Aspiration of foreign bodies in lower respiratory tract in children

Abstract

Introduction. Injury due to foreign body aspiration (FBA) is a common and serious pediatric emergency, requiring prompt recognition and early treatment to minimize the potentially serious and sometimes fatal consequences. FBA continues to be a cause of childhood morbidity and mortality, usually in pre-school children. Aim of the study. Case assesment of FBA in children based upon age, gender, locality and level of respiratory tract lesion. Materials and methods. The cohort study included 106 patients hospitalized between 2011 - 2016 in Pneumology Department, Mother and Child’s Institute of the Republic of Moldova, diagnosed with FBA, confirmed via bronchoscopy performed with general inhalative anesthesia. Foreign body extraction was carried out by means of rigid bronchoscopy after thorough aspiration and prevention of mucosal bleeding. Statistics were assessed using the EpiInfosoftware. Results. It was established that pediatric FBA in the respiratory tract is more frequent among girls 57.5%: 95CI, 47.6 – 67.1 cases (61 girls) and 42.5%: 95CI, 32.9 – 52.4 cases (45 boys). The average age (aa) was 1.9±0.17 years, varying between 0.6–14 years. The batch was divided into 3 groups according to childhood stages: 1) the most frequent FBA was estimated in toddlers – 88.9%: 95 CI, 81.1 – 94 cases, aa 1.57±0.06 years; 2) in children > 3y.o. – 8.5%: 95CI, 4 - 15.5 cases, aa 6.4±1.1 years; 3) and it was rarely found in infants – 2.8%: 95CI, 0.6 - 15.5 cases, aa 0.76±0.11 years (F statistic = 93.5; p<0,0001). There was a prevalence of accidental FBA in children from countryside – 67%: 95CI, 57.2 - 75.8 cases, less often this event occured in children from urban areas – 24.5%: 95CI, 16.7 - 33.8 cases and episodically – in children from municipalities (8.5%: 95CI, 4 – 15,5 cases). The majority of foreign bodies were found in the bronchial tree 89.6%: 95CI, 82.2 – 94.7 cases; without designation – in 6 – 5.7%: 95CI, 2.1 – 11.9 cases; in trachea and larynx 2 and 3 cases (1.9%: 95CI, 0.2 - 6.6 and 2.8%: 95CI, 0.6 -8). Conclusions. FBA prevails in girls – 57.5%: 95CI, 47.6 – 67.1 cases. The most vulnerable age is from 1 to 3 y.o. when children are more often exposed to habitual accidents (statistic factor = 93.5; p<0,0001). There is evidence of a critical situation in the rural areas, compared to the urban ones. By localization the most frequent lodgment of foreign bodies was in the bronchi.