DS children had significantly higher rates of medical complications like pneumionia(36.9% DS vs. 11.1% controls) , ARDS(32.8% DS vs. 1.9% controls) and acute renal failure(17.3% DS vs. 2.9% controls) DS patinets are more put on mechanical ventilation (24.8% DS vs. 5.8% controls). Mortality rate is significantly higher in patients with DS(5.0% DS vs. 0.5% controls) but all deaths occurred among children from low- middle-income contry.