Chronic aspiration in children: Evaluation of the lipid-laden macrophage index

Chronic pulmonary aspiration (CPA) causes significant morbidity, but is und erdiagnosed because of difficulties in establishing a diagnosis. The lipid- laden macrophage index (LLMI) is said to differentiate between those with a nd without CPA. Records of 113 patients were reviewed to determine specific ity and sensitivity of the LLMI for CPA. Diagnostic accuracy was inferred f rom treatment outcome. Mean LLMI for aspirators was 104 +/- 62 (range, 20-233), and for nonaspirat ors, 44 +/- 39 (range, 0-170) (P < 0.05). Sensitivity and specificity were 0.69 and 0.79, respectively. While the LLMI provides clinically helpful inf ormation, it does not stand alone as the gold standard for the diagnosis of CPA. Failure to thrive and neurological impairment correlated with CPA, us ing Fisher's exact test CPA was not diagnosed in any patient with normal gr owth, normal neurological development, and an LLMI <86. No other clinical o bservation (cough, wheeze. vomiting, difficulty feeding, choking with feedi ng. recurrent pneumonia, bronchopulmonary dysplasia, chronic chest X-ray ch anges. endotracheal tube, tracheostomy tube, nasogastric feeding tube, or t ranspyloric feeding tube) or diagnostic study (upper gastrointestinal serie s, gastroesophageal scintigraphy, modified barium swallow, or pH probe) cor related with the diagnosis of CPA. Pediatr Pulmonol. 1999; 28:94-100. (C) 1 999 Wiley-Liss, Inc.