ASPIRATION PNEUMONIA

Ayu Setyorini M Mayangsari

 DEFINITION
• Pneumonia that result from passage of the
oropharyngeal, esophageal or stomach
contents into the lower respiratory tract

Acute Chronic
 RISK FACTOR
• Temporary or permanent depressed
consciousness due to neurologic disease,
debilitation, anesthesia, or drugs
• Deglutition abnormality (newborn,
neuromuscular disorder)
• Congenital malformations (H type TEF, laryngeal
cleft, palatal cleft)
• Gastroesophageal reflux esp in laryngomalacia
• Accidental aspiration of large amounts of gastric
contents  seizzure, vomiting
 Contributing factors to growth and
virulence of oral flora
• Poor oral hygiene
• Gingivitis
• Periodontitis
• Oral candidiasis
• Longterm hospitalization, longterm
administration of antibiotic or H2 blocker 
higher risk
 MICROORGANISM
• Higher possibility of anaerobic bacteria that
living in oral cavity
– Fusobacterium spp. (especially F. nucleatum),
– Pigmented Prevotella
– Porphyromonas spp.
– Prevotella oralis
– Peptostreptococcus spp.
 PATHOPHYSIOLOGY
• Aspirate  inflammatory response of the airways
• The intensity of response related to the composition
of the aspirated substance
– Low pH  more is more inflammatory reaction
– Inert materials usually produce less inflammation
• Loss of ciliated epithelium  reduces the defenses of
the respiratory epithelium  predispose to infection
• If the insult is recurrent  not be sufficient time for
healing  chronic respiratory symptom ex.
bronchiectasis
 CLINICAL MANIFESTATION
• The symptoms resembled pneumonia
• Always think of this when the pneumonia is
reccurent
• Cough during or after feeding
• The onset of the infection is sometimes more
insidious  Weeks to months of malaise,
low-grade fever, and cough, with significant
weight loss and anemia, may precede
consolidation
• Most frequent involvement are lung
dependent area
– Posterior segments of the upper lobes and upper
segments of the lower lobes with the child in
dorsal decubitus
– The basal segments of the lower lobes are more
commonly affected with the child sitting upright
 MANAGEMENT
• THE SAME LIKE MANAGEMENT OF
PNEUMONIA ONLY WITH INCREASED RATE TO
ADD METRONIDAZOLE
• Bronchoscopy :
– Direct visualization
– Diagnostic : Obtain bronchoalveolar lavage (BAL)
 macrophages heavily laden with lipid
• Feeding management :
– Do not breastfeed while the infant in supine
position
– Small but frequent feeding
– Increased the thickness of food
– Nasogastric feeding (have some dx value too)
• GERD management
• Correct the structural anomaly
 COMPLICATION
• Lung abscess due to higher possibility of
anaerobic microorganism