Children aspiration

Numerous case studies have described death following the accidental ingestion of kerosene by children (usually under the age of 5 but as old 15 years). The deaths are usually attributed to lipoidal pneumonia (Morrison and Sprague 1976 Santhanakrishnan and Chithra 1978 Zucker et al. 1986) that was probably induced by the aspiration of the kerosene. Specific respiratory effects associated with death from kerosene ingestion include pneumothorax (Mahdi 1988 Zucker et al. 1986), emphysema (Mahdi 1988), and pneumonitis (Singh et al. 1981). Cardiac arrhythmia was reported as the cause of death in one child however, it was suspected that myocarditis and pulmonary edema may have been the cause of the rapid deterioration and death of the child (Dudin et al. 1991). 

A 6-month-old child was breast-fed exclusively by a mother who had been a strict vegetarian for at least 7 years. He was totally unresponsive to stimuli. His hemoglobin was 5.7 g/dL, and his bone marrow aspirates showed megaloblastic changes in blood cells. His serum folate and iron were normal. His urine contained increased amounts of homocystine, methylmalonic acid, and glycine. Propose a reason for this infant s illness, and discuss its biochemical etiology. Discuss other possible reasons for the same or similar symptoms in a patient. Explain the abnormal serum and urine chemistries. 

Child 6-12 months Dose 5-10 ml (Position child in left lateral decubitus position to reduce risk of aspiration)... 

One 13-month-old boy died 8 days after immunization. Autopsy showed that the cause of death was aspiration of vomit. The most commonly reported neurological adverse events were febrile seizures. Epilepsy was diagnosed in three children sjmptoms manifested for the first time 1, 10, and 21 days after immunization. One child was later diagnosed as having severe Lennox-Gastaut syndrome medical records subsequent to the acute phase were not available for the other two. 

When all parental aspirations are centered on a single child, the pressure from that ambition can cause the boy or girl to try to do everything right, to be as successful as parents want, to demonstrate that he or she is after all, and first of all, the exceptional child they wanted. To strive to fulfill this unrealistic ideal, the only child must endure the twin pressures that perfectionism creates to live error-free (to avoid making mistakes at all costs), and to always excel (and not fail at all costs). 

Almost everyone who aspires to become a chemist does so from a love of science and a desire to help humankind. But the food chemist especially is devoted to helping people. Julia Child, one of the first chefs to have her own television program, said that a chef is one of the most generous and nurturing people in the world, because there is nothing more caring than to want to feed people. The same could be said of food chemists, who want to ensure the world s food supply, its safety and continuation. 

The funnel-shape of the cow horn makes it easy to use this form of treatment - however we must remember the report from Segal [19] in which the complications of rectal perforation and colitis are ascribed to the instruments and methods used to administer treatments rectally. The hollowed out reed is only used in children. Here the prescribed solution is first aspirated into the hollow reed and the blackened tip is inserted into the rectum. The sangoma will then blow through the hollow reed forcing the herbal medicine into the rectum of the child. 

The video esophagram, or modified barium swallow, is the standard technique to evaluate dysphagia. This examination is more sensitive than clinical evaluation of aspiration (DeMatteo et al. 2005), and is also more sensitive than the conventional upper GI series for the detection of aspiration (Vazquez and Buonomo 1999). A scout radiograph of the chest should be obtained to assess for evidence of aspiration. For the examination, the child must be securely... 

A pouchogram of the atretic proximal esophagus is not usually necessary because of the low incidence a fistula from the proximal pouch (Fig. 2.9). In addition, this is a dangerous procedure if improperly performed. Air or non-ionic isotonic contrast medium can be injected to distend the pouch (Fig. 2.10). Over distention of the pouch with contrast medium will invariably result in aspiration so only a small volume of contrast medium, not exceeding 1-2 ml, is injected into the blind-ending pouch with the child in the true lateral position. Contrast medium must be removed at the end of the procedure. 

A 22-G needle can be used for most therapeutic injections as it can reach most superficial musculoskeletal structures in children but a larger bore needle is usually required for aspiration. For therapeutic injections, usually a mixture of depomedrone and bupivacaine 0.5% is administered, with the dose varying according to the age of the child and the region being injected. 

Parenteral nutrition did not cause any evident local or general complications. Three premature infants of the first Test Series died between the fourth and sixth day of life however, none of their metabolic parameters differed from those found in the surviving children. The cause of death in two of the infants was extensive amniotic aspiration one child had severe hyaline membrane disease. 

Drng overdose Accidental aspiration of a cyanoacrylate adhesive by a toddler was complicated by tracheal and bronchial obstruction [47 ]. At bronchoscopy several pieces of glue were removed from both main-stem bronchi and the child made a full recovery. 

Most children are managed with NPPV (1,50). However, some require invasive ventilation through a tracheostomy. The main indications for a tracheostomy in children are airway abnormalities such as tracheobronchomalacia or tracheal stenosis, chronic disease of prematurity, and NMD (1,51,52). The indications for a tracheostomy are comparable to those of the adult population. They include the persistence of hypercapnia despite NPPV and additional measures such as daytime mouthpiece ventilation, aspiration, and bulbar dysfunction (53). In children, NPPV is more difficult to perform in those who might be 24-hour dependent, than in adults. Infants with primaiy alveolar hypoventilation (Ondine s curse) are preferentially ventilated by means of a tracheostomy (18). Tracheostomy ventilation favors airway inflammation (54) and may affect speech and language development (55). In children with progressive NMD, the decision of a tracheostomy has to be discussed on an individual basis, taking into account the familial environment and the parent s and child s perspective (52,56). In any case, sending children home with invasive ventilation is more difficult than when noninvasive ventilation is used (52). 

Most bacterial nosocomial lower respiratory tract infections occur by aspiration of bacteria that colonize the oropharynx or upper gastrointestinal tract of the child. Both intubation and mechanical ventilation alter or circumvent some of the patient s natural barrier defenses against infection. These interventions allow organisms from the oropharyngeal or upper gastrointestinal tract greater access to the lower respiratory tract. The aspiration of contaminated materials may be obvious or, more commonly, it is subclinical. The normal respiratory flora of children admitted to a hospital consists of both gram-positive and... 

Fedrizzi MS, Ronchezel MV, Hiliaro MO et al (1997) Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis. J Rheumatol 24 1820-1825 Fink AM, Berman L, Edwards D et al (1995) The irritable hip immediate ultrasound guided aspiration and prevention of hospital admission. Arch Dis Child 72 110-113 Frick SL (2006) Evaluation of the child who has hip pain. 

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