These changes, increased GM-CSF and EPO but decreased VEGF, were found in a previous study also in children with DS aged between 1 and 15 years.34 A most recent study demonstrated that children with DS and CHD requiring surgery exhibit significantly greater levels of all Epo, VEGF, and GM-CSF than in children with DS/CHD not requiring surgery and with DS who had a normal heart.23 However, the infants with DS/CHD in Huggard’s study were >6 weeks post-operative when sampled this may account for the differences in findings. Here, EPO is linked to coronary artery disorder.