Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment

Abstract

BACKGROUND AND OBJECTIVE: Children with neurologic impairment (NI) are commonly hospitalized for different types of pneumonia, including aspiration pneumonia. We sought to compare hospital management and outcomes of children with NI diagnosed with aspiration versus nonaspiration pneumonia.

Diagnostic Testing and Hospital Outcomes of Children with Neurologic Impairment and Bacterial Pneumonia

“…1 Infants <1 year of age were excluded as many neurologic impairment diagnoses (eg, cerebral palsy) are not assigned until an older age. As in our prior work, 10 hospitalizations for pneumonia were identified based on previously validated methods using principal ICD-9-CM diagnosis codes for pneumonia (480.0-2, 480.8-9, 481, 482.0, 482.30-2, 482.41-2, 482.83, 482.89-90, 483.8, 484.3, 485, 486, 487.0) and pulmonary effusion/empyema (510.0, 510.9, 511.0-1, 511.8-9, 513), 9 as well as ICD-9-CM codes for aspiration pneumonia (507.x). For children with multiple hospitalizations, 1 admission was randomly selected for inclusion to minimize the chance of biasing the findings with a small group of children who experienced a large number of admissions.…”

“…Nine neurologic impairment categories were assessed: (1) static neurologic disease; (2) progressive neurologic disease; (3) anatomic abnormality; (4) epilepsy; (5) genetic or metabolic condition; (6) cerebrovascular disease; (7) peripheral neurologic disease; (8) behavioral; and (9) not otherwise specified/other. 1,10 These neurologic impairment categories are not mutually exclusive (ie, patients may have diagnoses in multiple categories). Underlying medical comorbidities included the number of non-neurologic complex chronic conditions (CCCs) 14 endured by each patient and assistance with medical technology.…”

Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy

“…Perhaps the largest limitation of the current study the reliance on accurate coding of bRTIs in the PHIS database. To define our outcome of interest, we only labeled follow‐up visits as due to a bRTI if they had appropriate ICD‐9‐CM codes and treatment with antibiotics used in previous studies . Unfortunately, PHIS does not provide any microbiology testing results and we are unable to detect bacterial culture or gram stain results, limiting our ability to assess for acute infection versus chronic colonization.…”

Dirichlet‐multinomial modelling outperforms alternatives for analysis of microbiome and other ecological count data

“…These authors characterized the bacterial assemblages in the lungs (obtained via bronchoalveolar lavage; BAL), gastric fluid, and oropharyngeal region (OR) of each subject via sequencing of the 16S locus. Aspiration is linked to pneumonia in both adults and children (Holas, DePippo, & Reding, ; Marik, ; Thomson et al, ), but the provenance of aspirated microbes is poorly understood. Duvallet et al () showed that the lung microbiome of patients with difficulty swallowing is more similar to the microbiome of the oropharyngeal region than that of gastric fluid.…”

“…To understand how DMM could affect inferences made using previously published, empirical data, we analyzed data from Duvallet et al to pneumonia in both adults and children (Holas, DePippo, & Reding, 1994;Marik, 2001;Thomson et al, 2016), but the provenance of aspirated microbes is poorly understood. Duvallet et al (2019) showed that the lung microbiome of patients with difficulty swallowing is more similar to the microbiome of the oropharyngeal region than that of gastric fluid.…”