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Akhtar RN, Behn N, Morgan S. Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice. Dysphagia 2024; 39:484-494. [PMID: 38006420 PMCID: PMC11127846 DOI: 10.1007/s00455-023-10633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/19/2023] [Indexed: 11/27/2023]
Abstract
Dysphagia affects individuals across all ages and has pervasive and potentially life-threatening consequences. Individuals with dysphagia are assessed and treated by speech and language therapists (SLTs), however, little attention has been paid to their practices in Pakistan. This study aimed to explore SLTs practices for dysphagia assessment, signs and symptoms observed during evaluation, and management strategies, alongside barriers and facilitators to service delivery in Pakistan. A 45-item survey was distributed to SLTs online. Responses were received from 101 participants and analyzed descriptively, and open-text responses were analyzed using content analysis. Results revealed that 65.3% SLTs worked across the lifespan, and most (79.4%) had dysphagia-related experience of five years or less. SLTs were an active workforce engaged with varying ages, disorders, and settings, yet dysphagia contributed to a small caseload percentage for most. Analyses found informal clinical exams were more frequently used than instrumental assessments. A variety of service provision facilitators were described, such as supportive teams and accessible resources, and responses about barriers revealed gaps in awareness, education, and guidance. This exploratory study presents novel and unexplored data which provides a deeper understanding of dysphagia-related care in Pakistan.
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Affiliation(s)
- Rohma N Akhtar
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK.
- City University of London, London, UK.
| | - Nicholas Behn
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
| | - Sally Morgan
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
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2
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Smith JB, Kamarunas E, O'Donoghue C. The Influence of Side-Lying Position on Oropharyngeal Swallow Function in At-Risk Infants: An Exploratory Study. Clin Pediatr (Phila) 2023; 62:1087-1100. [PMID: 36919839 DOI: 10.1177/00099228231159158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.
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Affiliation(s)
- Julian B Smith
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
- Speech-Language Pathology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
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3
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Jaffe N, Ball LJ, Evans S. Feeding and nutrition in the pediatric leukodystrophy patient. Curr Probl Pediatr Adolesc Health Care 2023; 53:101350. [PMID: 36609123 DOI: 10.1016/j.cppeds.2022.101350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Nicole Jaffe
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Laura J Ball
- Mississippi University for Women, Columbus, MS, USA
| | - Sally Evans
- Chief, Rehabilitation Medicine Children's Hospital of Philadelphia
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4
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Freitag N, Tews P, Hübl N, Krug K, Kristin J, Distelmaier F, Schramm D. Laryngeal sensation and its association with aspiration and cough in children with neurological impairment. Pediatr Pulmonol 2021; 56:3796-3801. [PMID: 34553847 DOI: 10.1002/ppul.25694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Aspirations are frequent in children with neurological impairment. They significantly increase the risk for acute and chronic respiratory insufficiencies leading to high morbidity and mortality. Laryngeal sensation deficits have been linked to aspirations in adults and are a suspected cause for dysphagia in children. In a similar neurological circuit as swallowing, laryngeal receptors trigger coughing as a protective airway reflex. The aim of this study was to examine the association between impaired laryngeal sensation (ILS), aspiration, and coughing in neurologically impaired children. DESIGN AND METHODS In a retrospective study, 110 children with suspected dysphagia underwent a clinical evaluation of swallowing and a flexible endoscopic evaluation of swallowing (FEES) between 2013 and 2019 in the children's university clinic Düsseldorf were analyzed. Laryngeal sensation was tested by the endoscopic touch method. Associations were computed using χ2 -test. RESULTS Fifty-four patients (49.1%) had a neurological impairment, 56 patients (50.9%) had no or other comorbidities and served as a control cohort. Children with neurological impairment suffered from ILS significantly more often than children with no or other comorbidities (χ²(1) = 4.63, p = .031). ILS was associated with all other FEES variables but did not correlate with coughing. The symptom coughing correlated with aspiration in the group of neurologically impaired children and in children ILS. CONCLUSION ILS is a potential cause of aspirations in children with neurological impairment. Physicians need to pay special attention to the occurrence of coughing in children with neurological impairment and/or ILS since it signals aspirations that took place.
