The most dangerous time of life for fatal aspiration pneumonia is during the brief period just before and immediately after birth. Neonatal aspiration syndromes are reported in 4% of all live births and are associated with significant morbidity and mortality. The significant mortality rate in newborns and infants may be due to the subtle signs of aspiration (ie, apnea and increased swallowing frequency) and the lack of cough during aspiration at this stage of development.
Aspiration pneumonia is the most common form of hospital-acquired pneumonia among adults and occurs in 4 to 8 of every 1,000 patients who are admitted to hospitals in the United States. Mortality rates ranging from 20 to 65% have been reported for aspiration pneumonia. read
Several conditions may increase the incidence of dysphagia, aspiration, and pneumonia. Three studies of consecutive patients who were admitted to the hospital for acute stroke found a significant portion of material aspirated on videofluoroscopic swallow evaluation (VSE), a moving picture radiograph of the oral-pharyngeal area during swallow of solid food and liquids. In these studies, aspiration was found in 37%, 38%, and 22% of patients. The importance of identifying aspiration was underscored by the results of a retrospective review of stroke patients (n = 378), which found an association between aspiration on VSE and pneumonia. Cervical spinal surgery can also increase aspiration risk. For example, in one study of 83 consecutive patients who had undergone preoperative and postoperative VSE evaluation, 42% of patients undergoing anterior cervical operations, 20% of those undergoing posterior cervical procedures, but none of those undergoing lumbar surgery aspirated after the procedure. Elderly residents of long-term care facilities are also at increased aspiration risk.