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Inhalation of foreign bodies in children. Report of 500 cases
Insights
Foreign body aspiration in children, especially those aged 1-3, requires prompt bronchoscopic removal. Post-procedure care with prednisolone and nebulization significantly reduces complications like laryngeal edema and tracheostomy.
Area of Science:
- Pediatric Pulmonology
- Pediatric Surgery
- Emergency Medicine
Background:
- Inhalation of foreign bodies is a significant cause of childhood mortality.
- Foreign body aspiration is most common in children aged 1-3 years, particularly boys.
- Symptoms may be absent, and chest X-rays can be normal, necessitating examination even with a history of aspiration.
Purpose of the Study:
- To report on the experience of managing 500 children with suspected foreign body inhalation.
- To evaluate the efficacy of post-bronchoscopic care in reducing complications.
- To highlight the importance of timely intervention and management strategies.
Main Methods:
- Review of 500 pediatric cases with suspected foreign body inhalation.
- Bronchoscopic removal of aspirated foreign bodies.
- Routine administration of prednisolone (1-2 mg/kg) and nebulization post-bronchoscopy.
Main Results:
- Bronchoscopic removal is the primary treatment, with surgical intervention (thoracotomy/bronchotomy) for intractable cases.
- Post-bronchoscopic complications, such as laryngeal edema requiring tracheostomy, were significantly reduced by prednisolone and nebulization.
- The incidence of post-bronchoscopic tracheostomy was 1.4%, and the overall mortality rate was 1.8% in the series of 500 children.
Conclusions:
- Early diagnosis and bronchoscopic removal are crucial for managing foreign body aspiration in children.
- Post-bronchoscopic medical management with prednisolone and nebulization effectively minimizes airway complications.
- Effective management strategies lead to low rates of tracheostomy and mortality in pediatric foreign body inhalation cases.
Abstract:
Inhalation of foreign bodies is a major cause of accidental death during childhood. Aspiration of foreign bodies is common in children aged 1 to 3 years, especially in boys. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airways, because some children with aspirated foreign bodies are without symptoms and chest x-ray films may not show abnormalities. Bronchoscopic removal of the foreign bodies requires close communication between the anesthesiologist and the endoscopist. Forgotten foreign bodies in the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess. Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience in 500 children with suspected foreign body inhalation. We routinely use prednisolone, 1 to 2 mg. per kilogram, and nebulization just after bronchoscopic examination of the airways. This medication greatly diminishes the rate of postbronchoscopic complications such as laryngeal edema, which require tracheostomy. In our series of 500 case, the incidence of postbronchoscopic tracheostomy is 1.4 per cent and the total mortality rate is 1.8 per cent.