The characteristics of foreign bodies aspirated by children across different continents: A comparative review.

BACKGROUND: Foreign body aspiration (FBA) is a common issue in pediatric emergencies, with regional variations. Various cultures and foods, parents' and physicians' inadequate experience, and lack of bronchoscopy equipment are some attributable factors in the regional variation of FBA. AIM: To more accurately represent the demographic characteristics of aspirated foreign bodies (FBs) across various continents, this review attempted to provide organized information based on the reviewed articles. METHODOLOGY: A search was conducted in PubMed/PubMed Central, EMBASE, and google scholar. From the 36 included articles, information on age, gender, bronchoscopy type, type of FB, location, history of choking, and time elapsed between aspiration and admission were extracted. RESULTS: A total of 14,469 cases were evaluated. According to the findings, children under two accounted for more than 75% of FBAs. Nuts and seeds were the most common FBs in most countries, whereas plastic and metal objects had higher rates in Brazil, and calcified objects were more prevalent in Thailand. The right bronchus was the most frequent location, and rigid bronchoscopy was the most often utilized type of bronchoscope. In addition, a significant percentage of patients were referred to the emergency rooms in the first 12-24 h following the aspiration incident. Moreover, Asian patients reported more choking history, and Europeans had fewer witnesses of FBA. CONCLUSIONS: There is a lack of standardized reporting systems and organized guidelines in pediatric FBA. To select the ideal time for endoscopies and create educational programs, a collaboration between experienced researchers, pediatric pulmonologists, radiologists, and otolaryngologists is required.

Transbronchial Lung Cryobiopsy in children.

BACKGROUND: Transbronchial Lung Cryobiopsy (TBLC) is a novel technique, available globally only in a limited number of centers. Since the data on the role of TBLCs amongst pediatric patients is limited, the aim was to evaluate its efficacy in diagnosing lung diseases amongst children. METHODS: The records of 28 pediatric patients were retrospectively reviewed from October 2016 till September 2018. The participants' demographic information, procedural indications, sample adequacy, diagnostic utility, and the complications associated with this type of bronchoscopy apparatus were further assessed. RESULTS: Twenty-eight pediatric patients aged 22 months to 17 years underwent TBLC. From the 73 obtained biopsies, 97% had an adequate sampling size. The diagnostic yield of this method was 92.8%. The most common complication was mild bleeding. Transient hypoxemia and bronchospasm were observed in eleven and eight patients, respectively. Furthermore, most of them (78.6%) had uneventful post-procedure and recovery. CONCLUSIONS: TBLC was a relatively safe and effective method with high accuracy and fewer complications in diagnosing and monitoring lung diseases in the selected children. However, more extensive multicentre trials are warranted to corroborate the potential benefits of this novel technique.

Failures in emergency management of pediatric airway foreign bodies by rigid bronchoscopy: we have yet to complete our learning.

Background: Several children are affected by airway foreign body aspiration (FBA) resulting from life-threatening conditions. Choking has been considered the major symptom and is defined as airway blockage by a foreign body (FB), leading to marked morbidity or mortality. This retrospective study indicates the possibility of misdiagnosis or rigid bronchoscope (RB) failure, which is the standard gold method for extracting FB in the airway. Methods: Six children with airway FBA who failed treatment using RB between 2018 and 2019 were retrospectively studied. The inclusion criterion was a history of failure to extract FB using RB followed by flexible fiberoptic bronchoscopy (FFB). Results: In the present study, among 63 patients who had undergone rigid bronchoscopy, airway FBs were successfully removed in 57 (90.48%). Rigid bronchoscopy failed in 6 (9.52%) patients. The age of cases at the time of bronchoscopy ranged from 11 months to 13 years. FFB was performed to extract missing or remaining FBs and was done successfully in all patients. The patients made an uneventful recovery following FB extraction using the FFB method. Conclusions: It is not easy to diagnose and treat airway FB in children. Rigid bronchoscopy has been approved as a method to manage airway FB, but a negative bronchoscopy result must usually be interpreted carefully. FFB is applicable as a proper and relatively safe diagnostic and therapeutic tool in managing airway FBs among the pediatric population, especially in cases where rigid bronchoscopy was performed but missed or failed to extract the FB.

Role of Flexible Fiberoptic Bronchoscopy in the Diagnosis and Treatment of Pediatric Airway Foreign Bodies: A 5-Year Experience at a Tertiary Care Hospital in Iran.

