How Can We Do Better? Learning From 617 Pediatric Patients With Airway Foreign Bodies Over a 2-Year Period in an Asian Population

Abstract

Background: Foreign body (FB) in the pediatric airway is a prevailing and crucial emergency with presenting symptoms often overlapping with other common pediatric conditions. There are limited number of large cohort studies in an Asian population which demonstrate the diversity of symptoms, investigations which will aid in obtaining the diagnosis, and management. Using this large cohort, we aim to evaluate the type and location, clinical presentations and outcomes of medical management related to pediatric airway FB in an Asian society. Methods: This is a retrospective study of all airway FB treated in Kunming Children's Hospital, China from February 2016 to June 2019. Six hundred and thirty-two clinical and operative records of all airway FB were retrieved and reviewed from the hospital's central electronic medical records. A total of 617 patients were included in our study. Results: The age ranged from 4 months to 12 years (mean = 1.74 years). The duration of symptoms ranged from 1 h to 605 days, with the diagnosis established at an average 9.16 days. Almost all had multiple symptoms, most commonly cough (98.5%) followed by noisy breathing (98.2%). Majority of the FBs (95.5%) were organic and the rest inorganic. Of the organic FBs, peanut was the most common (31.6%), followed by walnut (13.3%) and sunflower seeds (9.2%). Comparatively, 80.8% of the organic FBs were retrieved incomplete while 85.7% of the inorganic FBs were completely intact. Multiple FBs were noted in 43.3% of the patients, with 2.4% of them in different locations. Conclusions: Airway FB can be easily missed with resultant delay in diagnosis. In an Asian population, walnut and sunflower/pumpkin seeds feature more prominently compared to Western populations. Sunflower seed FBs tend to present earlier and are found intact in the trachea. Rigid bronchoscopy is the most common technique used to remove such FBs and pulmonary-related complications post-operatively, though rare, are the most common adverse outcomes. Preventive strategies targeting the appropriate age group and this type of FB may be useful in an Asian population.

The Role of Rigid Bronchoscopy in Children With Tracheobronchial Foreign Body Aspiration

“…Chest CT scan was taken in 2 patients; it was avoided to reduce exposure to ionizing radiation. In this study, right bronchial tree was the most common site of impaction, like reported by the previous studies (Chisholm and Johnson, 2018;Gao et al, 2020). It is mostly due to the position and wider diameter of the right bronchi.…”

Tracheobronchial Foreign Bodies in Children: Experience From 1,328 Patients in China

“…In the present study, the most common location of FBs was the right main bronchus (38.33%). Because the right bronchus is straighter and has larger diameter than the left, entrapment of FBs is more likely in this bronchus ( 25 ), and our finding is consistent with the results of most retrospective studies previously conducted ( 6 , 9 , 17 , 18 , 26 , 27 ), but inconsistent with the findings of a few studies ( 8 , 11 ). Given the observation of multiple FBs in 64 cases (4.82%) in the present study, it is important to explore the complete bronchial tree systematically when searching for FBs.…”

The characteristics of foreign bodies aspirated by children across different continents: A comparative review

“…The diverse types of FB depended on eating habits, parentral supervision, and cultural influences, especially in Asian families. 20,39 With the development of urban life, grandparents have taken on the responsibility of caring for children. Despite this, they are unaware of food choking hazards and feed the children to the same food that they eat.…”

“…This could be due to the mechanical and chemical irritation of organic FBs, which causes more granulation formation in the airways. 20 Therefore, some foods necessitate more skill. Nutritionists for example, should recommend peanuts to school-aged children who have developed mastication skills.…”

“…Pulmonologists should be certain about additional FBs in distal and contralateral airways by bronchoscopy. 20,55 The adverse effects of rigid bronchoscopy have greatly decreased as the subspecialty field of interventional pulmonology has grown. Rigid bronchoscopy requires general anesthesia and requires an experienced team as well as ventilation equipment.…”