Bronchoscopy in children suspected of lower airway aspiration

INTRODUCTION: Foreign body aspiration (FBA) of the bronchial tree may be a life-threatening condition in children. This retrospective study explores the anamnestic, clinical and objective findings in patients with FBA to the lungs and evaluates the frequency and outcome of the condition in patients in the age group of highest risk. METHOD: Medical files from patients below 18 years of age who had a foreign body removed from the lungs in our hospital were extracted using the procedure code for removal of foreign bodies in the lower airways ("Danish Patient Register") in the period 1990-2013. RESULTS: In the period, a total of 49 children underwent endoscopic foreign body extraction and for 29 of the patients, the files were available for clinical data collection. The median age was 19 months. In nine patients (33%), no symptoms were recorded at admission. Thoracic X-ray was pathologic in 19 (67%) and pulmonary auscultation in 21 patients (73%). Two patients (7%) were in need of post-operative anaesthetic support as a result of respiratory failure, and the over-all complication rate was 28% (eight patients). No fatal outcomes were observed. CONCLUSIONS: The majority of the children in our study were in the 0-3-year age group. A raised suspicion of a foreign body in the lower airways should always trigger bronchoscopy. At admittance, not all patients present with respiratory symptoms. Although no deaths were observed, lower airway foreign body in small children remain a potentially life-threatening condition.