Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy

Manrique, Dayse; Sato, Juliana

doi:10.1016/j.ijporl.2009.05.002

Cited by 21 publications

(21 citation statements)

References 17 publications

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“…Moreover, treatment of excessive saliva production in neurologically impaired children results in improvement of respiratory symptoms. [22][23][24] This study showed no association between lipid laden macrophage index and BAL amylase. This lack of correlation could be due to differences in accuracy between the two tests.…”

Section: Figcontrasting

confidence: 51%

Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children

Abu-Hasan

ElMallah

Neal

et al. 2014

Pediatric Allergy, Immunology, and Pulmonology

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Background: Chronic pulmonary aspiration is a common cause of chronic respiratory symptoms in children. However, there is no gold standard diagnostic test for aspiration. In this study, we explore the diagnostic value of measuring salivary amylase in bronchoalveolar lavage (BAL) fluid as a marker of chronic aspiration in children with different chronic respiratory illnesses. Methods: Measurements of salivary amylase in BAL fluid were routinely done in patients undergoing flexible bronchoscopy. Patients' demographic and clinical data were extracted from records and reviewed by one of the investigators. Patients were classified into three different groups based on the reviewer's assessment of risk for aspiration. BAL amylase measurements were masked from the reviewer. Multiple regression analysis was used to determine the effect of the patients' clinical variables on BAL amylase. Results: Sixty-four patients (median age 2 years; range 0-14 years) were included. Indications for bronchoscopy included chronic cough (n = 20), chronic wheezing (n = 27), Cystic Fibrosis (n = 6), recurrent pneumonia (n = 5), and lung infiltrate in immunocompromised patients (n = 6). Young age, history of excessive drooling, and wet cough were predictive of high BAL amylase. Thirteen patients were considered at no risk of aspiration, 41 patients were at low risk, and 10 patients were at high risk based on clinical symptoms and other diagnostic tests. No significant differences in BAL amylase levels were found between the three groups. However, when high and low risk groups were combined and compared to the no risk group, there was a significantly higher BAL amylase level in the combined at risk groups (1,722 vs. 307 U/L; p = 0.03). Receiver operator curve analysis demonstrated that amylase cutoff value of 250 U/L differentiates between the two risk groups with sensitivity of 66.7% and specificity of 69.2%. Conclusion: Salivary amylase level in BAL can help identify children at risk for chronic pulmonary aspiration.

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Section: Figcontrasting

confidence: 51%

Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children

Abu-Hasan

ElMallah

Neal

et al. 2014

Pediatric Allergy, Immunology, and Pulmonology

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“…27 There is evidence from uncontrolled trials that salivary gland botulinum neurotoxin A [29][30][31][32] and salivary gland surgery may reduce respiratory infections. [33][34][35] Optimizing airway clearance There is evidence from uncontrolled trials that surgery to improve upper airway obstruction improves blood oxygen levels, 36,37 and sleep disturbance and daytime function, 38 but no evidence about its effects on preventing respiratory illness. Most spinal deformities in children with CP involve neuromuscular scoliosis.…”

Section: Identifying and Preventing Aspirationmentioning

confidence: 99%

“…There is evidence from uncontrolled trials that salivary gland botulinum neurotoxin A 29–32 and salivary gland surgery may reduce respiratory infections 33–35 …”

Section: Part 1: Recognizing and Managing Risks To Prevent Respiratormentioning

confidence: 99%

Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement

Gibson

Blackmore²,

Chang

et al. 2020

Develop Med Child Neuro

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Respiratory illness is the leading cause of mortality in children with cerebral palsy (CP). Although risk factors for developing chronic respiratory illness have been identified, comprehensive clinical care recommendations for the prevention and management of respiratory illness do not currently exist. We invited over 200 clinicians and researchers from multiple disciplines with expertise in the management of respiratory illness in children with CP to develop care recommendations using a modified Delphi method on the basis of the RAND Corporation-University of California Los Angeles Appropriateness Method. These recommendations are intended for use by the wide range of practitioners who care for individuals living with CP. They provide a framework for recognizing multifactorial primary and secondary potentially modifiable risk factors and for providing coordinated multidisciplinary care. We describe the methods used to generate the consensus recommendations, and the overall perspective on assessment, prevention, and treatment of respiratory illness in children with CP.

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“…Data about surgical treatments are conflicting. Some authors reported that surgical saliva reduction was effective in reducing respiratory infections, but others found no significant reduction in respiratory infections . The usefulness of oral motor therapy has not been systematically studied in children with CP.…”

Section: Recurrent Aspirationmentioning

confidence: 99%

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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Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy

Cited by 21 publications

References 17 publications

Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children

Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children

Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement

Respiratory morbidity in children with cerebral palsy: an overview

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