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REVIEW
Aspiration syndromes as a cause of bacterial colonization of the lower respiratory tract in children
Marios M. Papadopoulos 1
,
 
Kostas Douros 1
,
 
Michalis V. Anthracopoulos 2
,
 
Mark Everard 3
,
 
Kostas N. Priftis 1
 
 
 
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1
3rd Paediatric Clinic, University of Athens, “Attikon” Regional General Hospital, Athens, Greece
 
2
Paediatric Pneumonological Unit, Paediatric Clinic, University of Patras, Rio Regional General Hospital, Patras, Greece
 
3
Department of Respiratory Medicine, Sheffield Children’s Hospital, Sheffield, UK
 
 
Corresponding author
Kostas N. Priftis   

3rd Paediatric Clinic, University of Athens, University General Hospital «Αttikon» 1 Rimini street, 12462 Chaidari
 
 
Pneumon 2011;24(3):271–279
 
Article (PDF)
References (86)
 
KEYWORDS
aspiration
 infection
 lower respiratory
 children
 
ABSTRACT
Aspiration syndromes facilitate the colonization of the lower airways with bacterial pathogens and predispose to recurrent chest infections, chronic suppurative lung disease and bronchiectasis. In recent years important steps forward have been made in the understanding of the physiology of swallowing, the mechanisms underlying gastro-oesophageal reflux and the upper respiratory protective mechanisms for preventing aspiration. The diagnosis of aspiration however, and especially the establishment of a causal association with respiratory symptoms, remains challenging. Aspiration occurs sporadically and intermittently, and its manifestations are non-specific. There is no laboratory test that can establish with certainty whether or not aspiration lung disease is present; the diagnostic approach therefore remains primarily clinical, and laboratory investigations can only strengthen or weaken a clinical suspicion.
 
REFERENCES (86)
1.
de Benedictis FM, Carnielli VP, de Benedictis D. Aspiration lung disease. Pediatr Clin N Am 2009; 56:173-190.
Google Scholar
 
 
2.
Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008; 43:519-531.
Google Scholar
 
 
3.
Boesch RP, Daines C, Willging Kaul A, Cohen AP, Wood RE, Amin RS. Advances in the diagnosis and management of chronic pulmonary aspiration in children. Eur Respir J 2006; 28:847-861.
Google Scholar
 
 
4.
Boogaard R, Huijsmans SH, Pijnenburg MW, Tiddens HA, de Jongste JC, Merkus PJ. Tracheomalacia and Bronchomalacia in children: Incidence and patient characteristics. Chest 2005; 128:3391-3397.
Google Scholar
 
 
5.
Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. Chest 1997; 111:1266-1272.
Google Scholar
 
 
6.
Hickling KG, Howard R. A retrospective survey of treatment and mortality in aspiration pneumonia. Intensive Care Med 1988; 14:617-622.
Google Scholar
 
 
7.
Bonten MJ, Gaillard CA, van der Geest S, et al. The role of intragastric acidity and stress ulcus prophylaxis on colonization and infection in mechanically ventilated ICU patients. A stratified, randomized, double-blind study of sucralfate versus antacids. Am J Respir Crit Care Med 1995; 152:1825-1834.
Google Scholar
 
 
8.
Campinos L, Duval G, Couturier M, Brage D, Pham J, Gaudy JH. The value of early fibreoptic bronchoscopy after aspiration of gastric contents. Br J Anaesth 1983; 55:1103-1105.
Google Scholar
 
 
9.
Marraro GA, Luchetti M, Spada C, Galassini E, Giossi M, Piero AM. Selective medicated (normal saline and exogenous sur factant) bronchoalveolar lavage in severe aspiration syndrome in children. Pediatr Crit Care Med 2007; 8:476-481.
Google Scholar
 
 
10.
Owayed AF, Campbell DM, Wang EEL. Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med 2000; 154:190-194.
Google Scholar
 
 
11.
Lodha R, Puranik M, Natchu UC, Kabra SK. Recurrent pneumonia in children: clinical profile and underlying causes. Acta Paediatr 2002; 91:1170-1173.
Google Scholar
 
