ABSTRACT
Sialorrhea, defined as an excess flow of saliva or excessive secretions, is common in patients with cerebral palsy and other neurologic disorders and is associated with clinical complications such as increased risk of local skin reactions, infections, aspiration, pneumonia, and dehydration. Upon failure of non-pharmacologic measures, clinicians have several noninvasive pharmacologic options available to manage sialorrhea. This review of the literature provides detailed descriptions of medications used, efficacy, safety, and practical considerations for use of non-injectable pharmacologic agents. The literature search included published -human studies in the English language in PubMed and Google Scholar from 1997 to 2022. Relevant citations within articles were also screened. A total of 15 studies representing 719 pediatric patients were included. Glycopyrrolate, atropine, scopolamine, and trihexyphenidyl all have a potential role for sialorrhea management in children; however, glycopyrrolate remains the most studied option with 374 (n = 52.0%) of the 719 patients included in the systematic review receiving this medication. Overall, glycopyrrolate showed similar efficacy but higher tolerability than its comparators in 2 comparative studies and is often considered the first-line agent. Patient-specific (age, route of administration) and medication-specific (dosage formulation, medication strength) considerations must be weighed when initiating a new therapy or switching to another medication upon treatment failure. Owing to the high propensity of adverse events with all agents, clinicians should consider initiating doses at the lower end of the dosage range, as previous studies have noted a dose-dependent relationship.
Subject(s)
Brain Neoplasms/therapy , Neoplasms, Germ Cell and Embryonal/therapy , Pineal Gland , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/blood , Brain Neoplasms/complications , Child , Humans , Male , Neoplasms, Germ Cell and Embryonal/blood , Neoplasms, Germ Cell and Embryonal/complications , Radiotherapy DosageABSTRACT
The pathogenesis of bronchopulmonary dysplasia is controversial. Oxygen toxicity, mechanical trauma to the lung secondary to respirator therapy, and congestive heart failure with a left to right shunt through a patent ductus arteriosus have all been implicated. Our data suggest that in addition to these three conditions, all of which are edemagenic, infants with bronchopulmonary dysplasia have a significantly greater mean fluid intake in the first five days of life when compared with infants with respiratory distress syndrome or patent ductus arteriosus alone. We suggest that the addition of a fluid load may potentiate the effects of other factors and increase the risk of bronchopulmonary dysplasia in infants with respiratory distress syndrome who require respiratory support.
Subject(s)
Bronchial Diseases/complications , Lung Diseases/complications , Pulmonary Edema/etiology , Respiratory Distress Syndrome, Newborn/complications , Bronchial Diseases/etiology , Ductus Arteriosus, Patent/complications , Heart Failure/complications , Humans , Infant, Newborn , Lung Diseases/etiology , Oxygen Inhalation Therapy/adverse effects , Respiratory Distress Syndrome, Newborn/therapy , Respiratory Therapy , Water-Electrolyte BalanceSubject(s)
Intermittent Positive-Pressure Breathing , Positive-Pressure Respiration , Adult , Aerosols , Bronchodilator Agents/administration & dosage , Child , Humans , Intermittent Positive-Pressure Breathing/adverse effects , Positive-Pressure Respiration/adverse effects , Pulmonary Atelectasis/therapy , Respiratory Function TestsABSTRACT
In monolayer cel cultures from late gestation (28-day) rabbit fetal lungs, cortisol (5.5 X 10(-6)M) enhances lecithin synthesis and reduced cellular growth. The addition of insulin (25-100 muU/ml) abolishes the stimulatory effect of cortisol on lecithin synthesis but does not affect its growth-inhibiting activity.