneumonia (8.0, 5.4 and 13.6) respectively.4 They also sustain more severe acute lung injury (58% vs 13%) and acute respiratory distress syndrome when admitted to intensive care (46% vs 7%) compared with children without DS.5 In the Danish database involving >450 000 subjects, of which 118 received palivizumab, the incident rate ratio for the risk of respiratory syncytial virus (RSV) hospitalisation (RSVH) and the geometric mean ratio for the duration of hospital stay in children with DS was 3.43 and 1.91, respectively, compared with children with bronchopulmonary dysplasia (2.58 and 1.36) and congenital heart disease (CHD; 1.70 and 1.25).6 LRTI and CHD remain the most important causes of mortality in children with DS of all ages. Overall, the neonatal and infant mortality in children with DS in the Netherlands is fivefold (1.65% vs 0.36%) and eightfold higher (4% vs 0.48%) than children without DS,1 while infant mortality in Chile related to DS, relative to the population without DS, is steadily rising, with an annual percentage change of 4.6%.7 Since the first report by Bloemers et al 8 on the risk of RSVH in children with DS, both with and without underlying CHD, the number of publications supporting the same findings have steadily increased. Huggard and Molloy,9 in a recent article, systematically confirmed that DS is an …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.026 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.008 | 0.010 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".