 
12.
White DR, Giambra BK, Hopkin RJ, Daines CL, Rutter MJ. Aspiration in children with CHARGE syndrome. Int J Pediatr Otorhinolaryngol 2005; 69:1205-1209.
Google Scholar
 
 
13.
Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB. Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 2007; 42:1024-1031.
Google Scholar
 
 
14.
Lefton-Greif MA, Carroll JL, Loughlin GM. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Pediatr Pulmonol 2006; 41:1040-1048.
Google Scholar
 
 
15.
Sheikh S, Allen E, Shell R, et al. Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants. Chest 2001; 120:1190-1195.
Google Scholar
 
 
16.
Khoshoo V, Edell D. Previously healthy infants may have increased risk of aspiration during syncytial viral bronchiolitis. Pediatrics 1999; 104:1389-1390.
Google Scholar
 
 
17.
Weinberger M. Gastroesophageal reflux disease is not a significant cause of lung disease in children. Pediatr Pulmonol Suppl 2004; 26:197-200.
Google Scholar
 
 
18.
Jack CI, Calverley PM, Donnelly RJ, et al. Simultaneous tracheal and oesophageal pH measurements in asthmatic patients with gastro-oesophageal reflux. Thorax 1995; 50:201-204.
Google Scholar
 
 
19.
Donnelly RJ, Berrisford RG, Jack CI, Tran JA, Evans CC. Simultaneous tracheal and esophageal pH monitoring: investigating reflux-associated asthma. Ann Thorac Surg 1993; 56:1029-1033.
Google Scholar
 
 
20.
Borrelli O, Battaglia M, Galos F, et al. Non-acid gastro-oesophageal reflux in children with suspected pulmonary aspiration. Dig Liver Dis 2010; 42:115-121.
Google Scholar
 
 
21.
Morton RE, Wheatley R, Minford J. Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability. Dev Med Child Neurol 1999; 41:329-334.
Google Scholar
 
 
22.
Phua SY, McGarvey LP, Ngu MC, Ing AJ. Patients with gastrooesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity. Thorax 2005; 60:488-491.
Google Scholar
 
 
23.
Jeffery PK, Li D. Airway mucosa: secretory cells, mucus and mucin genes. Eur Respir J 1997; 10:1655-1662.
Google Scholar
 
 
24.
Jaoude PA, Knight PR, Ohtake P, El-Solh AA. Biomarkers in the diagnosis of aspiration syndromes. Expert Rev Mol Diagn 2010; 10:309-319.
Google Scholar
 
 
25.
Dor A, London D, Ater D, Bibi H, Khvolis E, Ben D. The prevalence of gastroesophageal refluxin children with tracheomalacia and laryngomalacia. Chest 2001; 119:409-413.
Google Scholar
 
 
26.
Eastham KM, Fall AJ, Mitchell L, Spencer DA. The need to redefine non-cystic fibrosis bronchiectasis in Childhood. Thorax 2004; 59:324-327.
Google Scholar
 
 
27.
Hare KM, Grimwood K, Leach AJ, et al. Respiratory bacterial pathogens in the nasopharynx and lower airways of Australian indigenous children with bronchiectasis. J Pediatr 2010; 157:1001-1005.
Google Scholar
 
 
28.
Starner TD, Zhang N, Kim G, Apicella MA, McCray PB Jr. Haemophilus influenzae forms biofilms on airway epithelia: implications in cystic fibrosis. Am J Respir Crit Care Med 2006; 174:213-220.
Google Scholar
 
 
29.
Eastburn MM, Katelaris PH, Chang AB. Defining the relationship between gastroesophageal reflux and cough: probabilities, possibilities and limitations. Cough 2007; 3:4.
Google Scholar
 
 
30.
Ανθρακόπουλος ΜΒ. Χρόνιος ή υποτροπιάζων βήχας στα παιδιά. Μήπως πρόκειται για άσθμα; Πνεύμων 2003; 16:271-284.
Google Scholar
 
 
31.
Weir K, McMahon S, Barry L, Masters IB, Chang AB. Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children Eur Respir J 2009; 33:604-611.
Google Scholar
 