Background: Foreign body aspiration can be a life-threatening incidence amongst children. The aim of this study was to evaluate the usefulness and outcomes of foreign body removal with emphasis on accuracy of flexible fiberoptic bronchoscopy and the predictors of post-procedure complications in children. Materials and Methods: Records of patients who had undergone flexible fiberoptic bronchoscopy for foreign body extraction in Namazi Hospital affiliated to Shiraz University of Medical Sciences from 2012 to 2017 were retrospectively reviewed. Results: 109 patients in whom foreign body were detected by flexible fiberoptic bronchoscopy were enrolled. The patients' age range was between 10 days to 16 years, with the male predominance and the peak incidence amongst toddlers aged 1 to 2 years. The majority of foreign body were situated in the left main bronchus (22.9%). Coughing (37.5%) and chocking (20.8%) were the most commonly recorded symptoms. Hyperinflation (63.5%) and lung collapse (19.2%) were the most radiological findings. The duration of the procedure for 50.5% of the patients was 5-8 minutes. No complications were recorded during the flexible fiberoptic bronchoscopy procedure. Ninety-five percent of the patients had more than one visit before their admission for bronchoscopy with incorrect diagnosis of asthma/reactive airway disease and pneumonia, 74 and 20%, respectively. Conclusion: Although rigid bronchoscopy is still considered as the gold standard and preferred method in managing the airways foreign bodies, flexible fiberoptic bronchoscopy also can be used as an effective diagnostic and therapeutic tool with high success.

Foreign Body Retrieval by Using Flexible Cryoprobe in Children.

BACKGROUND: Foreign body aspiration (FBA) can be a life-threatening emergency and the cause of significant morbidity and mortality in children. Although rigid bronchoscopy is considered as the treatment of choice for the retrieval of foreign bodies (FBs) among pediatrics, extraction with the flexible fiberoptic bronchoscope (FFB) has become increased in popularity over the last few years. Recently, though there have been some reports about the use of cryoprobes as tools for the removal of FBs in adults, there is a limited experience concerning pediatrics, especially during the infancy period. The aim of this study is to describe the characteristics of FBs and cryoextraction as the new method of treatment. METHODS: This retrospective study was conducted on 50 pediatric patients with FBA who were managed by using the flexible cryoprobes to evaluate their outcomes between September 2013 and October 2018. RESULTS: A total of 50 children ranging in age from 7 months to 15 years underwent cryoextraction for the airway FBA retrieval with FFB using a cryoprobe. The main symptoms patients complained of were choking, cyanosis, cough, and noisy breathing. History, clinical examination, and finally radiologic examination were the diagnostic tools. The treatment consisted of FFB using cryoprobes under slight general anesthesia with maintaining the patient's spontaneous breathing. Using cryoextraction turned to be very useful. CONCLUSION: Using cryoextraction can be a reliable and preferred method with minimal complications for extracting airway FBs among children, especially those that have a friable texture.

Bronchoscopic surfactant administration in premature neonate with persistent lobar atelectasis: the new concept.

Neonatal pulmonary atelectasis (NPA) is the collapse or closure of a lung resulting in reduced or absent gas exchange. NPA is a common clinical complication among premature neonates and can contribute to a need for prolong mechanical ventilation and poor prognosis. It is usually unilateral. Chests X-ray, CT scan, and recently ultrasonography are diagnostic aids. Unfortunately, there are little experiences in the treatment of this condition. Administration of surfactant by ultrathin bronchoscope illustrates here as new concept in the treatment of persistent NPA in small size neonates.

Pharyngomalacia in Neonates: The Missed Issue.

Background: Airway malacia (AM) is a weakness of the airway's frameworks making them collapsible during the respiratory phases. Although the larynx, trachea, and bronchus are the usual sites for malacia to occur, there is another important type of malacia that involves the pharynx. Pharyngomalacia (PM) or concentric pharyngeal wall inspiratory collapse (PWIC) is mostly missed during bronchoscopic evaluations in the neonates with noisy breathing because people are not aware of this condition. Methods: This study aimed to evaluate the nasopharyngeal investigation among neonates suffering from noisy breathing. The retrospective study was undertaken to assess the frequency of PM and to propose indications for intervention in 100 neonates with noisy breathing. A thin fiberoptic bronchoscope was used to evaluate the upper airways under conscious status without any sedation in the neonates. Results: A total of 100 neonates with noisy breathing from September 2015 to October 2018 were retrospectively analyzed. The most common presenting symptom was inspiratory stridor which was observed in 35 (92.1%) of cases. PM was diagnosed in 38 neonates (38%) including 27 (71%) males and 13 (29%) females. Seventeen (44.7%) cases had mild, 11 (28.9%) cases had moderate, and 10 (26.4%) cases had a severe type of PM. PM was more prominent at the velopharynx level in 15 (39.4%) cases, and it was accompanied by up to six synchronous airway abnormalities. The most frequent synchronous airway abnormality was laryngomalacia in 13 (34.3%). Conclusion: PM is one of the causes of noisy breathing in infants. Since PM can be accompanied by the presence of other types of airway malacia, the issue becomes more complicated. On the other hand, lack of experience and facilities are two main causes for the accurate diagnosis and effective management among neonates. This study indicates that the investigation of pharynx is a missed part of the many workups that are used to diagnose the site of involvement in neonates with noisy breathing.

