Similarities and differences in aspirated tracheobronchial foreign bodies in patients under the age of 3 years

Abstract

Objective: To investigate the clinical pathological features of aspirated tracheobronchial foreign body (FB) cases in children under the age of 3 years and to improve the level of diagnosis and treatment.

Methods: A retrospective study was conducted examining 316 children under the age of 3 years who had been treated for tracheobronchial FB in Shenzhen children's hospital between January 2004 and December 2008. We analyzed the patients for gender, age, FB localization, treatment history, the history of foreign body aspiration (FBA), the type of foreign body and the cause of death. In addition, each patient was analyzed for FB-related complication, the results of bronchoscopic removal and the presence of foreign bodies in the airways.

Results: Fifty-two infants under the age of one year (median age=10m, group A), 199 children between the ages of 1 and 2 years (median age=17 m, group B) and 65 children between the ages of 2 and 3 years (median age=30m, group C) were included in this study. There were 38 (73.1%) patients with a confirmed history of FBA in group A, a higher percentage than that observed in group B (55.8%) or group C (53.8%) (P<0.05). Earthnuts were the most common cause of FB (171 cases, 54.1%). Melon seeds (including sunflower seeds, watermelon seeds and pumpkin seeds) were the second most common cause of FB (62 cases, 19.6%). Animal sources (including 16 pig bones, 8 fish bones, 7 chicken bones and 4 other animal-based foods) comprised 11.1% (35 cases) of FB cases and were the third most common cause of FB. The percentage of animal-based FBs observed in group A was higher than in groups B and C (P<0.01). Five inorganic FBs (a pushpin, a rubber band, a screw, a small stone and a plastic toy) were also observed and were the least common type of FB. There were no significant differences in the distribution of FBs between the left (41.8%) and right (40.5%) bronchia. There is no difference in the distribution of FBs among the three groups either. The data show that the youngest cohort of patients (0-1 years) is the most likely to be sent to the hospital to receive treatment within 24h of aspiration (50%) (P<0.01). Five patients (1.58%) died as the result of FBA.

Conclusions: FBAs of animal-derived FBs (especially animal bones) are very common in infants in southern China. Children between the ages of 1 and 2 years are most likely to suffer from FBA. FBA in children under the age of 3 years carries significant hazards, including morbidity and mortality. Asphyxia and/or cardiopulmonary arrest is prone to occur shortly after FBA in infants, but these events can occur days later in older children after FBA because of delays in the diagnosis and/or treatment of this condition.