Foreign Body Aspiration in Children-Retrospective Study and Management Novelties

The Impact of Deep Learning on Determining the Necessity of Bronchoscopy in Pediatric Foreign Body Aspiration: Can Negative Bronchoscopy Rates Be Reduced?

INTRODUCTION

This study aimed to evaluate the role of deep learning methods in diagnosing foreign body aspiration (FBA) to reduce the frequency of negative bronchoscopy and minimize potential complications.

METHODS

We retrospectively analysed data and radiographs from 47 pediatric patients who presented to our hospital with suspected FBA between 2019 and 2023. A control group of 63 healthy children provided a total of 110 PA CXR images, which were analysed using both convolutional neural network (CNN)-based deep learning methods and multiple logistic regression (MLR).

RESULTS

CNN-deep learning method correctly predicted 16 out of 17 bronchoscopy-positive images, while the MLR model correctly predicted 13. The CNN method misclassified one positive image as negative and two negative images as positive. The MLR model misclassified four positive images as negative and two negative images as positive. The sensitivity of the CNN predictor was 94.1 %, specificity was 97.8 %, accuracy was 97.3 %, and the F1 score was 0.914. The sensitivity of the MLR predictor was 76.5 %, specificity was 97.8 %, accuracy was 94.5 %, and the F1 score was 0.812.

CONCLUSION

The CNN-deep learning method demonstrated high accuracy in determining the necessity for bronchoscopy in children with suspected FBA, significantly reducing the rate of negative bronchoscopies. This reduction may contribute to fewer unnecessary bronchoscopy procedures and complications. However, considering the risk of missing a positive case, this method should be used in conjunction with clinical evaluations. To overcome the limitations of our study, future research with larger multi-center datasets is needed to validate and enhance the findings.

TYPE OF STUDY

Original article.

LEVEL OF EVIDENCE

III.

"Innovative multidisciplinary care in pediatric magnet aspiration: A case report"

INTRODUCTION

Foreign body (FB) inhalation is a potentially life-threatening condition in children. Magnets, being rare, aspirated objects, pose significant threat due to their physical and magnetic properties.

CASE PRESENTATION

A 10-year-old girl with a history of magnet aspiration went into respiratory distress due to dislodgement of magnet to opposite main bronchus following failed attempt of removal via Rigid Bronchoscopy. Despite reattempts with advance techniques of removal, the foreign body removed via right sided thoracotomy. Post operatively, patient remained on mechanical ventilator, ultimately, discharging in stable condition with mild residual cough on follow-up.

DISCUSSION

Magnets as airway foreign bodies are rare and challenging to manage. Their magnetic properties increase the risk of migration, airway obstruction, and tissue damage. Early diagnosis and intervention, primarily via rigid bronchoscopy, are critical. In cases where bronchoscopy fails, thoracotomy remains a viable option. Multidisciplinary care is essential to address complications and ensure successful outcomes.

CONCLUSION

This case highlights the importance of prompt diagnosis, timely surgical intervention, and meticulous postoperative care in managing complex airway foreign bodies. In challenging cases of magnet inhalation, rigid bronchoscopy is key, with thoracotomy needed in refractory situations.

Neuromodulators in Acute and Chronic Cough in Children: An Update from the Literature

Cough is one of the most common reasons leading to pediatric consultations, negatively impacting the quality of life of patients and caregivers. It is defined as a sudden and forceful expulsion of air from the lungs through the mouth, typically triggered by irritation or the stimulation of sensory nerves in the respiratory tract. This reflex is controlled by a neural pathway that includes sensory receptors, afferent nerves, the brainstem's cough center, efferent nerves, and the muscles involved in coughing. Based on its duration, cough in children may be classified as acute, lasting less than four weeks, and chronic, persisting for more than four weeks. Neuromodulators have shown promise in reducing the frequency and severity of cough by modulating the neural pathways involved in the cough reflex, although they require careful monitoring and patient selection to optimize the outcomes. This review aims to examine the rationale for using neuromodulators in the management of cough in children.

An Investigation of the Pediatric Rigid Bronchoscopy Complication with Three Different Anesthesia Regimes

Background

Foreign body aspiration is common in children and poses a significant risk of morbidity and mortality. Rigid bronchoscopy is the most common method for removing aspirated foreign bodies.

Objectives

Anesthesiologists play a critical role in managing these procedures, aiming to find the best strategies with the fewest complications. This study aims to compare anesthesia-related complications during rigid bronchoscopy in children using muscle relaxants versus no muscle relaxants.

