Abstract: Objective To explore the characteristics of aspiration pneumonia in children with congenital upper airway dis-eases.Methods A retrospective review was performed on hospitalized children with a documented diagnosis of congenital upper airway disease and aspiration pneumonia at a tertiary children's hospital from December 2014 to June 2018. Differences were evaluated between cases with and without neurologic impairment.Results A total of 72 cases were reviewed, including 47 males and 25 females, with median age of 4 months. Laryngomalacia was the most common upper airway lesion with a high rate of compound lower airway lesions and other comorbidities. Main clinical manifestations were coughing, choking and wheezing. The vast majority (80.6%) of children had onset of symptoms before 3 months of age. Fifty-four out of 69 cases showed positive aspiration findings in radionuclide salivagram. Twenty out of 35 cases showed positive aspiration findings in upper gastrointestinal series. Flexible laryngoscopy identified 61 cases with upper airway lesion among 64 children. Flexible bronchoscopy identified 13 cases with upper airway lesion and 7 cases with lower airway lesion among 27 children. Fifty cases showed positive pathogen findings. Fifty-four cases received nasogastric tube feeding. Fifteen received ICU treatment and 3 cases died finally. Those with neurologic impairment were more likely to have recurrent pneumonia and had higher cost for hospitalization.Conclusion Children with aspiration pneumonia and congenital upper airway diseases usually present with symptoms before 3 months of age. They have a high prevalence of synchronous airway lesions and other comorbidities. Patients with neurologic impairment combined are more likely to have recurrent pneumonia and higher financial burden. Endoscopy and radionuclide salivagram are useful tools for diagnosis.

Key words: Aspiration pneumonia, Children, Upper airway