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Drooling, Aspiration, and Oesophageal Problems
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Laryngomalacia is typically associated with coexisting reflux. It is unclear if it is causative, although the increased work of breathing can make it self-perpetuating. Reflux has also been linked with: Subglottic stenosis—gastric acid in the presence of mucosal trauma (i.e. endotracheal intubation) may lead to stenosis. This is important when considering laryngotracheal reconstruction, because reflux exposure may affect wound healing.Apparent life-threatening events (ALTEs).Recurrent croup.Recurrent respiratory papillomatosis (reflux is thought to affect the rate of recurrence).Anterior commissure web formation.
Emergencies, accidents, non-accidental injury and the law
Published in Rachel U Sidwell, Mike A Thomson, Concise Paediatrics, 2020
Rachel U Sidwell, Mike A Thomson
Apparent life-threatening events are unexpected episodes in infants that may involve: ApnoeaUnresponsivenessChokingCentral cyanosis or pallor
Reflux and Eosinophilic Oesophagitis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
An apparent life-threatening event (ALTE) is an episode of apnoea, choking or gagging that to the caregiver appears to be a near-death episode. Over half may be associated with reflux33 although the significance of this is uncertain.
Spontaneous neonatal subdural haemorrhage: always non-accidental injury?
Published in British Journal of Neurosurgery, 2020
Adikarige Haritha Dulanka Silva, Lara Gander, Haren Wijesinghe, Desiderio Rodrigues
These issues certainly make the finding of retinal haemorrhages in the context of any neonate or infant presenting with ASDH a difficult conundrum. The systematic review from the Royal College of Paediatrics and Child Health13 provides the most upto date guidance on this issue and addresses most concerns, namely that:Meta analysis provides a high association with retinal haemorrhage and abusive head trauma (AHT) (odds ratio = 15.3 with 95% CI 18.8–25.7)Retinal haemorrhages are rare with accidental trauma and most associated with high impact head injury or crush injuryWhilst bleeding disorders are a recognised cause for retinal haemorrhages, no substantive evidence exists for the putative association of retinal haemorrhages with apparent life-threatening events, prolonged cough, seizures and cardio-pulmonary resuscitation, although larger scale studies are warrantedWith infants <42 days of age being investigated with suspected abuse with retinal haemorrhages, consideration should be given as to whether these have occurred as a consequence of delivery (with the commonest mode of delivery associated being either vacuum delivery on its own or with failed forceps delivery)
Clinical considerations when treating neonatal aspiration syndromes
Published in Expert Review of Respiratory Medicine, 2019
Andrea Calkovska, Daniela Mokra, Vladimir Calkovsky, Katarina Matasova, Mirko Zibolen
When it comes to aspiration, nutritive swallowing is a critical moment, with fine coordination between swallowing and breathing required. In the second swallowing phase, a contraction of about 20 pairs of pharyngeal and laryngeal muscles with short apnea takes place. Centers for swallowing and respiratory control are situated close to each other in the brainstem, with this anatomical proximity facilitating coordination [25]. Coordination between swallowing and breathing matures in the 32nd – 36th week of gestation [26]. Neural immaturity of the newborn impairs coordination. Preterm infants swallow preferentially at different phases of respiration than full-term neonates [27]; as such, they are more threatened by apneas of prematurity and apparent life-threatening events of infancy, via LCR or tracheal aspiration [28].
Safety evaluation of the DTaP5-IPV-Hib-HepB vaccine: a review
Published in Expert Opinion on Drug Safety, 2022
Francesca Fortunato, Domenico Martinelli, Pier Luigi Lopalco, Rosa Prato
In the overall analysis, serious adverse events related to study vaccines, occurring after any vaccination dose, were reported in 9 subjects in the DTaP5-IPV-Hib-HepB group. These events included febrile convulsion (1 subject), idiopathic thrombocytopenic purpura (1), prolymphocytic leukemia (1), hypotonia (1), apparent life-threatening event (1), abdominal pain and crying (1), and fever ≥39.5°C (3) [16]. Three additional subjects had serious adverse events (intussusception, diarrhea, and gastroenteritis) which were considered exclusively related to the concomitantly administered rotavirus vaccine (RotaTeq®, manufacturer Merck Sharp and Dohme B.V., marketing authorization holder MSD VACCINS) [7].