Methods

In this clinical trial, 60 eligible children were randomly divided into three equal groups: SP: Spontaneous ventilation with sevoflurane and propofol; VA: Controlled ventilation with sevoflurane and atracurium; VR: Controlled ventilation with sevoflurane and rocuronium. At the end of anesthesia, complications such as cough, bucking, hypoxemia, laryngospasm, and bronchospasm were compared, along with the pulmonologist's level of satisfaction, surgery duration, and total anesthesia time in the three groups.

Results

The comparison between the SP, VR, and VA groups revealed the following: No significant difference was found in the incidence of cough and respiratory distress following foreign body aspiration among the three groups (P = 0.262 and P = 0.762, respectively); minimum oxygen saturation during rigid bronchoscopy differed significantly between the groups (P = 0.013); bucking during bronchoscopy was significantly more frequent in the SP group (P = 0.017); laryngospasm was significantly more common in the SP group compared to the other two groups (P = 0.004); agitation during recovery was significantly lower in the propofol (SP) group; pulmonologist satisfaction was highest in the VR group, followed by the VA group, with a significant difference compared to the SP group (P = 0.021); although the SP group experienced more frequent hypoxemia, the difference was not statistically significant; there was no significant difference in anesthesia or bronchoscopy duration across the three groups.

Conclusions

The study results suggest that using muscle relaxants in rigid bronchoscopy offers several advantages, including fewer intraoperative complications such as bucking and laryngospasm. Additionally, controlled ventilation reduced the need for intravenous anesthetics and opioids, minimizing adverse effects and shortening recovery times.

Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children

Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0-18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1-3; moderate, 4-6; high, 7-10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11-39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P < .001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78-4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016-2019 to 50% in 2020 (P = .042).

CONCLUSION

FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making.

WHAT IS KNOWN

• Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process.

WHAT IS NEW

• The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.

Foreign Body in the Nasal Cavity: A Case Report

We present a case of a pediatric patient who presented to the emergency room with acute nasal discharge, foul smell, and nasal pain. The patient's mother witnessed her inserting a foreign body into the nasal passage. After thorough examination and diagnostic imaging, a metallic necklace bead was identified as the foreign body lodged in the nasal cavity. The patient was promptly prepared for emergency operating room intervention. The metallic foreign body was successfully extracted without complications using endoscopic equipment and careful manipulation. The patient recovered well, was admitted for one day for observation and supportive care, and was discharged home in excellent condition. Follow-up in the clinic revealed a satisfied patient with no complaints, no septal perforation, and a patent airway.

Foreign body aspiration in children at University of Gondar Comprehensive Specialized Hospital, a two year retrospective study

Introduction

Foreign body aspiration (FBA) is defined as asphyxia, suffocation, or inhalation of items of food, such as bone and seed, and non-food, such as toys, into the respiratory tract. Aspiration of foreign bodies is an important and preventable cause of mortality and morbidity in children, especially those less than 3 years of age. The aim of this study was to analyse the clinical and radiological profile, modes of management, and outcomes of foreign body aspiration in children at the University of Gondar Comprehensive Specialized Hospital and identify areas of possible interventions for proper management of such cases.

Method

A retrospective review of the medical records of all patients suspected of foreign body aspiration at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) from January 1, 2021, to January 1, 2023, G.C. was conducted. Clinico-radiological features, types and locations of foreign bodies, modes of management, and patient outcomes were studied.

Results

A total of 73 patients suspected of having a possible foreign body aspiration were identified. The median age of the patients was 24 months, with an IQR of 14 and 39, with 46 (75.3 %) being under 3 years of age. 45 (61.6 %) were male, while 28 (38.4 %) were female, making the M:F ratio 1.6:1. A foreign body aspiration history could be obtained in 68 (93.1 %) of the patients, while in 4 (5.9 %) of the cases, patients or their families were not aware of any kind of aspiration. Among the children presented, 65 (89 %) had a choking episode, coughing 66 (91 %), vomiting 63 (86.3 %), tachypnea 61 (83.6 %), and stridor 15 (20.5 %). The most common physical finding observed was nasal flaring along with subcostal and intercostal retraction in 59 (80.8 %), followed by decreased air entry in 40 (54.8 %), wheeze in 37 (50.7 %), and absent air entry in the affected side in 4 (5.5 %) of the patients. A chest x-ray was done on all patients. 28 (41.2 %) had normal chest x-rays. With regard to procedure-related complications, 3 (4.1 %) patients had cardiac arrest, 1 (1.36 %) had pneumothorax, and 1 patient died.

Conclusion

Any bronchopulmonary infection with an unusual course should be suspected of being the result of the aspiration of a foreign body. Increased public and professional awareness of the importance of early bronchoscopy in all suspected cases of foreign body aspiration is necessary. In order to lower the incidence, those providing care must be taught routine preventive measures.