Milk aspiration pneumonia

　　The main causes of milk aspiration pneumonia include the following points:

　　1. Swallowing disorders:Infants have immature swallowing reflexes and uncoordinated swallowing movements, making them prone to milk aspiration. Brain injury or cranial nerve lesions can also cause delayed or incomplete swallowing reflexes. The emptying time of milk in the pharynx is prolonged, and sometimes due to uncoordinated neuromuscular activity in the pharynx, part of the milk enters the esophagus during swallowing, part flows out through the nasal cavity, and part is inhaled into the respiratory tract, causing pneumonia.

　　2. Esophageal malformation:When the esophagus is atresia, milk cannot enter the stomach through the esophagus and stays in the pharynx, along with saliva, and is inhaled into the lungs. If there is only a tracheoesophageal fistula, milk can directly enter the lungs through the fistula. However, sometimes the fistula is very small and not easy to find.

　　3. Incomplete esophageal function:Milk enters the esophagus and then refluxes to the pharynx before being inhaled. For example, infants with relaxed esophageal sphincters are prone to aspiration after vomiting, and sometimes reflux can also be caused by esophageal neuromuscular coordination.

　　4. Severe cleft palate, hare lip cleft:Generally, it does not affect swallowing, but severe defects may cause difficulty in suckling, which can lead to aspiration.

　　After milk is aspirated into the alveoli, the lung tissue shows an inflammatory reaction, with neutrophils, phagocytes, and red blood cells exuding a few hours later, thickening of the alveolar wall, and obvious interstitial inflammation. After several weeks, fibrosis appears, and if aspiration occurs repeatedly, it can present as chronic interstitial pneumonia.

　　Children often have complications such as bronchitis, pneumonia, and even asphyxia. Long-term retrograde aspiration can lead to interstitial pneumonia, pulmonary fibrosis, and bronchiectasis. Severe cases may have respiratory failure and heart failure. Mild cases have shortness of breath during activity, and severe cases have asthma that cannot lie flat, dark complexion, and edema of the face and feet, which are due to lung and kidney deficiency caused by long-term illness, leading to lung deficiency in the inability to descend Qi, and kidney deficiency in the inability to descend Qi, and other complications. White sticky sputum, or white frothy sputum, more sputum in the morning and evening. When complicated with infection, the amount of sputum increases, and it is mucopurulent sputum. Long-term repeated coughing, vomiting, and other symptoms.

　　1. Symptoms of the primary disease causing aspiration

　　If milk from infants with swallowing dysfunction flows out of the nose, coughing occurs at the same time, and sometimes cyanosis appears. Infants with a blind end of the esophagus, due to milk staying in the pharynx, there is a sputum sound during breathing. Children with esophagotracheal fistula have hiccups, shortness of breath, and cyanosis during feeding. Those with incomplete esophageal function are prone to regurgitation.

　　2. Respiratory system symptoms and signs

　　The severity is related to the amount and frequency of aspiration. Less aspiration or accidental aspiration is mainly bronchitis, with symptoms such as cough, asthma, and shortness of breath. When aspiration is large, pneumonia occurs. A large amount of aspiration at one time can cause asphyxia, respiratory arrest, and after resumption of breathing, there is obvious shortness of breath and a lot of rales in the lungs. Long-term repeated aspiration can lead to atelectasis pneumonia, eventually leading to pulmonary fibrosis or concurrent bronchiectasis. Severe cases may have respiratory failure and heart failure. Mild cases have shortness of breath during activity, and severe cases have asthma that cannot lie flat, dark complexion, and edema of the face and feet, which are due to lung and kidney deficiency caused by long-term illness, leading to lung deficiency in the inability to descend Qi, and kidney deficiency in the inability to descend Qi, and other complications. White sticky sputum, or white frothy sputum, more sputum in the morning and evening. When complicated with infection, the amount of sputum increases, and it is mucopurulent sputum. Long-term repeated coughing, vomiting, and other symptoms.

　　3. X-ray manifestation

　　In the early stage, due to foreign body stimulation of the bronchus, spasm occurs, but it is not completely blocked. X-ray shows extensive emphysema and bronchitis changes, widening of the hilum shadow, thickening of pulmonary vessels or appearance of inflammatory patchy shadows. Repeated aspiration involving the interstitium can form interstitial pneumonia.

　　To avoid milk aspiration pneumonia, when feeding preterm infants and low birth weight infants, great attention should be paid to the breastfeeding position, following the principle of 'elevate the head of the bed, feed in accordance with the amount'. Generally speaking, infants weighing less than 1500 grams with poor swallowing reflex should be fed by nasogastric tube until the swallowing reflex is corrected, and then fed with a nipple. For children with digestive tract malformations, it is necessary to receive early hospital surgery to avoid unintended consequences.

　　The examination items include: chest X-ray, chest CT examination, and blood routine.
　　1.Peripheral blood leukocyte count increases, neutrophil count increases, and those with cyanosis should follow up with blood gas examination.
　　2.X-ray manifestation: In the early stage, due to foreign body stimulation of the bronchus, spasm occurs, but it is not completely blocked. X-ray shows extensive emphysema and bronchitis changes, widening of the hilum shadow, thickening of pulmonary vessels or appearance of inflammatory patchy shadows. Repeated aspiration involving the interstitium can form interstitial pneumonia.

　　New mothers should learn the correct feeding method. First, before each feeding, the baby should be given a clean and dry diaper, and the mother should wash her hands first with warm water and then clean the nipple. The mother should be in a comfortable position during feeding to reduce fatigue, hold the baby face down on the mother's side, with the mouth and chin close to the breast. The mother should use the index and middle fingers to support the breast, and completely insert the nipple and areola into the baby's mouth. Pay attention not to block the baby's nostrils to avoid affecting breathing. The baby's suckling action is slow and strong, and the mother's milk will flow out in large quantities. At this time, the mother can use her fingers to block it or pause for a moment to prevent the baby from choking. The mother should sit up and not lie down to feed the baby.
　　Feeding time per feeding: Each breast can be fed for 5 to 15 minutes. Because the milk ejection reflex of breast milk takes at least 3 minutes, 75% is emptied within 5 minutes, and 90% is emptied within 10 minutes. Both breasts should be emptied during each feeding, and one side should be emptied before the other. The feeding time should be 15 to 20 minutes, not exceeding 30 minutes. Because long feeding times can make newborns develop the habit of slow feeding, and it is also not conducive to promoting milk secretion. After feeding, the baby can be held upright and gently tapped on the back to expel air, and then the baby should be placed on the side to prevent aspiration of milk into the trachea.
　　Methods to judge if the baby is full: From the mother's breast feeling, the breasts are fuller before feeding, softer after feeding, and the mother has a let-down feeling. From the baby's situation, you can hear several to ten times of swallowing sounds; the baby is quiet and satisfied during the interval between feedings; the baby gains an average of more than 125 grams per week; the baby's stool is soft and golden in color, with 2 to 4 bowel movements a day, and the diaper is wet for 6 times or more in 24 hours, which indicates that the baby is full.

　　Immediately insert an endotracheal tube and aspirate the milk in the trachea. Strengthen nursing care, pay attention to keeping warm, and ensure that the respiratory tract is unobstructed. Initially, intravenous nutrition should be provided, and after the condition improves, feeding should be done through the nose or mouth. Antibiotics should be used to prevent secondary infections, and treatment should be given for the underlying causes.