The clinical features of acute lung injury (ALI) in the pediatric population have been incompletely characterized. This is largely because prior studies have been retrospective in nature and because the definition of ALI has not been standardized in the literature. In light of this, we have begun a prospective study of pediatric ALI in two large medical centers using a recently approved international consensus definition (AJRCCM; 149: 818-824, 1994). This definition requires bilateral infiltrates on chest radiograph, a PaO2/FiO2 <300 and no evidence of left atrial hypertension. To date, thirty patients have been identified. The clinical disorders associated with ALI were primary pneumonia (23%), sepsis (13%), meningitis (7%), gastric aspiration(17%), fresh water drowning (13%) and other (27%). Overall mortality was 33%. Interestingly, the development of dysfunction of two or more nonpulmonary organ systems was associated with a higher mortality (67%) than those patients with only one or no other organ system dysfunction (19%) (p<0.05). In addition, only 10% of patients developed pneumothorax, all of whom survived. In conclusion, this data suggests that approximately 50% of pediatric ALI is associated with an infectious etiology with aspiration syndromes, primarily gastric and fresh water drowning, representing the second most common association (30%). Also, although the overall mortality is 33%, there is considerable heterogeneity in the prognosis for survival from pediatric ALI. This seems to be largely influenced by the presence or absence of nonpulmonary organ system dysfunction.

(Support in part by NIH HL 51856.)