Flexible endoscopy of aerodigestive tract in small infants.

BACKGROUND: Flexible endoscopy (FE) is a useful method for diagnosing airway problems. Congenital or acquired airway lesions in infants may lead to respiratory distress that requires comprehensive investigation and management. This study was designed to evaluate the use of FE in small infants. METHODS: Infants who had symptoms of respiratory distress and received FE when they were less than 1-year-old were studied and their medical history, diagnoses, interventions, and complications from FE were investigated. RESULTS: The study population consisted of 568 small infants (334 boys and 234 girls) who weighed 5.1 +/- 2.4 kg, and received FE when they were 4.5 +/- 3.6 months of age. Most patients (91.2%) received diagnostic FE and the remainder (8.8%) received therapeutic procedures. Stridor (38.0%) was the most common indication for FE and laryngomalacia (33.3%) was the most frequent finding. Synchronous FE diagnosis was found in 351 (61.8%) cases. No major complications associated with FE were found. CONCLUSION: Flexible endoscopy allows direct visualization of dynamic motion of the small aerodigestive tract. Laryngomalacia was the most common FE finding of respiratory distress in small infants. Synchronous FE lesions were frequently found in this young age group and it necessitated a thorough investigation of the entire aerodigestive tract.

Thoracic empyema in children: early surgical intervention hastens recovery.

The optimal management of thoracic empyema in children is still controversial. In this retrospective study, we analyze our six-year experience in the management of empyema. From April 1995 to December 2001, 39 patients under age 6 years were admitted with the diagnosis of empyema. These patients were assigned by the method of empyema management to one of two groups (either the conservatively treated or surgically treated group). The surgical patients were divided on the basis of the timing of surgical intervention into either the early (within 8 hospital days) or late (beyond 8 hospital days) surgical group. There was no difference in total hospital stay between those treated conservatively (24.3 +/- 11.6 days) and surgically (24.5 +/- 7.9 days). Among the surgically treated patients, recipients of early surgical intervention had significantly shorter hospital stay (20.2 +/- 5.9 days) than those receiving late surgical intervention (30.1 +/- 6.5 days). Early surgical intervention in cases of thoracic empyema in young children can shorten hospitalization. These children should undergo surgery if their clinical course does not improve within one week.