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considerations as are settings in which the aspiration occurs. Aspiration
pneumonias developing outside the hospital generally involve aerobes and are
adequately treated with ampicillin with or without sulbactam, or clindamycin.
Nosocomial infections following aspiration require broader aerobic and anaerobic
coverage. Ampicillin/sulbactam is used most commonly, although regimens such
as clindamycin and gentamicin have also been described. In neurologically
impaired children, with either aspiration or tracheostomy-associated pneumonia,
antibiotics effective against penicillin-resistant anaerobic bacteria and P.
aeruginosa have been shown to produce superior clinical and microbiologic
responses.
The use of corticosteroids in the treatment of aspiration pneumonia is
controversial. Because experimental evidence indicates no more than minimal
benefit and because the concomitant immune suppression may contribute the
development of secondary bacterial pneumonia, their administration is not usually
indicated in the ED.
Clinical Indications for Discharge or Admission
Children with significant aspiration pneumonia, diagnosed either by clinical
suspicion or radiograph, require admission to the hospital, particularly if there is
associated hypoxia or respiratory distress.

BRONCHOPULMONARY DYSPLASIA
CLINICAL PEARLS AND PITFALLS
Diagnosis is usually established prior to presentation to the ED.
Management involves supportive measures, including supplemental
oxygen, assurance of adequate hydration, and often bronchodilators.

Current Evidence
BPD is a chronic respiratory disease, usually occurring in premature infants. BPD
is a clinical diagnosis, requiring supplemental oxygen at a prescribed
postconceptual or chronologic age, with associated radiographic findings. The
definition continues to evolve, and therefore specifics of the diagnostic

parameters have changed over time.
The etiology of BPD is thought to be multifactorial. While newer data suggest
a genetic predisposition, previously defined risk factors include prematurity,
relatively long duration of supplemental oxygen therapy after birth, need for