A rare case of massive foreign body aspiration mimic asthma.

Foreign Body Aspiration (FBA) remains as one of the leading causes of morbidity and mortality among pediatrics, especially in younger ones. Asphyxia caused by FBA is a main and common cause of this morbidity and mortality. Unfortunately, many FBAs may be misdiagnosed and an appropriate management becomes postponed specially in cases without any vivid evidence. Due to wide spectrum of signs and symptoms, FBA can be easily misdiagnosed with a recurrent pneumonia, asthma and immunodeficiency disorders. In this case report, the author presents the case of a 4-year-old girl who aspirated a massive amount of meat. She had been misdiagnosed with asthma and pneumonia for about 4 months, but eventually the problem was managed by an extraction using bronchoscopy cryoprobe.

Isolation and identification of Pandoraea spp. From bronchoalveolar lavage of cystic fibrosis patients in Iran.

BACKGROUND: Pandoraea species are gram negative, motile, non-spore forming, rod shaped and oxidase positive, obligate aerobes bacteria, and have one polar flagellum. Most of Pandoraea species are associated with lung infections in cystic fibrosis patients. Cystic fibrosis is the most prevalent autosomal recessive hereditary disease in the world that affects various organs of the body. The main important cause of death in these patients is lung involvement. This study was conducted to isolate and identify Pandoraea bacterium from bronchoalveolar lavage and sputum samples of cystic fibrosis patients in Shiraz, Iran. METHODS: In this research 31 samples of bronchoalveolar lavage and sputum were examined by culture and PCR method. Then confirmed isolates were evaluated for susceptibility to different antibiotics and ability to produce biofilm. RESULTS: The results of this study after cultivation, purification and DNA extraction led to the isolation of 4 Pandoraea bacterium by PCR using specific primers. Antibiotic susceptibility test were indicated all isolates were resistant to gentamicin, amikacin and imipenem and susceptible to ciprofloxacin, trimethoprim-sulfumethoxazole, piperacillin and tetracycline. Ability to create biofilm was indicated by some of Pandoraea isolates. According to findings of this study, ability to synthesis biofilm by Pandoraea isolates and resistance to some antibiotics are very important. CONCLUSIONS: Our study notes the role of P. pnomenusa as an emerging pathogen that can cause chronic lung colonization in CF patients. Identification tools need to be accurate and must be based on molecular techniques. Also our findings should raise awareness about antibiotic resistance in cystic fibrosis patients in Iran and ability of including bacterial agents to produce biofilm is an alarm for public health. Thus clinicians should exercise caution about finding of clinical relevance of this pathogen to the infection and prescribing antibiotics, especially in cases of children infections.

Bronchial Leech Infestation in a 15-Year-Old Female.

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the right B7-8 bronchus and removed by forceps and a Dormia basket.

Effect of albumin administration prior to exchange transfusion in term neonates with hyperbilirubinemia--a randomized controlled trial.

OBJECTIVE: To determine the role of intravenous administration of human albumin prior to blood exchange in term neonates for reduction of total serum bilirubin (TSB). DESIGN: Randomized controlled trial. SETTING: Neonatal Unit of Nemazee Hospital, affiliated with Shiraz University of Medical Sciences, southern Iran. PATIENTS: Fifty out-born term neonates with gestation age <37 weeks, birth weight <2500 g, otherwise healthy with TSB > or =25 mg/dL requiring blood exchange due to intensive phototherapy failure. INTERVENTION: Intervention group (n=25) received intravenous human albumin 20% (1 g/kg) one hour before exchange while the control group (n=25) underwent a blood exchange. OUTCOME MEASURES: TSB level at 6 and 12 hours post-exchange, total duration of phototherapy, need for a second exchange transfusion and adverse effects. RESULTS: The mean TSB level in albumin-treated group was significantly lower than that in the control group at 6 and 12 hours post-exchange (P<0.001). Mean duration of phototherapy was significantly reduced in the albumin-treated group, compared to that in the control group (8.6+/-2.4 vs. 25+/-8.2 hours) (P<0.001). None of the neonates in albumin-treated group needed exchange transfusion again and no side effects were observed. CONCLUSION: Infusion of 20% albumin (1 g/kg) one hour prior to blood exchange can significantly reduce the post-exchange total serum bilirubin and duration of phototherapy.