 
32.
Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49:498-547.
Google Scholar
 
 
33.
Li AM, Sonnappa S, Lex C, et al. Non-CF bronchiectasis: does knowing the aetiology lead to changes in management? Am J Respir Crit Care Med 2006; 174:213-220.
Google Scholar
 
 
34.
Stoeckli SJ, Huisman TA, Seifert B, Martin-Harris BJ. Interrater reliability of videofluoroscopic swallow evaluation. Dysphagia 2003; 18:53-57.
Google Scholar
 
 
35.
Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallow compare? Laryngoscope 2007; 117:1723-1727.
Google Scholar
 
 
36.
Leder SB, Karas DE. Fiberoptic endoscopic evaluation of swallowing in the pediatric population. Laryngoscope 2000; 110:1132-1136.
Google Scholar
 
 
37.
Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (FEES) using the penetration-aspiration scale: a replication study. Dysphagia 2002; 17:308-315.
Google Scholar
 
 
38.
Link DT, Willging JP, Miller CK, Cotton RT, Rudolph CD. Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Ann Otol Rhinol Laryngol 2000; 109:899-905.
Google Scholar
 
 
39.
Furuya ME, Moreno-Córdova V, Ramírez-Figueroa JL, Vargas MH, Ramón-García G, Ramírez-San Juan DH. Cutoff value of lipid-laden alveolar macrophages for diagnosing aspiration in infants and children. Pediatr Pulmonol 2007; 42:452-457.
Google Scholar
 
 
40.
Kieran SM, Katz E, Rosen R, Khatwa U, Martin T, Rahbar R. The lipid laden macrophage index as a marker of aspiration in patients with type I and II laryngeal clefts. Int J Pediatr Otorhinolaryngol 2010; 74:743-746.
Google Scholar
 
 
41.
Midulla F, Guidi R, Tancredi G, et al. Microaspiration in infants with laryngomalacia. Laryngoscope 2004; 114:1592-1596.
Google Scholar
 
 
42.
Kazachkov MY, Muhlebach MS, Livasy CA, Noah TL. Lipid-laden macrophage index and inflammation in bronchoalveolar lavage fluids in children. Eur Respir J 2001; 18:790-795.
Google Scholar
 
 
43.
Mousa HM, Rosen R, Woodley FW, et al. Esophageal impedance monitoring for gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2011; 52:129-139.
Google Scholar
 
 
44.
Di Pace MR, Caruso AM, Catalano P, Casuccio A, De Grazia E. Evaluation of esophageal motility using multichannel intraluminal impedance in healthy children and children with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2011; 52:26-30.
Google Scholar
 
 
45.
Pilic D, Fröhlich T, Nöh F, et al. Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: Data from the German Pediatric Impedance Group. J Pediatr 2011; 158:650-654.e1.
Google Scholar
 
 
46.
Borrelli O, Galos F, et al. Non-acid gastro-oesophageal reflux in children with suspected pulmonary aspiration. Dig Liver Dis 2010; 42:115-121.
Google Scholar
 
 
47.
Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O’Connor JA. Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement. J Pediatr Gastroenterol Nutr 2006; 42:16-21.
Google Scholar
 
 
48.
Kawamura O, Aslam M, Rittmann T, Hofmann C, Shaker R. Physical and pH properties of gastroesophagopharyngeal refluxate: a 24-hour simultaneous ambulatory impedance and pH monitoring study. Am J Gastroenterol 2004; 99:1000-1010.
Google Scholar
 
 
49.
Chang AB, Cox NC, Purcell J, et al. Airway cellularity, lipid laden macrophages and microbiology of gastric juice and airways in children with reflux oesophagitis. Respir Res 2005; 6:72.
Google Scholar
 
 
50.
Rosen R, Fritz J, Nurko A, Simon D, Nurko S. Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children. Pediatrics 2008; 121:e879-84.
Google Scholar
 
 
51.
Kim CK, Kim HB, Kurian T, Chung JY, Yoo Y, Koh YY. Increased laryngeal lavage lipid-laden macrophage index during acute bronchiolitis. Acta Paediatr 2007; 96:1025-1029.
Google Scholar
 