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Affiliation(s)
- Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Pia Tews
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Katrin Krug
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Julia Kristin
- Department of Otorhinolaryngology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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5
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Reflux–Aspiration in Chronic Lung Disease. Ann Am Thorac Soc 2020; 17:1030. [PMID: 32437248 PMCID: PMC7393788 DOI: 10.1513/annalsats.202002-110le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Aerodigestive disorders, those affecting the upper and lower airway or upper gastrointestinal tract, are interrelated anatomically during fetal development and functionally after birth. Successful respiration and feeding requires careful coordination to promote effective swallowing and prevent aspiration. I describe the epidemiology, including the prevalence of the most common aerodigestive disorders. The ability of an infant to feed by mouth at discharge, without a surgically placed feeding tube, is an important neurodevelopmental marker. Therefore, aerodigestive disorders have a high potential for lifelong morbidities and health care expenditures. When available, published research on related medical costs for these disorders is provided.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, and St. Jude Children's Research Hospital, Memphis, TN
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8
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Chirteş IR, Mărginean CO, Gozar H, Georgescu AM, Meliţ LE. Lung Abscess Remains a Life-Threatening Condition in Pediatrics - A Case Report. J Crit Care Med (Targu Mures) 2018; 3:123-127. [PMID: 29967884 PMCID: PMC5769901 DOI: 10.1515/jccm-2017-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/25/2017] [Indexed: 12/04/2022] Open
Abstract
Pulmonary abscess or lung abscess is a lung infection which destroys the lung parenchyma leading to cavitations and central necrosis in localised areas formed by thick-walled purulent material. It can be primary or secondary. Lung abscesses can occur at any age, but it seems that paediatric pulmonary abscess morbidity is lower than in adults. We present the case of a one year and 5-month-old male child admitted to our clinic for fever, loss of appetite and an overall altered general status. Laboratory tests revealed elevated inflammatory biomarkers, leukocytosis with neutrophilia, anaemia, thrombocytosis, low serum iron concentration and increased lactate dehydrogenase level. Despite wide-spectrum antibiotic therapy, the patient’s progress remained poor after seven days of treatment and a CT scan established the diagnosis of a large lung abscess. Despite changing the antibiotic therapy, surgical intervention was eventually needed. There was a slow but steady improvment and eventually, the patient was discharged after approximately five weeks.
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Affiliation(s)
| | - Cristina Oana Mărginean
- Paediatrics Clinic 1 Tîrgu Mureş, Tîrgu Mureş, Romania.,University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Horea Gozar
- Paediatric Surgery and Orthopedics Clinic Tîrgu Mureş, Tîrgu Mureş, Romania.,University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Anca Meda Georgescu
- Infectious Diseases Clinic 1 Tîrgu Mureş, Tîrgu Mureş, Romania.,University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Lorena Elena Meliţ
- Paediatrics Clinic 1 Tîrgu Mureş, Tîrgu Mureş, Romania.,University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
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de Benedictis FM, Bush A. Respiratory manifestations of gastro-oesophageal reflux in children. Arch Dis Child 2018; 103:292-296. [PMID: 28882881 DOI: 10.1136/archdischild-2017-312890] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 01/11/2023]
Abstract
Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients' symptoms. Evidence for the assessment of children with suspected extraoesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.
