Aspiration of Foreign Bodies in Children

Abstract

ABSTRACT

The study included all 57 child patients observed in the Department of Paediatric Anaesthesia and Intensive Care of the S. Orsola-Malpighi Hospital of Bologna over the last 10 years who were admitted for suspected foreign body aspiration. The diagnostic and operative examination was always done with the patient under general anesthesia and breathing spontaneously, by use of rigid bronchoscopes (Storz). A total of 60 endoscopic examinations were made of the 57 patients, of whom 61.4% were boys, of an average age of 39.5 months. An early diagnosis (first 24 h) was made in only 54% of the patients. The diagnosis in the other 46% was often delayed or overlooked. Radiology showed aspiration only in the two cases of a radiodense foreign body; the diagnosis was supported by indirect signs such as atelectasis in 25.1% (11) of the examinations, air-trapping in 22.7% (10), atelectasis with emphysema in 22.7% (10), hyperinflation with a shift of the mediastinum in 6.8% (3), and recurrent foci of pneumonia in 9.1% (4). The radiologic picture was completely negative in 13.6% (6) cases. In 80.7% of cases a foreign body was removed. Organic material, mainly peanuts, represented 76.1% of the findings, particularly in the 0- to 3-year age range. In 19.6% of cases, inorganic material was extracted from school-age children. The incidence of nonretrieval of the foreign body was highest in the 4- to 6-year age range. In 37% of cases, multiple sites were identified; in 43.5%, the right bronchial tracts were affected, and in 32.6%, the left. Only in 8.7% was the aspiration bilateral. In two cases, spontaneous expulsion of the foreign body took place. A foreign body was not located in 20% of the patients. The average duration of the procedure was 99 ± 46.8 min. No complications directly linked to the endoscopic examination were found. Antibiotics, dexamethasone therapy, and ventilation support by continuous positive airway pressure also helped to avoid postextractive sequelae. A history suggesting probable aspiration in a child under the age of 3 should direct doctors toward diagnostic and operative endoscopic examination of the patient, even where there is a negative clinical and radiologic picture. Prevention should in any case be the primary aim as regards the aspiration of foreign bodies in children. This should be stimulated by appropriate educational campaigns to raise awareness.