An apple a day won't keep the doctor away: presentation, treatment, and outcome in pediatric apple aspirations
- 22 May 2020
- journal article
- research article
- Published by Wiley in Pediatric Pulmonology
- Vol. 55 (7), 1697-1704
- https://doi.org/10.1002/ppul.24768
Abstract
Introduction Foreign body (FB) aspiration is a frequent and preventable source of morbidity and mortality, especially in children under 4 years of age. Few comprehensive studies exist on presentation and outcome of apple aspirations in children. Methods In a retrospective analysis of bronchoscopy records of a tertiary medical care center from January 2007 to August 2019, we identified pediatric cases of suspected apple aspirations. Results A total of 11 suspected apple aspirations were identified (observation time 12.7 years, n = 5858 bronchoscopies, n = 226 interventions due to suspected FB aspirations in total). The mean age of patients was 24 months (standard error mean, 7 months; range, 8‐83 months), and 6 out of 11 cases (55%) were male. Bronchoscopy confirmed apple aspiration in n = 6/11 cases (55%). In n = 2/11 cases (18%), a bite of the apple was located in the esophagus causing significant tracheal narrowing, and in n = 3/11 cases (27%), no FB was found. In all cases of airway FB identification, extraction was successful. Hypersalivation was associated with esophageal FB location, whereas persistent cough, stridor, or dyspnea were associated with airway FB location. Outcomes ranged from complete reconstitution 1 day after bronchoscopy in most cases to hypoxemia with severe brain damage in one patient. Discussion This analysis shows that apple aspirations are not entirely uncommon in children and may lead to disastrous complications. Typical signs of airway location are persistent cough, stridor or dyspnea, whereas hypersalivation may point toward an esophageal location. In each case of suspected apple aspiration, timely bronchoscopy with possible FB extraction should be performed by an experienced team.Keywords
This publication has 27 references indexed in Scilit:
- The national cost burden of bronchial foreign body aspiration in childrenThe Laryngoscope, 2014
- Successful emergency airway management in a case of removal of foreign body bronchus in a pediatric patientAnesthesia: Essays and Researches, 2014
- Food choking hazards in childrenInternational Journal of Pediatric Otorhinolaryngology, 2013
- Foreign Body Aspiration in ChildhoodPediatric Emergency Care, 2012
- The Anesthetic Considerations of Tracheobronchial Foreign Bodies in ChildrenAnesthesia & Analgesia, 2010
- Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000–2008World Journal of Pediatrics, 2009
- Tracheobronchial foreign bodies in children: Experience at ORL clinic Tuzla, 1954–2004International Journal of Pediatric Otorhinolaryngology, 2007
- Extraction of a Rubber Bullet From a Bronchus After 1 YearSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1999
- Tracheobronchial foreign body aspiration in childhoodEuropean Journal of Pediatrics, 1986
- Bronchoscopic removal of aspirated foreign bodies in childrenThe American Journal of Surgery, 1984