A Five-Year Review on Pediatric Foreign Body Aspiration

Abstract

Introduction Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.

Challenges in Diagnosing Foreign Bodies in Children

“…The FB may be identified as either radio-opaque or radiolucent, which is seen in most objects. Radiolucent objects are hardly picked up on plain radiographs [1]. Hence, a computed tomography scan is better in these cases [4].…”

“…It is frequently seen and is commonly classified into organic or inorganic FB aspiration. The most commonly aspirated organic FB found in the Malaysian pediatric group is peanuts [1]. FB aspiration results in high morbidity, ranging from 10-20% worldwide, and accounts for 7% of accidental deaths in children under four [2].…”

“…The pediatric population is more susceptible to FB aspiration due to a lack of molar teeth, underdeveloped swallowing coordination, and the tendency to talk or play while ingesting [3]. The presenting signs and symptoms in this group of patients are highly variable and may result in severe sequelae ranging from choking, respiratory distress, cyanosis, and asphyxia, which may mimic other respiratory illnesses and infections [1,4]. The gold standard for the treatment of aspirated FB is rigid bronchoscopy with forceps removal.…”

“…The gold standard for the treatment of aspirated FB is rigid bronchoscopy with forceps removal. Flexible bronchoscopy is sometimes used to localize the FB prior to removal by rigid bronchoscopy and to remove FB located peripherally [1,[5][6]. Thorough clinical history and examination are crucial in the diagnosis of airway FB as 85% of the cases can be detected during the first physician encounter, whilst 15% of cases may go unnoticed and result in complications such as pneumonia and atelectasis [7].…”

Thoracic surgery in Egypt

“…Providing teams with resources and the latest technology to connect virtually will help in knowledge sharing across the specialties more effectively and benefit a larger patient population. Ardila et al recently proposed a deep learning algorithm that uses a patient's current and prior CT volumes to predict the risk of to remove distally located FB in adults and children (52,56,58,59). In our current practice, scarf pins are a common inhaled FB particularly in young and middle-aged females who wears headscarves due to religious or traditional causes.…”