Inhalation pneumonitis in children with severe cerebral palsy

© 1999 Dr. Gordon BaikieAspiration occurs frequently in children with severe cerebral palsy. Our study demonstrated at least one positive test for aspiration in 68% of children. The salivagram was positive in 56%, the barium video-fluoroscopy in 39%, and the milk scan in only 6%. The study demonstrates poor agreement between radiological tests of aspiration. This suggests that the tests measure different aspects of swallowing, that the intermittent nature of aspiration results in poor agreement, or that the tests are poor measures of aspiration. Positive radiological tests of aspiration are associated with a history from parents that the child has asthma and with poorer motor skills. A history of cough or wheeze, of cough with feed, of regurgitation and of recent asthma are associated with positive tests. Poorer overall adaptive ability, smaller head circumference centile, higher resting respiratory rate and abnormal measures of gastro-oesophageal reflux are associated with positive tests of aspiration. Chronic respiratory acidosis occurred in some children. Our study of this abnormality was hampered by the problem of defining normal values, and the appropriate reference range for our methodology. Using the Arbus nomogram definition of chronic respiratory acidosis we found an association between chronic respiratory acidosis and larger angle of scoliosis, poorer clearance of aspiration from the lung on salivagram, poorer clearance of acid from the oesophagus on pH probe, a history of pneumonia, and better weight for height Z score. Gastro-oesophageal reflux is associated with aspiration as mentioned. Both younger age and decreasing levels of ability are associated with greater frequency of gastro-oesophageal reflux. A history of asthma, regurgitation, a parental impression that the child aspirates but not a history of vomiting, were more frequent in children with gastro-oesophageal reflux. Altered voice following liquid feeding was associated with gastro-oesophageal reflux. We found less gastro-oesophageal reflux amongst children with more severe scoliosis, though this may have been the result of inadequate probe placement. There is poor agreement between the pH probe and milk scan in the diagnosis of gastro-oesophageal reflux