 
52.
Moran JR, Block SM, Lyerly AD, Brooks LE, Dillard RG. Lipid-laden alveolar macrophage and lactose assay as markers of aspiration in neonates with lung disease. J Pediatr 1988; 112:643-645.
Google Scholar
 
 
53.
Starosta V, Kitz R, Hartl D, Marcos V, Reinhardt D, Griese M. Bronchoalveolar pepsin, bile acids, oxidation, and inflammation in children with gastroesophageal reflux disease Chest 2007; 132:1557-1564.
Google Scholar
 
 
54.
McNally P, Ervine E, Shields MD, et al. High concentrations of pepsin in bronchoalveolar lavage fluid from children with cystic fibrosis are associated with high interleukin-8 concentrations. Thorax 2011; 66:140-143.
Google Scholar
 
 
55.
Mertens V, Blondeau K, Vanaudenaerde B, et al. Gastric juice from patients «on» acid suppressive therapy can still provoke a significant inflammatory reaction by human bronchial epithelial cells. J Clin Gastroenterol 2010; 44:e230-235.
Google Scholar
 
 
56.
Sidorenko GI, Zborovskiĭ EI, Levina DI. Surface-active properties of the exhaled air condensate (a new method of studying lung function. Ter Arkh 1980; 52:65-68.
Google Scholar
 
 
57.
Λουκίδης Σ. Ο ρόλος του συμπυκνώματος του εκπνεόμενου αέρα στην αξιολόγηση της φλεγμονής των αεραγωγών. Πνεύμων 2004; 17:39-44.
Google Scholar
 
 
58.
Hunt J. Exhaled breath condensate: an evolving tool for noninvasive evaluation of lung disease. J Allergy Clin Immunol 2002; 110:28-34.
Google Scholar
 
 
59.
Horváth I, Hunt J, Barnes PJ, et al. Exhaled breath condensate: methodological recommendations and unresolved questions. Eur Respir J 2005; 26:523-548.
Google Scholar
 
 
60.
Ono E, Mita H, Taniguchi M, et al. Comparison of cysteinyl leukotriene concentrations between exhaled breath condensate and bronchoalveolar lavage fluid. Clin Exp Allergy 2008; 38:1866-1864.
Google Scholar
 
 
61.
Jackson AS, Sandrini A, Campbell C, Chow S, Thomas PS, Yates DH. Comparison of biomarkers in exhaled breath condensate and bronchoalveolar lavage. Am J Respir Crit Care Med 2007; 175:222-227.
Google Scholar
 
 
62.
Farhath S, He Z, Nakhla T, et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics 2008; 121:e253-259.
Google Scholar
 
 
63.
McVeagh P, Howman-Giles R, Kemp A. Pulmonary aspiration studied by radionuclide milk scanning and barium swallow y A, et al. Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy. Dev Med Child Neurol 2005; 47:86-93.
Google Scholar
 
 
64.
Spartalis ΕD, Tomos P, Lachanas E, Pavlopoulos D, Michail ΟP, Karakatsani A. Tumorlets and carcinoid secondary to congenital broncho-oesophageal fistula. Pneumon 2008;21:246-253.
Google Scholar
 
 
65.
Ravelli AM, Panarotto MB, Verdoni L, Consolati V, Bolognini S. Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease. Chest 2006; 130:1520-1526.
Google Scholar
 
 
66.
Cook SP, Lawless S, Mandell GA, Reilly JS. The use of the salivagram in the evaluation of severe and chronic aspiration. Int J Pediatr Otorhinolaryngol 1997; 41:353-361.
Google Scholar
 
 
67.
Thompson DM. Laryngopharyngeal sensory testing and assessment of airway protection in pediatric patients. Am J Med 2003; 115(Suppl 3A):166S-1668S.
Google Scholar
 
 
68.
Perlman PW, Cohen MA, Setzen M, et al. The risk of aspiration of pureed food as determined by flexible endoscopic evaluation of swallowing with sensory testing. Otolaryngol Head Neck Surg 2004; 130:80-83.
Google Scholar
 
