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Objectives: Fifty-six consecutive neurologically impaired pediatric children underwent laryngotracheal separation (LTS) for acute recurrent and chronic aspiration in the last 18 years. The population demographics, indications for surgery, and comorbidities are reviewed. This study reports early and late complications and survivorship including admissions for pneumonia/aspiration. Diagnosis related group (DRGs) and work relative value units (wRVUs) were measured to document the potential benefits before and after LTS., Study Design: Retrospective review of patient charts and records in an electronic medical record during an 18 year period., Methods: Information was obtained by a chart review and utilization of the electronic medical record. Patient specific DRG and wRVU data on their hospitalizations and outpatient encounters at the Alfred I. duPont Hospital for Children of the Nemours Foundation and survival data were recorded. Data was analyzed using chi-square analysis, a two-tailed t test, and a Fisher's Exact test., Results: Laryngotracheal separation achieved complete control of aspiration in all the children. A significant reduction in the number of hospital admissions for pneumonias after surgery was noted. After LTS there was a reduced average number of DRGs per month (p < .001) as well as wRVUs. Transient fistula formation (11%) was the most common complication. No patient had his or her procedure reversed to date., Conclusion: Laryngotracheal separation is 100% effective in controlling aspiration in all of neurologically impaired children in this study, It is a valuable procedure to prolong the life of children who have intractable aspiration. After LTS, a decrease in DRGs and wRVUs reduces health care costs for these patients. Prior to LTS, all medical and surgical treatment options for aspiration should be discussed and considered, based on the extent of the child's underlying neurologic status, ability to verbally communicate, degree of upper airway obstruction, and hope of recovery of neurologic function.

Laryngotracheo-esophageal cleft is a rare congenital anomaly that results from complete or partial failure of the development of the tracheoesophageal septum. The presenting symptoms include stridor, respiratory distress, and coughing or cyanotic episodes with feeding. There are four classifications for laryngeal clefts; the severity depends on the type present. We discuss the anesthesia management of a neonate with a Type IV cleft who presented for an emergency gastric division to prevent pulmonary aspiration and later returned for final repair of the defect.

Chronic aspiration in the neurologically impaired child is associated with significant medical and social complications. Traditional surgical management has often relied on tracheotomy. This may well fail to control aspiration. The purpose of this retrospective study was to determine which neurologically impaired children would benefit from a laryngotracheal separation (LTS), as opposed to tracheotomy, as the primary surgical procedure to control chronic salivary aspiration. Patient selection was based on neurologic status, verbal communication ability, likelihood of neurologic recovery, and failure of previous treatments to control aspiration. Nineteen neurologically impaired children aged 8-172 months with chronic salivary aspiration underwent LTS. A total of 73.6% of these patients had prior tracheotomies, yet they continued to aspirate. Two early and three late complications were noted. No instances of fistula formation were noted. There were no deaths related to complications of the surgery or persistent aspiration. Follow-up 1-62 months after surgery demonstrated that complete control of the aspiration was achieved in all of these children. Two of the children who had achieved verbal communication prior to the procedure lost this ability. Improved general health and ability to resume oral intake was noted in all patients. This, combined with a decrease in the need of frequent suctioning, was felt by the families of these children to be a major improvement in the quality of life. Laryngotracheal separation appears to be a simple and effective means of controlling chronic aspiration. It should be considered as a primary treatment of aspiration in the properly selected child with neurologic disease.

Pediatricians have a critical role in the evaluation of children who experience a choking episode and foreign body injury. Familiarity with important symptoms and signs improves diagnostic skills and complements radiographic evaluation. Further reduction in injury prevention is assisted by parental education and avoidance of objects and foods that produce the greatest risk. Design modifications of toys and other products for children's use is the next important step in this safety process.