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Affiliation(s)
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial School of Medicine, London, UK
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Coon ER, Srivastava R, Stoddard GJ, Reilly S, Maloney CG, Bratton SL. Infant Videofluoroscopic Swallow Study Testing, Swallowing Interventions, and Future Acute Respiratory Illness. Hosp Pediatr 2017; 6:707-713. [PMID: 27879283 DOI: 10.1542/hpeds.2016-0049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Tube feedings are commonly prescribed to infants with swallowing abnormalities detected by videofluoroscopic swallow study (VFSS), but there are no studies demonstrating efficacy of these interventions to reduce risk of acute respiratory illness (ARI). We sought to measure the association between swallowing interventions and future ARI, among VFSS-tested infants. METHODS Retrospective cohort of all infants (<12 months) tested with VFSS at a children's hospital between January 1, 2010, and January 1, 2012. Hospital ARI encounters (emergency, observation, or inpatient status) in a 22-hospital integrated health care delivery system, between the first VFSS and age 3 years, were measured. VFSS results were grouped by normal, intermediate, and oropharyngeal aspiration (OPA), with OPA further subdivided by silent versus cough and thin versus thick liquid OPA. Cox regression modeled the association between swallowing interventions (thickened or nasal tube feedings) and ARI, accounting for changes in swallowing and interventions over time. RESULTS 576 infants were tested with a VFSS in their first year of life, receiving a total of 1051 VFSSs in their first 3 years of life. More than 60% of infants received a measured feeding intervention. With the exception of infants with silent OPA who received thickened feedings, neither thickening nor nasal tube feedings, compared with no intervention, were associated with a decreased risk of subsequent ARI. CONCLUSIONS Swallowing interventions and repeated testing are common among VFSS-tested infants. However, the importance of diagnosing and intervening on VFSS-detected swallowing abnormalities for the majority of tested infants remains unclear.
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Affiliation(s)
- Eric R Coon
- Divisions of Pediatric Inpatient Medicine, and
| | - Rajendu Srivastava
- Divisions of Pediatric Inpatient Medicine, and.,Institute for Health Care Leadership, Intermountain Healthcare, Salt Lake City, Utah
| | - Gregory J Stoddard
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Susan L Bratton
- Pediatric Critical Care Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
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11
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Gastric reflux: association with aspiration and oral secretion pH as marker of reflux: a descriptive correlational study. Dimens Crit Care Nurs 2016; 34:84-90. [PMID: 25650493 DOI: 10.1097/dcc.0000000000000096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia. OBJECTIVES The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions. METHODS A descriptive correlational study was conducted in mechanically ventilated surgical or medical patients receiving gastric tube feedings. Oral secretions were suctioned hourly and tracheal secretions every 2 to 3 hours for 12-hour periods over 1 to 2 days in 15 patients. RESULTS There were 142 paired samples of oral tracheal secretions. A majority of samples (60%) had the same results, with 32% both pepsin-positive and 27% both pepsin-negative. The range of pH measurements was 4 to 8, with a mean of 6.3 ± 0.05. Ninety oral specimens had a pH of 4 to 6. Forty-seven of the oral specimens with pH measures between 4 and 6 (52%) were pepsin-positive. The correlation of pH percent pepsin-positive oral secretions was not significant. CONCLUSION Aspiration events were more frequent than reflux events. Measurement of actual pepsin concentration to detect new reflux and aspiration events is recommended in future studies. Bedside pH measures of oral secretions are not a valid marker of gastric reflux.
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12
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Calvo I, Conway A, Henriques F, Walshe M. Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review. Dev Med Child Neurol 2016; 58:541-53. [PMID: 26862075 DOI: 10.1111/dmcn.13058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics.
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Affiliation(s)
- Irene Calvo
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland.,Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milano, Italy
| | - Aifric Conway
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Filipa Henriques
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
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Ferguson NF, Estis J, Evans K, Dagenais PA, VanHangehan J. A Retrospective Examination of Prandial Aspiration in Preterm Infants. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/sasd24.4.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
We conducted this retrospective study to identify potential signs of aspiration in preterm infants based on crib-side nursing documentation.
Study Design and Methods
A total of 2,590 bottle-feedings were examined for signs of distress across 41 preterm infants who were referred for a swallowing evaluation. All infants underwent either a videofluoroscopic swallow study (VSS) or upper gastrointestinal study (GIS). Physiologic and behavioral warning signs were coded across feedings 10 days prior to the imaging study. Presence or absence of documented aspiration during VSS/GIS was coded for each infant.
Results
Distress signs were documented in seven percent of oral feeding attempts. Aspiration was more common when the crib-side nurse documented coughing (LR+, 8.77; 95% CI, .99–77.09), compromised oxygen saturation levels (LR+, 2.15; CI, .86–5.47), and tachypnea (LR+, 2.15; CI, .28–3.01) during bottle-feeding.
Clinical Implications
Evidence-based distress signs that signal increased suspicion for prandial aspiration will facilitate correct clinical judgments at crib-side. Early identification and prevention of prandial aspiration improves health outcomes for preterm infants.
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Affiliation(s)
- Neina F. Ferguson
- Audiology and Speech Language Pathology, East Tennessee State University
Johnson City, TN
| | - Julie Estis
- Speech Pathology and Audiology, University of South Alabama
Mobile, AL
| | - Kelli Evans
- Department of Speech-Pathology and Audiology, Western Washington University
Bellingham, WA
| | - Paul A. Dagenais
- Department of Speech-Pathology and Audiology, University of South Alabama
Mobile, AL
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Abstract
Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.
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Affiliation(s)
- Xiaowen Hu
- Department of Respiratory Disease, Anhui Provincial Hospital, Hefei, China
| | - Joyce S Lee
- Department of Medicine, University of California, San Francisco, CA
| | - Paolo T Pianosi
- Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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16
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Smith BK, Goddard M, Childers MK. Respiratory assessment in centronuclear myopathies. Muscle Nerve 2014; 50:315-26. [PMID: 24668768 DOI: 10.1002/mus.24249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/23/2022]
Abstract
The centronuclear myopathies (CNMs) are a group of inherited neuromuscular disorders classified as congenital myopathies. While several causative genes have been identified, some patients do not harbor any of the currently known mutations. These diverse disorders have common histological features, which include a high proportion of centrally nucleated muscle fibers, and clinical attributes of muscle weakness and respiratory insufficiency. Respiratory problems in CNMs may manifest initially during sleep, but daytime symptoms, ineffective airway clearance, and hypoventilation predominate as more severe respiratory muscle dysfunction evolves. Respiratory muscle capacity can be evaluated using a variety of clinical tests selected with consideration for the age and baseline motor function of the patient. Similar clinical tests of respiratory function can also be incorporated into preclinical CNM canine models to offer insight for clinical trials. Because respiratory problems account for significant morbidity in patients, routine assessments of respiratory muscle function are discussed.
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Affiliation(s)
- Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
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Romagnoli V, Priftis KN, de Benedictis FM. Middle lobe syndrome in children today. Paediatr Respir Rev 2014; 15:188-93. [PMID: 24630779 DOI: 10.1016/j.prrv.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/17/2014] [Accepted: 01/26/2014] [Indexed: 11/25/2022]
Abstract
Middle lobe syndrome in children is a distinct clinical and radiographic entity that has been well described in the pediatric literature. However, issues regarding its etiology, clinical presentation, and management continue to puzzle the clinical practitioner. Pathophysiologically, there are two forms of middle lobe syndrome, namely obstructive and nonobstructive. Middle lobe syndrome may present as symptomatic or asymptomatic, as persistent or recurrent atelectasis, or as pneumonitis or bronchiectasis of the middle lobe and/or lingula. A lower threshold of performing a chest radiograph is warranted in children with persistent or recurrent nonspecific respiratory symptoms, particularly if there is clinical deterioration, in order to detect middle lobe syndrome and to initiate a further diagnostic and therapeutic workup.
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Affiliation(s)
- Vittorio Romagnoli
- Department of Mother and Child Health, Salesi University Children's Hospital, Ancona, Italy
| | - Kostas N Priftis
- Pulmonology Unit, 3(rd) Department of Paediatrics, University General Hospital "Attikon", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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18
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Abstract
This article offers an over view of lung development, physiology, and evaluation of lung damage due to aspiration. Considerations specific to pediatric patients are discussed.
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Affiliation(s)
- Marni Simon
- The Pediatric Lung and AspirationConnecticut Children’s Medical CenterHartford, CT
| | - Melanie Sue Collins
- The Pediatric Lung and AspirationConnecticut Children’s Medical CenterHartford, CT
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19
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Clinical profile of recurrent community-acquired pneumonia in children. BMC Pulm Med 2013; 13:60. [PMID: 24106756 PMCID: PMC3852007 DOI: 10.1186/1471-2466-13-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this case-control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients. METHODS The study involved 146 children with ≥2 episodes of radiographically confirmed CAP in DLA in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences, and 145 age- and gender-matched controls enrolled in Milan, Italy, between January 2009 and December 2012. The demographic and clinical characteristics of the cases and controls were compared, and a comparison was also made between the cases with rCAP (i.e. ≤3 episodes) and those with highly recurrent CAP (hrCAP: i.e. >3 episodes). RESULTS Gestational age at birth (p = 0.003), birth weight (p = 0.006), respiratory distress at birth (p < 0.001), and age when starting day care attendance (p < 0.001) were significantly different between the cases and controls, and recurrent infectious wheezing (p < 0.001), chronic rhinosinusitis with post-nasal drip (p < 0.001), recurrent upper respiratory tract infections (p < 0.001), atopy/allergy (p < 0.001) and asthma (p < 0.001) were significantly more frequent. Significant risk factors for hrCAP were gastroesophageal reflux disease (GERD; p = 0.04), a history of atopy and/or allergy (p = 0.005), and a diagnosis of asthma (p = 0.0001) or middle lobe syndrome (p = 0.001). Multivariate logistic regression analysis, adjusted for age and gender, showed that all of the risk factors other than GERD and wheezing were associated with hrCAP. CONCLUSIONS The diagnostic approach to children with rCAP in DLAs is relatively easy in the developed world, where the severe chronic underlying diseases favouring rCAP are usually identified early, and patients with chronic underlying disease are diagnosed before the occurrence of rCAP in DLAs. When rCAP in DLAs does occur, an evaluation of the patients' history and clinical findings make it possible to limit diagnostic investigations.
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20
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Shakespeare AS. Aspiration lung disorders in bovines: a case report and review. J S Afr Vet Assoc 2012; 83:921. [PMID: 23327148 DOI: 10.4102/jsava.v83i1.921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/14/2012] [Indexed: 01/30/2023] Open
Abstract
Lung aspiration disorders in bovines are invariably diagnosed as infectious aspiration pneumonias. There is a distinct differentiation between aspiration pneumonia and aspiration pneumonitis in humans that can be applied to bovines. The nature and quantity of the aspirate can result in differing pathogeneses which can require differing therapeutic approaches. Whilst blood gases were important in detecting and prognosticating lung problems, changes in barometric pressure with altitude have to be considered when interpreting partial pressures of oxygen. Anatomical differences in the lungs of bovines can explain why this species is more prone to certain pneumonic problems. Pulmonary physiotherapy is important in treating lung disorders in humans and should be considered as an adjunct therapy in bovine respiratory conditions. A case work-up was used to highlight some of the points discussed in this article.
