Foreign body aspiration in 48 children: clinical manifestations and outcomes

PURPOSE: This study aimed to have a deeper insight into the clinical spectrum of foreign body aspiration in children and to prospect the further clinical implications of early diagnosis. METHODS: We conducted a retrospective medical chart review of 48 children with foreign bodies at The Catholic University of Korea, Seoul St. Mary's Hospital, between January 2009 and December 2013 in terms of age, sex, symptoms and signs, radiologic findings, and clinical courses. Patients were divided into 2 groups according to the time from aspiration to a definite diagnosis. The 2 groups were compared for clinical courses, radiologic findings, and the length of hospitalization. RESULTS: Approximately 85% of patients were 3 years of age or younger. About one-fifth of patients had no history of foreign body aspiration. Cough and coarse breathing sounds were the most common symptoms and signs. The most frequent radiologic finding was pulmonary air trapping (33.3%). The mostly commonly aspirated foreign body was peanut and detected in left main bronchus. Cough, sputum, and absence of aspiration history were more common in the delayed diagnosed group than in the early diagnosed group. CONCLUSION: Our results suggest that the number of accidents associated with foreign body aspiration can be reduced by keeping infants with nut formula under close observation and by conducting assertive bronchoscopic examination on children with delayed recovery from respiratory infections. After removal of foreign bodies, close monitoring and expectation of possible complications can prevent patients from a long hospital stay.

Outcome of acute respiratory distress syndrome in children: a single center study

PURPOSE: This study aimed to determine the incidence, etiology, prognostic factors, and outcome of acute respiratory distress syndrome (ARDS) in children and to provide epidemiological data of children with ARDS treated at the pediatric intensive care unit (PICU) of a single center in Korea. METHODS: We conducted a retrospective medical chart review of 19 children diagnosed with ARDS at the PICU of The Catholic University of Korea, Seoul St. Mary's Hospital, between March 2009 and February 2012. RESULTS: Of the 334 PICU patients, 19 (5.6%) satisfied the American-European Consensus Conference definition of ARDS. Thirteen patients with ARDS died (mortality rate, 68.4%). Pneumonia was the most common cause of ARDS and observed in 10 patients (52.6%). There were significant differences between survivors and nonsurvivors in the PaO2/FiO2 ratio and the number of organ failure. The mortality rate was significantly higher in patients with a baseline PaO2/FiO2 ratio 100 mmHg (84.6% vs. 33.3%, P=0.046). We observed that a higher number of organ failure during the PICU stay, resulted in a higher mortality rate (P=0.037). Multiple logistic regression analysis showed that the PaO2/FiO2 ratio (adjusted odds ratio, 0.958) was independently associated with the increased risk of death after controlling for the number of organ failure. CONCLUSION: The mortality rate of ARDS in children was 68.4% in this study, a higher rate than those reported in other national and international studies. The PaO2/FiO2 ratio at the time of ARDS onset was a helpful prognostic factor for predicting the mortality rate of children with ARDS.

Usefulness of flexible bronchoscopy in treatment of atelectasis in children

PURPOSE: This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection. METHODS: The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary's Hospital from April 2007 to January 2013. RESULTS: A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases. CONCLUSION: Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered.