The lifetime risk of pneumonia in patients with neuromuscular scoliosis at a mean age of 21 years: The role of spinal deformity surgery

Keskinen, Heli; Lukkarinen, Heikki; Korhonen, Katariina; Jalanko, Tuomas; Koivusalo, Anna-Maria; Helenius, Ilkka

doi:10.1007/s11832-015-0682-8

Cited by 20 publications

(24 citation statements)

References 30 publications

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“…Sewell et al report a postoperative improvement in activity and participation in children with CP (GMFCS levels IV and V) and significant scoliosis. In patients with idiopathic scoliosis, surgery may improve pulmonary function, but these data are lacking concerning patients with CP, although this is one of the goals for this surgery . Another purpose for scoliosis surgery in patients with CP is to decrease the incidence of pneumonia; however, there is little evidence that this is the case .…”

Section: Recurrent Aspirationmentioning

confidence: 99%

“…43,47 Another purpose for scoliosis surgery in patients with CP is to decrease the incidence of pneumonia; however, there is little evidence that this is the case. 47 A recent systematic review concluded that there is only limited high-quality evidence for outcomes after scoliosis surgery in children with CP and that this procedure is associated with a moderately high complication rate. The intervention appears to be indicated for deformity correction, but currently there is insufficient evidence to make recommendations for this surgery as a way to also improve functional outcomes, caregiver outcomes, and quality of life.…”

Section: Deformity Of the Spine And Chest Wallmentioning

confidence: 99%

“…In patients with idiopathic scoliosis, surgery may improve pulmonary function, but these data are lacking concerning patients with CP, although this is one of the goals for this surgery . Another purpose for scoliosis surgery in patients with CP is to decrease the incidence of pneumonia; however, there is little evidence that this is the case . A recent systematic review concluded that there is only limited high‐quality evidence for outcomes after scoliosis surgery in children with CP and that this procedure is associated with a moderately high complication rate.…”

Section: Recurrent Aspirationmentioning

confidence: 99%

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Respiratory morbidity in children with cerebral palsy: an overview

Boel

Pernet²,

Toussaint³

et al. 2018

Develop Med Child Neuro

121

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Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. What this paper adds Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

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Section: Recurrent Aspirationmentioning

confidence: 99%

Section: Deformity Of the Spine And Chest Wallmentioning

confidence: 99%

Section: Recurrent Aspirationmentioning

confidence: 99%

See 1 more Smart Citation

Respiratory morbidity in children with cerebral palsy: an overview

Boel

Pernet²,

Toussaint³

et al. 2018

Develop Med Child Neuro

121

View full text Add to dashboard Cite

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“…Surgery corrects deformity and improves child and carer QoL ( 90 ). However, motor function or risk of pneumonia do not improve ( 92 ). This is probably because motor function and respiratory illness antecede scoliosis.…”

Section: Risk Factors For Respiratory Illnessmentioning

confidence: 99%

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

et al. 2020

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Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.

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“…In one retrospective cohort, lifetime pneumonia risk was related to epilepsy, non-cerebral palsy causes and major scoliosis. However, the yearly incidence of pneumonia did not decrease after spinal surgery [ 49 ]. In a recently published retrospective cohort with early onset neuromuscular scoliosis, spinal fusion was associated with minimal short- and long-term morbidity, but there was 28% mortality at 10-year follow-up and 50% predicted mortality at 15 years [ 47 , 50 ].…”

Section: Treatmentmentioning

confidence: 99%

Respiratory illness in children with disability: a serious problem?

Proesmans

2016

Breathe

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Key pointsChildren with neurocognitive impairment often present with chronic or recurrent respiratory problems.The respiratory problems have an important impact on quality of life and life expectancy.The underlying causes are multiple: risk of aspiration, insufficient cough, upper airway obstruction and progressive kyphoscoliosis.There is often a complex interplay between these known risk factors.The diagnostic and therapeutic approach should be multidisciplinary.Educational aimsTo provide data on the prevalence of respiratory problems in children with disability and to increase awareness on this topic.To provide insight into the complex interplay of the underlying causes and risk factors for chronic lung infection and respiratory failure.To give an overview of the diagnostic approaches relevant in this context.To highlight possible therapeutic approaches.To touch on ethical considerations in this group of vulnerable and complex patients.

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The lifetime risk of pneumonia in patients with neuromuscular scoliosis at a mean age of 21 years: The role of spinal deformity surgery

Cited by 20 publications

References 30 publications

Respiratory morbidity in children with cerebral palsy: an overview

Respiratory morbidity in children with cerebral palsy: an overview

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

Respiratory illness in children with disability: a serious problem?

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