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Ongkasuwan J. In Search of the Elusive Laryngotracheal Cleft. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2012; 25:143-149. [DOI: 10.1089/ped.2012.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Julina Ongkasuwan
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Wallis C, Ryan M. Assessing the Role of Aspiration in Pediatric Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012. [DOI: 10.1089/ped.2012.0148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Colin Wallis
- Respiratory Unit, Great Ormond Street Hospital and the Institute of Child Health, London, United Kingdom
| | - Martina Ryan
- Speech and Language Therapy Department, Great Ormond Street Hospital, London, United Kingdom
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Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol 2012; 47:321-37. [PMID: 22009835 DOI: 10.1002/ppul.21576] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 08/11/2011] [Indexed: 11/08/2022]
Abstract
Aspiration is a significant cause of respiratory morbidity and sometimes mortality in children. It occurs when airway protective reflexes fail, especially, when dysphagia is also present. Clinical symptoms and physical findings of aspiration can be nonspecific. Advances in technology can lead to early diagnosis of dysphagia and aspiration, and, new therapeutic advances can significantly improve outcome and prognosis. This report first reviews the anatomy and physiology involved in the normal process of swallowing. Next, the protective reflexes that help to prevent aspiration are discussed followed by the pathophysiologic events that occur after an aspiration event. Various disease processes that can result in dysphagia and aspiration in children are discussed. Finally, the various methods for diagnosis and treatment of dysphagia in children are reviewed.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, St. Jude Children's Research Hospital, Memphis, Tennessee 38103, USA.
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de Benedictis FM, Bush A. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med 2012; 185:12-23. [PMID: 21920920 DOI: 10.1164/rccm.201107-1174ci] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We review recent advances in the use of corticosteroids (CS) in pediatric lung disease. CS are frequently used, systemically or by inhalation. Their mechanisms of action in pulmonary diseases are ill defined. CS exert direct inhibitory effects on many inflammatory cells through genomic mechanisms. There is a time lag before clinical response, and the washout of effects is also prolonged. Prompt relief in some conditions, such as croup, may be related to airway mucosal vasoconstriction through a nongenomic mechanism. CS have proven beneficial roles in the treatment of asthma, croup, allergic bronchopulmonary aspergillosis, and subglottic hemangioma. In some conditions, such as bronchiolitis, cystic fibrosis, and bronchopulmonary dysplasia, their use is controversial and is not recommended routinely. In other conditions, such as tuberculosis, interstitial lung disease, acute lung aspiration, and acute respiratory distress syndrome, CS are often used empirically despite the lack of clear evidence of their benefit. New drug regimens, including the more flexible use of inhaled corticosteroids and long-acting β-agonists in asthma, the lack of efficacy of oral corticosteroids in preschool children with acute wheeze, the severe complications of systemic dexamethasone used to prevent bronchopulmonary dysplasia and thus more restricted use, and the beneficial effect of pulse high-dose intravenous methylprednisolone in patients with allergic bronchopulmonary aspergillosis or cystic fibrosis are among the major recent developments. There is concern about adverse effects, especially growth and adrenal suppression, induced by systemic CS in children. These have been reduced, but not eliminated, with the use of the inhaled route. The benefits must be weighed against the potential detrimental effects.
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Abstract
Early identification and management of aspiration associated with oral intake will help contribute to the best possible outcome for infants and children who have airway protection issues with swallowing. Though the incidence and prevalence of aspiration specifically related to swallowing dysfunction across medical conditions in the pediatric population is unknown, there is accumulating evidence of swallowing-related aspiration in infants and children with diagnoses that include structural abnormalities of the upper airway, central nervous system abnormalities, and progressive neurological disease. Chronic aspiration is associated with compromised respiratory health, progressive lung disease, bronchiectasis, and respiratory failure; thus, early detection and appropriate management is crucial. Determining the etiology and effect of aspiration is complex, and multiple evaluations are often required. This article will focus on instrumental studies of swallowing physiology used in the diagnosis and management of swallowing dysfunction and aspiration. Therapeutic strategies to improve airway protection during swallowing will also be described.
