considerations as are settings in which the aspiration occurs Aspiration pneumonias developing outside the hospital generally involve aerobes and are adequately treated with ampicillin with or without sulbactam, or clindamycin Nosocomial infections following aspiration require broader aerobic and anaerobic coverage Ampicillin/sulbactam is used most commonly, although regimens such as clindamycin and gentamicin have also been described In neurologically impaired children, with either aspiration or tracheostomy-associated pneumonia, antibiotics effective against penicillin-resistant anaerobic bacteria and P aeruginosa have been shown to produce superior clinical and microbiologic responses The use of corticosteroids in the treatment of aspiration pneumonia is controversial Because experimental evidence indicates no more than minimal benefit and because the concomitant immune suppression may contribute the development of secondary bacterial pneumonia, their administration is not usually indicated in the ED Clinical Indications for Discharge or Admission Children with significant aspiration pneumonia, diagnosed either by clinical suspicion or radiograph, require admission to the hospital, particularly if there is associated hypoxia or respiratory distress BRONCHOPULMONARY DYSPLASIA CLINICAL PEARLS AND PITFALLS Diagnosis is usually established prior to presentation to the ED Management involves supportive measures, including supplemental oxygen, assurance of adequate hydration, and often bronchodilators Current Evidence BPD is a chronic respiratory disease, usually occurring in premature infants BPD is a clinical diagnosis, requiring supplemental oxygen at a prescribed postconceptual or chronologic age, with associated radiographic findings The definition continues to evolve, and therefore specifics of the diagnostic parameters have changed over time The etiology of BPD is thought to be multifactorial While newer data suggest a genetic predisposition, previously defined risk factors include prematurity, relatively long duration of supplemental oxygen therapy after birth, need for