Aspiration pneumonia in children – causes, symptoms, treatment

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Aspiration pneumonia in children is an inflammatory disease of the lower respiratory tract with cough, fever, rapid breathing and changes in chest X-ray. The disease most often affects children under the age of 5 who have developed a pulmonary infection, e.g. as a result of aspiration of the contents from the gastrointestinal tract to the bronchial tree.

What is childhood aspiration pneumonia?

Aspiration pneumonia is an inflammatory disease that affects the respiratory tract. Children under 5 years of age most often suffer from aspiration pneumonia. Pathogenic microbes enter the lung tissue through various routes. The most common bacterium that causes pneumonia, i.e. Streptococcus pneumoniae it is aspirated along with the secretions from the upper respiratory tract. The viruses infect the lung tissue mainly by inhalation. Some bacteria, e.g. Staphylococcus aureus reach the lungs through the bloodstream. Pulmonary infection can also develop through continuity from infected tissue and through aspiration of contents from the gastrointestinal tract.

The causes of aspiration pneumonia

1. Numerous predisposing factors favor the penetration of bacteria from the gastrointestinal tract into the bronchial tree and lung tissue.

Belong to them:

1. gastroesophageal reflux, caused by periodic relaxation of the lower esophageal sphincter,
2. neurological diseases that cause, among others impaired cough reflex and tendency to convulsions,
3. children fed through a gastric tube, intubated e.g. during general anesthesia and with congenital or acquired tracheo-esophageal malformations, esophageal achalasia, duodenal atresia have a high risk of developing aspiration pneumonia,
4. lying down, alcohol, other stimulants and some medications also contribute to the regurgitation of food into the esophagus and respiratory tract,
5. newborns are prone to aspiration of amniotic fluid and meconium, which may result in infection Streptococcus agalactiaethat colonizes the mother’s birth paths.

Inflammation of the lungs usually occurs within 24 hours of childbirth, a complication may even be a very serious, systemic infection. Babies, on the other hand, often choke on food. In a healthy child, the risk of aspiration and the resulting numerous complications is small, because well-functioning defense mechanisms protect against this phenomenon. One of them is the cough reflex that is triggered automatically when the receptors in the respiratory mucosa are irritated. The function of cleansing the bronchial tree is also performed by pulmonary macrophages and an efficient ciliary apparatus that eliminates irritating factors together with the secretion.

2. Aspiration pneumonia is an inflammation of mostly bacterial, mixed aetiology, ie both aerobic and anaerobic bacteria.

Anaerobic bacteria such as: Fusobacterium spp., Prevotella spp., Peptostreptococcus spp., Bacteroides spp.which colonize the oral cavity and throat in predisposing conditions, quickly enter the respiratory tract. They are often accompanied by infection with aerobic bacteria such as: Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae.

Aspiration pneumonia – symptoms

The symptoms of aspiration pneumonia include, but are not limited to:

1. cough,
2. fever,
3. weakness,
4. sweating
5. pain in the chest,
6. purulent discharge from the respiratory tract,
7. rapid breathing,
8. general weakness
9. high fever,
10. chills.

These symptoms are sometimes very discreet, especially in newborns and infants, who may be limited to feeding difficulties, crying and anxiety. AT older children chest pain may occur when breathing. Abdominal pain is the primary symptom when the inflammation affects the lower lungs. In a physical examination of the pulmonary fields, crackles and muffled percussion noise may be present. important: there is no one such symptom from which it is possible to diagnose pneumonia. The diagnosis is made after analyzing the constellation of changes in the physical examination and auxiliary examinations.

Diagnosis of aspiration pneumonia

Densities of the pulmonary parenchyma are characteristic of aspiration pneumonia chest radiograph. They are located in the lower lobes if aspiration has occurred in a vertical position, or in the upper segments of the lower lobes and posterior segments of the upper lobes of the lungs if the secretion has entered the bronchial tree in a lying patient. X-rays should be ordered a few hours after aspiration, because inflammatory changes will not be present earlier.

It also performs physical examinationwhich consists in tapping the lung fields. Your doctor may hear breathing sounds and rattles which, in combination with your medical history and other circumstances, may suggest pneumonia is present.

Another test performed in the diagnosis of pneumonia is bronchofiberoskopia, which consists in collecting material from the bronchi. There is an endoscopic examination that covers the lumen of the trachea and large bronchi. The test is performed by inserting a flexible organ through the nose or mouth, at the end of which there is a small webcam that allows the doctor to observe the light of the respiratory tract. This test helps to remove any residual secretion or gastrointestinal content in the event of choking. Bronchofiberoscopy also helps to distinguish between aspiration, lung cancer and bronchoconstriction.

Aspiration inflammation – treatment

Treatment of aspiration pneumonia requires antibiotic therapy with drugs that are first used by the doctor when suspecting the disease:

1. penicillins with lactamase inhibitors,
2. clindamycyna,
3. crystal penicillin with metronidazole.

If the infection was caused by a bacterium in the family Enterobacteriaceae or Pseudomonas aeruginosa it is necessary to administer an aminoglycoside antibiotic or a XNUMXth generation cephalospotin. The infection will require different treatment Saphylococcus aureus (Staphylococcus aureus). In this case, cloxacillin should be ordered, and if it is a methicillin, vancomycin or linezolid resistant strain. Aspiration pneumonia takes 1-3 weeks to heal, unfortunately it tends to recur.

Aspiration of acidic food from the stomach can cause many other problems, including wheezing, chronic cough and hoarseness which must be differentiated from pneumonia.

The symptoms are the result of irritation of the respiratory mucosa with acidic gastric juice. They develop in a short time (usually up to two hours) from the aspiration of the contents to the respiratory tract. In addition to the problems listed above, the following may occur:

1. inflammation and foreign body sensation in the throat
2. increased sweating,
3. wet cough
4. tooth decay,
5. fever, wheezing at night.

Sometimes, consistently used, simple methods are enough to effectively reduce or even eliminate unpleasant symptoms:

1. it is recommended to feed babies with small, frequent portions of concentrated food, and the last feeding should be no later than 90 minutes before bedtime;
2. in addition, young children should not be placed in the supine position for about 90 minutes after a meal, older children should be advised to sleep with their upper body raised;
3. a proper diet is also important.

In case of failure of the above methods, it becomes necessary to introduce a therapy that accelerates the motility of the gastrointestinal tract and neutralizes the acid content of the stomach. Antibiotic therapy is necessary in the case of accompanying fever, clinical symptoms, and laboratory and radiographic signs of pneumonia. In special cases, in the case of failure of pharmacotherapy, surgical treatment is used.