Pediatrik Nöroloji Hastalarında Solunum Yolu Sorunları
Özet
Nörolojik hastalığı olan çocuklarda solunum sistemi problemleri, morbidite ve mortalitenin en önemli nedenlerini oluşturmaktadır. Yutma bozuklukları, gastroözefageal reflü ve solunum kaslarındaki güçsüzlük gibi faktörler, tekrarlayan akciğer enfeksiyonlarına ve kronik solunum yetmezliğine zemin hazırlamaktadır. Hastaların yaşam kalitesini artırmak için multidisipliner bir yaklaşım benimsenerek solunum fizyoterapisi, uygun beslenme yöntemleri ve gerektiğinde mekanik ventilasyon desteği ile erken müdahale kritik öneme sahiptir.
Respiratory issues represent a primary cause of morbidity and mortality among children with neurological impairments. Factors such as swallowing dysfunction, gastroesophageal reflux, and respiratory muscle weakness predispose these patients to recurrent pulmonary infections and chronic respiratory failure. Improving patient quality of life requires a multidisciplinary approach, prioritizing early intervention through respiratory physiotherapy, optimized nutritional management, and mechanical ventilation support when necessary.
Referanslar
Hollins S, Attard MT, von Fraunhofer N, et al. Mortality in people with learning disability: risks, causes and death certification findings in London. Dev Med Child Neurol1998;40:50–6.
Plioplys AV, Kasnicka I, Lewis S, et al. Survival rates among children with severe neurological disabilities. South Med J 1998;91:161–72.
Young NL, McCormick AM, Gilbert T, et al. Reasons for hospital admissions among youth and young adults with cerebral palsy. Arch Phys Med Rehabil 2011; 92: 46–50.
Veugelers R, Calis EA, Penning C, et al. A population-based nested case control study on recurrent pneumonias in children with severe generalized cerebral palsy: ethical considerations of the design and representativeness of the study sample. BMC Pediatr 2005; 5: 25
Reddihough DS, Baikie G, Walstab JE. Cerebral palsy in Victoria, Australia: mortality and causes of death. J Paediatr Child Health 2001; 37: 183–186.
Karatas AF, Miller EG, Miller F, et al. Cerebral palsy patients discovered dead during sleep: experience from a comprehensive tertiary pediatric center. J Pediatr Rehabil Med 2013; 6: 225–231.
Morton RE, Wheatley R, Minford J. Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability. Dev Med Child Neurol 1999; 41: 329–334.
Seddon PC, Khan Y. Respiratory problems in children with neurological impairment. Arch Dis Child. 2003;88:75-78.
Panitch HB. The pathophysiology of respiratory impairment in pediatric neuromuscular diseases. Pediatrics.2009;123:S215–8.
Escobar Henríquez R., Chateau Infante B. Respiratory Complications in Children with Neurological Diseases. In: Bertrand P., Sánchez I. (eds) Pediatric Respiratory Diseases. Springer, Cham 2020. p 245-253
Benditt JO, Boitano LJ. Pulmonary issues in patients with chronic neuromuscular disease. Am J Respir Crit Care Med. 2013;187:1046–55.
Casas MJ, Kenny DJ, McPherson KA. Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy. Dysphagia1994;9:40–6.
Mirrett PL, Riski JE, Glascott J. Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy. Dysphagia1994;9:174–9.
Rogers B, Stratton P, Msall M, et al. Long-term morbidity and management strategies of tracheal aspiration in adults with severe developmental disabilities. Am J Ment Retard1994;98:490–8.
Gustafsson PM, Tibbling L. Gastro-oesophageal reflux and oesophageal dysfunction in children and adolescents with brain damage. Acta Paediatr 1994;83:1081–5.
Abrahams P, Burkitt BF. Hiatus hernia and gastrooesophageal reflux in children and adolescents with cerebral palsy. Aust Paediatr J 1970;6:41–6.
Arvedson J, Rogers B, Buck G, et al. Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 1994;28:173–81.
Khan Y, Heckmatt JZ. Obstructive apnoeas in Duchenne muscular dystrophy. Thorax 1994;49:157–61.
Bohn D, Armstrong D, Becker L, et al. Cervical spine injuries in children. J Trauma1990;30:463–5.
