Altitude-related illness in children

Abstract

[] ~ ntil relatively recently, clinical illness related to exposure to high altitude was a concern mainly of mountaineers and physiologists. As our understanding of these conditions has grown, however, it has become clear that children are among those at highest risk of having altitude-related illnesses. In addition, with the growth of the populations of the mountainous regions of North America, as well as the advent of jet travel to those areas, greater numbers of children are either living at or vlsiting areas of sufficientaltitude to cause clinical illness. The rapidity of the ascent to altitude allowed by modem jet travel also allows less time for acclimatization and may increase the risk of these conditions developing. Finally, a number of pediatric illnesses are associated with either acute or chronic hypoxemia, and there may be lessons of relevance to the care of these children to be learned from the effects of altitude exposure. All of these factors combine to make altitude-related illness in children a topic of clinical relevance to pediatric practitioners. Despite intense research over the last half century, however, much of the basic pathophysiologic mechanism of illness related to altitude remains obscure. Although recent progress has been made toward identifying at least some therapeutic interventions for these conditions, approximately 20 deaths per year worldwide are ascribed to high-altitude pulmonary edema alone, and the number of hospital visits and mined vacations attributable to altitude-related ' illness as a whole is undoubtedly much higher. Unfortunately, little of the research on the physiologic and pathophysiologic