 
69.
Belafsky PC, Blumenfeld L, LePage A, Nahrstedt K. The accuracy of the modified Evan’s blue dye test in predicting aspiration. Laryngoscope 2003; 113:1969-1972.
Google Scholar
 
 
70.
Weir K, McMahon S, Chang AB. Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev 2005; 4:CD005303.
Google Scholar
 
 
71.
Lall A, Morabito A, Dall’Oglio L, et al. Total oesophagogastric dissociation: experience in 2 centres. J Pediatr Surg 2006; 41:342-346.
Google Scholar
 
 
72.
Schwarz SM, Corredor J, Fisher-Medina J, Rabinowitz S. Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics 2001; 108:671-676.
Google Scholar
 
 
73.
Muraji T, Takamizawa S, Satoh S, et al. Congenital cricopharyngeal achalasia: diagnosis and surgical management. J Pediatr Surg 2002; 37:E12.
Google Scholar
 
 
74.
Kiljander TO. The role of proton pump inhibitors in the management of gastroesophageal reflux disease-related asthma and chronic cough. Am J Med 2003; 115 Suppl 3A:65S-71S.
Google Scholar
 
 
75.
Canani RB, Cirillo P, Roggero P, et al; Working group on intestinal infections of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. Pediatrics 2006; 117:e817-820.
Google Scholar
 
 
76.
Mattioli G, Sacco O, Repetto P, et al. Necessity for surgery in children with gastrooesophageal reflux and supraoesophageal symptoms. Eur J Pediatr Surg 2004; 14:7-13.
Google Scholar
 
 
77.
Mattioli G, Sacco O, Repetto P, et al. Can laparoscopic antireflux surgery improve the quality of life in children with neurologic and neuromuscular handicaps? J Pediatr Surg 2004; 39:1761- 1764.
Google Scholar
 
 
78.
Mier RJ, Bachrach SJ, Lakin RC, et al. Treatment of sialorrhea with glycopyrrolate: a double blind, dose-ranging study. Arch Pediatr Adolesc Med 2000; 154:1214-1218.
Google Scholar
 
 
79.
Jongerius PH, van den Hoogen FJ, van Limbeek J, et al. Effect of botulinum toxin in the treatment of drooling: a controlled clinical trial. Pediatrics 2004; 114:620-627.
Google Scholar
 
 
80.
Reid SM, Johnstone BR, Westbury C, Rawicki B, Reddihough DS. Randomized trial of botulinum toxin injections into the salivary glands to reduce drooling in children with neurological disorders. Dev Med Child Neurol 2008; 50:123-128.
Google Scholar
 
 
81.
Stern Y, Feinmesser R, Collins M, Shott SR, Cotton RT. Bilateral submandibular gland excision with parotid duct ligation for treatment of sialorrhea in children: long-term results. Arch Otolaryngol Head Neck Surg 2002; 128:801-803.
Google Scholar
 
 
82.
Elpern EH, Scott MG, Petro L, Ries MH. Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest 1994; 105:563-566.
Google Scholar
 
 
83.
Abraham SS, Wolf EL. Swallowing physiology of toddlers with long-term tracheostomies: a preliminary study. Dysphagia 2000; 15:206-212.
Google Scholar
 
 
84.
Takamizawa S, Tsugawa C, Nishijima E, Muraji T, Satoh S. Laryngotracheal separation for intractable aspiration pneumonia in neurologically impaired children: experiencewith 11 cases. J Pediatr Surg 2003; 38:975-977.
Google Scholar
 
 
85.
Jadcherla SR, Gupta A, Stoner E, Coley B, Wiet G, Shaker R. Novel non-invasive technique for evaluation of glottis motion in infants and children: comparison of ultrasonography (USG) and transnasal endoscopic approach. Gastroenterology 2005; 128:Suppl 2:A300.
Google Scholar
 
 
86.
Stern Y, Feinmesser R, Collins M, Shott SR, Cotton RT. Polystyrene microspheres as a specific marker for the diagnosis of aspiration in hamsters. Am J Respir Crit Care Med 2002; 27:511-514.
Google Scholar
 
 
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