Jenkins JG, Bohn D, Edmonds JF, et al. Evaluation of pulmonary function in muscular dystrophy patients requiring spinal surgery. Crit Care Med 1982;10:645.
Noble-Jamieson CM, Heckmatt JZ, Dubowitz V, et al. Effects of posture and spinal bracing on respiratory function in neuromuscular disease. Arch Dis Child 1986; 61: 178–181.
Brouillette RT, Thach BT. A neuromuscular mechanism maintaining extra-thoracic airway patency. J Appl Physiol 1979;46:772–9.
Kortagal S, Gibbons VP, Stith JA. Sleep abnormalities in patients with severe cerebral palsy. Dev Med Child Neurol1994;36:304–11.
Smith PEM, Calverley PMA, Edwards RHT. Hypoxemia during sleep in Duchenne muscular dystrophy. Am Rev Respir Dis1988;137:884.
Begin R, Bureau MA, Lupien L, et al. Control of breathing in Duchenne’s muscular dystrophy. Am Rev Respir Dis1980;69:227–34.
Beckerman RC, Hunt CE. Neuromuscular diseases. In: Beckerman RC, Brouillette RT, Hunt CE, eds. Respiratory control disorders in infants and children. Baltimore: Williams &Wilkins, 1992:251–70.
Fauroux B, Guillemot N, Aubertin G, Nathan N et al. Physiologic benefits of mechanical insufflation exsufflation in children with neuromuscular diseases. Chest 2008;133:161–168.
Culebras A, Kelly JJ. Sleep disorders and neuromuscula rdiseases. Rev Neurol Dis 2008;5:153–158.
Kotagal S, Gibbons VP, Stith JA. Sleep abnormalities in patients with severe cerebral palsy. Dev Med Child Neurol 1994; 36: 304–311.
Rommel N, Omari T. Abnormal pharyngoesophageal function in infants and young children: diagnosis with high resolution manometry. J Pediatr GastroenterolNutr2011; 52:29–30.
Strickland SL, Rubin BK, Drescher GS, et al. AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respir Care 2013; 58: 2187–2193.
Plioplys AV, Lewis S, Kasnicka I. Pulmonary vest therapy in pediatric long-termc are. J Am Med Dir Assoc 2002; 3: 318–321.
Yuan N, Kane P, Shelton K, et al. Safety, tolerability, and efficacy of high-frequency chest wall oscillation in pediatric patients with cerebral palsy and neuromuscular diseases: an exploratory randomized controlled trial. J Child Neurol 2010; 25: 815–821.
Livingston MH, Shawyer AC, Rosenbaum PL, et al. Fundoplication and gastrostomy versus percutaneous gastrojejunostomy for gastroesophageal reflux in children with neurologic impairment: a systematic review and metaanalysis. J Pediatr Surg 2015; 50: 707–714.
Takano K, Kurose M, Mitsuzawa H, et al. Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability. Acta Otolaryngol 2015; 135: 1304–1310.
Formeister EJ, Dahl JP, Rose AS. Surgical management of chronic sialorrhea in pediatric patients: 10-year experience from one tertiary care institution. Int J Pediatr Otorhinolaryngol 2014; 78: 1387–1392.
Mahadevan M, Gruber M, Bilish D, et al. Botulinum toxin injections for chronic sialorrhoea in children are effective regardless of the degree of neurological dysfunction: A single tertiary institution experience. Int J Pediatr Otorhinolaryngol 2016; 88: 142–145.
Sharma S, Wu C, Andersen T, et al. Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 2013; 22: 1230–1249.
Hsiao KH, Nixon GM. The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy. Res Dev Disabil 2008; 29: 133–140.
Kontorinis G, Thevasagayam MS, Bateman ND. Airway obstruction in children with cerebral palsy: need for tracheostomy? Int J Pediatr Otorhinolaryngol 2013; 77: 1647–1650.
Smith PE, Edwards RH, Calverley PM. Oxygen treatment of sleep hypoxaemia in Duchenne muscular dystrophy. Thorax. 1989;44:997-1001.
Raphaelson M, Inati SK. Treating sleep disorders in neurology practice. Neurol Clin. 2012;30:1007-25.
