Awake upper airway obstruction in children with spastic quadriplegic cerebral palsy.
OBJECTIVE
Some children with severe cerebral palsy develop symptoms of upper airway obstruction (UAO) while awake. The aetiology, natural history and treatment of this complication have not previously been systematically described. This study documents a case series of children with severe cerebral palsy admitted to hospital because of severe awake UAO and reviews the relevant literature.


METHODS
The case records of children admitted to hospital with UAO while awake over an 8-month period were reviewed. Details of antecedent illness, comorbidities, acute management and follow up were collated. One case is presented in detail.


RESULTS
Eight children were admitted with UAO. Seven children required intensive care admission. One child died, and two underwent tracheostomy. Nasendoscopy showed pharyngeal collapse without anatomical obstruction in the majority. One child was discovered to have a brainstem malignancy.


CONCLUSIONS
Upper airway obstruction is a potentially severe and life-threatening complication of cerebral palsy. In this series, a majority of children had obstruction related to pharyngeal hypotonia and collapse. This can lead to prolonged hospitalization and intensive care admission. It may raise difficult management issues.
Department of Child Development and Rehabilitation, Royal Children's Hospital, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
Dominic J
DJ
Wilkinson
Gordon
G
Baikie
Robert G
RG
Berkowitz
Dinah S
DS
Reddihough
D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002547:Cerebral Palsy; D002648:Child; D006801:Humans; D007830:Larynx / Q000503:physiopathology; D008297:Male; D011782:Quadriplegia; D012189:Retrospective Studies; D014739:Victoria