40% of children. Similar results that chest wall deformity occurs in majority of patients with neuromuscular diseases 3-Methyladenine research buy were also presented by other authors, e.g. Healy, Mahon, Paschoal [7, 9, 24]. For some, not completely understood and researched reasons, GER appears to be more common, persistent, and severe in children with neurological impairment [6, 22, 25]. Neurological dysfunction and coexisting GER lead to vomiting, impairment of ventilation and aspiration of chyme. Any material

which refluxes may not be actively cleared as a result of disturbed peristalsis, and is more likely to be aspirated. As well as predisposing to chest infections, reflux episodes may provoke profound apnea and laryngeal spasm. Seddon and Khan estimated the incidence of GER in cerebral palsy from 32% to 75% [7]. In turn, Sullivan et al found GER in 1/3 of patients with chronic serious neurological impairment [22]. In our group GER was present in 43% of children, most frequently was diagnosed in patients with DD (67%) and with PE (48%). A high incidence in the first group may be TGF-beta inhibitor connected with the age range and the existence of physiological reflux and in some of these patients. A severe course of lower respiratory tract infections increases malnutrition, determined by, among others, the degree of nervous system dysfunction. According to Healy

malnutrition affects 40–80% of children with neurological diseases. Among our patients the body mass deficiency was present in 60%, most often in the groups with PE and CAODS. Malnutrition subjects the respiratory muscles to catabolism, leading to atrophy, weakness and reduced lung function; it also enables bacterial colonization of the airways and alters a resistance to infections. In such cases, cooperation between a gastrologist, physiotherapist and speech therapist is also necessary [6, 10, 11, 13, 19, 24]. The Selleckchem Nutlin 3 anamnesis frequently reveals in patients with neurological dysfunction prolonged hospitalizations in neonatal period [2, 5, 7, 21]. In these patients pneumonia is caused by endogenic or nosocomial pathogens. Gram-negative bacteria (E. coli, Klebsiella

pneumoniae, Pseudomonas aeruginosa, H.influenzae) and also Staphylococcus aureus MRSA, Streptococcus pneumoniae, Mycoplasma, Chlamydia pneumoniae, Legionella, Acinetobacter as well as viruses are very common pathogens in this group of patients [20]. Third generation cephalosporins, imipenems, fluoroquinolones with aminoglycosides, vancomycin and macrolides should be used in treatment of lower respiratory tract infections in such cases [19, 21, 23]. Pneumonia caused by RS virus often can be lethal in neurologically handicapped children, so in the treatment of recurrent lower respiratory tract infection application of Syntagis should be considered, especially in children with BPD syndrome [19]. Our findings indicate that in children with PE and neuromuscular diseases, the course of lower respiratory tract infections is the most severe.