Prevention of chronic pneumonia in children with severe motor and intellectual disabilities by long-term tobramycin inhalation: Its benefits and limitations

Yoshiaki Saito; Yuto Arai; Takanori Omae; Keisuke Watanabe; Yusuke Saiki; Toshiaki Tanaka; Chika Hosoda; Akiko Tamasaki-Kondo; Yoshihiro Maegaki; Kensaku Okada

doi:10.1016/j.braindev.2024.104317

Prevention of chronic pneumonia in children with severe motor and intellectual disabilities by long-term tobramycin inhalation: Its benefits and limitations

Brain Dev. 2025 Jan 8;47(1):104317. doi: 10.1016/j.braindev.2024.104317. Online ahead of print.

Authors

Affiliations

¹ Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, National Rehabilitation Center for Disabled Children, Tokyo, Japan. Electronic address: yo-saito@ryouiku.or.jp.
² Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
³ Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Akita University Hospital, Japan.
⁴ Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Tottori Prefectural Rehabilitation Center for Children with Disabilities, Yonago, Japan.
⁵ Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Belland General Hospital, Sakai, Japan.
⁶ Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Hiroshima City Education and Rehabilitation Center for Children, Hiroshima City Social Welfare Corporation, Hiroshima, Japan.
⁷ Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Hakuai Child Development, Home Care Support Clinic, Yonago, Japan.
⁸ Division of Infectious Diseases, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan.

PMID: 39787993
DOI: 10.1016/j.braindev.2024.104317

Abstract

Aim: To determine the effect of long-term tobramycin (TOB) inhalation therapy on recurrent pneumonia among ventilator-dependent children with profound neurological disabilities.

Methods: TOB inhalation was performed in eight series of trials in seven ventilator-dependent children who had intratracheal Pseudomonas aeruginosa and suffered from recurrent pneumonia. Their age at the initiation of therapy was 68 ± 50 months (mean ± standard deviation), whereas the duration of treatment was 30 ± 22 months. The participants were followed after the termination of therapy for a period of 38 ± 32 months.

Results: The annual rate of pneumonia was 5.6 episodes per year (n = 8) preceding the initiation of inhalation, which decreased to 3.7 (n = 8), 1.6 (n = 5), and 0.67 (n = 3) in the periods of 0-12, 12-24, and 24-36 months after initiation, respectively. The rates were 1.0 (n = 6), 0.6 (n = 5), and 1.4 (n = 5) in the periods of 0-12, 12-24, and 24-36 months after the termination of therapy.

Interpretation: Extended TOB inhalation therapy was effective in decreasing the morbidity of pneumonia in ventilator-dependent children with severe motor and intellectual disabilities.

Keywords: Inhalation; P. aeruginosa; Severe motor and intellectual disabilities; Tobramycin; Tracheostomy; Ventilator-associated pneumonia.