Aspiration pneumonitis and aspiration pneumonia in neurologically impaired children

Respiratory problems contribute significantly to the overall morbidity and mortality in neurologically impaired children.1-3 Plioplys3 studied severely disabled children living in institution in United States and found that 77% of deaths were result of pneumonia. Aspiration, either from secretions/food in the pharynx or from reflux of gastric contents, is a very common phenomenon in this group of children.1,4 The true prevalence of aspiration pneumonia is difficult to determine because of the vague definitions and varying levels of clinical recognition. Although aspiration syndrome is very common, there remain many pitfalls in its management, including failure to distinguish aspiration pneumonitis from aspiration pneumonia, failure to recognise the spectrum of pathogens, and the misconception that aspiration must be witnessed. A physician survey in a university medical centre5 found out that there is divergent approach to the treatment of cases of aspiration with empirical antibiotics frequently initiated to treat noninfectious stages of aspiration. This article will review on the pathophysiology, clinical features and management of aspiration pneumonitis and aspiration pneumonia, with special emphasis on aspects related to neurologically impaired children.