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Weir KA, McMahon S, Taylor S, Chang AB. Oropharyngeal aspiration and silent aspiration in children. Chest 2011; 140:589-597. [PMID: 21436244 DOI: 10.1378/chest.10-1618] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Limited information exists about the nature of and factors associated with oropharyngeal aspiration (OPA) and silent aspiration (SA) in children. A prospective study was undertaken to determine the factors associated with fluoroscopically identified OPA and SA. METHODS Three hundred children presenting with feeding difficulties underwent a videofluoroscopic swallow study (VFSS) for evaluation of swallowing. Swallowing performance on each food and fluid consistency was rated using the penetration-aspiration scale, and children were classified into the following groups: OPA, SA, overt aspiration (OA), and no aspiration (NA). RESULTS OPA occurred in 34% of children; of these, 81% had SA. SA was significantly associated with neurologic impairment (OR, 4.65; 95% CI, 2.26-9.54), developmental delay (OR, 4.62; 95% CI, 2.28-9.35), aspiration lung disease (OR, 3.22; 95% CI, 1.29-8.05), and enteral feeding (OR, 2.03; 95% CI, 1.04-3.62). Similar results were found for OPA. Children with SA were more likely to have neurologic disease (OR, 4.1; 95% CI, 1.1-15.8) than those with OA. Age or gender differences, gastroesophageal reflux disease, recurrent respiratory tract infections, and asthma were no more likely to occur in children with OPA, SA, or OA. CONCLUSIONS SA is very common in children with feeding difficulties and is most likely to occur in children with a neurologic problem. Limited medical diagnoses distinguished between aspirators (OPA, SA) and those with NA. VFSS should be performed in children with feeding difficulties and diagnoses of neurologic impairment, cerebral palsy, aspiration lung disease, and/or enteral feeding because of the increased likelihood of SA.
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Affiliation(s)
- Kelly A Weir
- Speech Pathology Department, Royal Children's Hospital, Brisbane, QLD; Queensland Children's Medical Research Institute, University of Queensland, QLD.
| | | | - Simone Taylor
- Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, QLD; Queensland Children's Medical Research Institute, University of Queensland, QLD; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Røksund OD, Clemm H, Heimdal JH, Aukland SM, Sandvik L, Markestad T, Halvorsen T. Left vocal cord paralysis after extreme preterm birth, a new clinical scenario in adults. Pediatrics 2010; 126:e1569-77. [PMID: 21098147 DOI: 10.1542/peds.2010-1129] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to study the incidence and long-term consequences of left vocal cord paralysis (LVCP) after neonatal surgical treatment of patent ductus arteriosus (PDA) in a population-based cohort of adults who were born at gestational ages of ≤28 weeks or with birth weights of ≤1000 g in western Norway. METHODS Subjects with a history of neonatal PDA surgery were examined with transnasal flexible laryngoscopy, and those with LVCP were examined with continuous laryngoscopy during maximal treadmill exercise (continuous laryngoscopy exercise testing). All subjects underwent lung function testing, ergospirometry, and pulmonary high-resolution computed tomography. Symptoms were recorded with a questionnaire. RESULTS Forty-four (86%) of 51 eligible preterm infants participated in the study, 13 (26%) had a history of PDA surgery and 7 (54%) had LVCP, with the laryngeal appearances varying slightly. As a group, subjects with LVCP had significant airway obstruction, no decreases in aerobic capacity, and no obvious evidence of longstanding aspiration on high-resolution computed tomography scans. The continuous laryngoscopy exercise tests revealed increasing respiratory symptoms in parallel with increasing anteromedial collapse of the left aryepiglottic folds as the exercise load increased. Hoarseness and voice-related symptoms were the most typical complaints. Symptoms were attributed erroneously to other diseases for at least 2 subjects. CONCLUSIONS LVCP is not uncommon in young adults exposed to PDA surgery as preterm infants. The condition may be overlooked easily, and symptoms may be confused with those of other diseases. Laryngoscopy should be offered on the basis of liberal indications after PDA ligation.
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Affiliation(s)
- Ola Drange Røksund
- Haukeland University Hospital, Department of Paediatrics, N-5021 Bergen, Norway
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