What is aspiration pneumonia?
When liquids are taken into the lungs, aspiration pneumonia occurs. Aspiration pneumonia is a form of pneumonia not caused by a bacteria or a virus. It is typically said that neurologically impaired children are at higher risk of aspiration pneumonia due to lack of a gag reflex. Interestingly, however, one study concluded that lack of a gag reflex is not a useful predictor of aspiration pneumonia and in fact absence of a gag should not be used to predict airway safety. Nonetheless, aspiration pneumonia is often the greatest threat to an HIE child's life.
Aspiration pneumonia can develop over time, bit by bit, or it may occur suddenly. For example, if a child aspirates massive amounts of gastric acid at one time, there could be acute respiratory distress within one hour. Some possible symptoms of aspiration pneumonia can include: tachychardia (fast heartbeat), cyanosis, bronchospasm, fever and hypoxemia. Presence of infiltrates on an Xray shows the intensity of the pneumonia. At http://www.vh.org/Providers/TeachingFile... , you'll find an example of an X-ray of lungs with aspiration pneumonia. It occurs most often in the left lung, but can be in right or bilateral.
How is aspiration pneumonia treated?
If you choose to treat your child at home (for example, if it is a mild case) you will need oxygen to supplement and a pulse oximeter to monitor oxygen levels. You will probably use suction catheters for deep tracheal suctioning as well. The doctor will likely prescribe an antibiotic. In terms of antibiotics, clindamycin (Cleocin) and amoxicillin (Augmentin) are often used in cases of aspiration pneumonia. Sometimes furosemide (Lasix) or another diuretic is prescribed. However, Lasix can cause a hearing impairment, usually associated with a high dosage. Nebulizer treatments, with albuterol, atrovent, or another medication, and chest percussions can also be done at home by the parent in cases of palliative care or a mild case.
In a hospital setting doctors may use high flow O2, positive pressure breathing (CPAP), give IV fluids to keep hydrated and also to stop reflux, do tracheal and deep tracheal suction, prescribe antibiotics, and prescribe nebulizer treatments and chest percussions to be done by a respiratory therapist. If saturation levels stay low or continue to drop despite O2 supplementation or CPAP, the doctor will be likely to intubate and place on a ventilator.
Tests the doctor will run on your child to determine diagnosis and treatment include: arterial blood gas (ABG), complete blood count (CBC), BUN and creatinine, blood cultures, sputum cultures and gram stain. Also some doctors order lipid laden macrophage, although studies have shown that it is not known to be a reliable indicator at this time. The doctor will listen for crackles and rales when breathing.
