Button Battery Ingestion In Children Research Articles

Animal study: Basic mechanism of vocal cord paralysis caused by button battery ingestion in children

PurposeVocal cord paralysis has been reported as a common complication of button battery (BB) ingestion, and there is a need to confirm the mechanism of vocal cord paralysis for the development of a standardized treatment. MethodsA new CR2032 BB and artificial saliva were placed in a fresh pig esophagus with the recurrent laryngeal nerve (RLN); the negative electrode faced the nerve in the experimental group, while the positive electrode faced the nerve in the control group. The pH values of the intra- and extraesophageal walls were measured simultaneously. Pathological examination was performed after the esophagus and nerves were damaged. ResultsAfter BB ingestion, the pH near the intraesophageal negative electrode increased rapidly, reaching 11.5 at 30 min and over 14 at 6 h, while the extraesophageal pH did not change at 1 h and began to accelerate after 2 h, reaching 10 at 6 h. After 6 h of exposure, the pathological section showed that the structure of the mucosa, submucosa, and muscle layer were destroyed; chromatin in the nucleus faded, and part of the nerve bundle in the adventitia had liquefaction necrosis. ConclusionThe basic mechanism of vocal cord paralysis caused by BB ingestion is that the OH− generated by the electrolytic reaction of the negative electrode penetrates the esophageal wall and corrodes the RLN, which may be the cause of vocal cord paralysis caused by BB ingestion without esophageal perforation.

The use of honey in button battery ingestions: a systematic review.

Button battery (BB) ingestions may cause severe and possibly fatal complications, especially if the battery is located in the esophagus. The application of oral honey has recently been proposed by the National Capital Poison Center in the USA and in an ESPGHAN position paper in Europe, but clinical trials and experimental studies are limited. The goal of this systematic review was to analyze the evidence for this approach. A systematic review of clinical trials and experimental studies on the oral application of honey after BB ingestion in children was performed. Inclusion criteria according to the PICO format were patient age 0-18 years, ingestion of BB, oral administration of honey or other substances, all in vivo and in vitro studies, as well as reported complication rate, esophageal injury, and mortality. A manual search in the databases MEDLINE, Web of Science and Cochrane was performed to identify relevant search terms to form the following queries and to construct the extensive search. Furthermore, the search was extended by using snowballing on the reports reference lists. The review is registered at Research Registry. The identifying number is reviewregistry1581. We found four publications that investigated the effects of honey after button battery ingestion. Three of these presented experimental in vitro and in vivo results and one reported a clinical retrospective study of 8 patients. Follow up studies are required to further elucidate the effectiveness of the treatment with honey. The time intervals in which the use of honey is effective is not clear. Furthermore, a physiological model is needed for in vitro testing, preferably mimicking peristalsis and dynamic flow of the applied substances. However, since it is easy to apply and of minimal risk in patients over one year of age, honey should be considered a possible treatment option during the interval between presentation and endoscopic removal of the retained BB. https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/643e9df96750410027ee11b0/, identifier: reviewregistry1581.

Clinical characteristics and serious complications of esophageal button battery ingestion in the pediatric on 83 cases

Objective: To analyze the clinical characteristics and complications of esophageal foreign bodies of button battery ingestion in children. Methods: A retrospective descriptive study included 83 children who were hospitalized in our hospital on account of button battery ingestion from January 2011 to December 2021. There were 50 males (60.2%) and 33 females (39.8%). The age ranged from 7.6 months to one month off 10 years, with a median age of 18 months. The data of patient demographics and time from ingestion to admission, location, symptoms, management, complications, and follow-up outcome were recorded. SPSS17.0 software was used for statistical analysis. Results: Seventy-two children (86.7%) were younger than 3 years old. The time from ingestion to admission ranged from 1 h to 2 months, with a median time of 8 h. Among the 63 children who were first diagnosed in our hospital, the most common clinical symptoms were nausea and vomiting (32 cases, 50.8%), dysphagia (31 cases, 49.2%), salivation (11 cases, 17.5%) and fever (10 cases, 15.9%). Seventy-three of 83 cases had complete preoperative diagnostic tests, and 55 cases (75.3%) were diagnosed by X-ray. In 56 cases (76.7%), the foreign badies were impacted in the upper third of esophagus. In 72 cases (86.7%), the foreign badies were removed by rigid esophagoscopy. 23 (27.7%) had serious complications, including tracheoesophageal fistula in 15 cases(TEF;65.2%), vocal cord paralysis (VCP;34.8%) in 8 cases, esophageal perforation in 3 cases (EP;13.0%), hemorrhage in 3 cases(13.0%), mediastinitis in 3 cases (13%), and periesophageal abscess in 1 case (4.3%). There were significant differences in the exposure time of foreign bodies and unwitnessed ingestion by guardians in the complications group (P<0.05). 2 cases died (2.4%)respectively due to arterial esophageal fistula bleeding and respiratory failure caused by stent displacement during the treatment of tracheoesophageal fistula. Conclusion: Accidental button battery ingestion can be life-threatening. and it mostly happens in children under 3 years old. Serious complications may happen cause of non-specific clinical manifestations and unwitnessed ingestions. Anterior and lateral chest X-ray is the first examination choice. Tracheoesophageal fistula is the most common serious complication.

Research progress of button battery ingestion in children

纽扣电池是儿童食管异物中一类非常特殊的异物，因其具有较强的腐蚀性，可导致严重并发症和较高的病死率，早期的诊治及预防成为减少损伤、避免并发症的主要策略。其吞入2 h内即可导致明显的腐蚀性损伤，甚至在取出后损伤仍可持续，出现严重的延迟并发症甚至死亡。近年来国外对于纽扣电池摄入在取出前的黏膜保护措施以及取出后的中和缓解策略得到认同和推广。国内对于本病的认识严重不足，一些观点过于陈旧，防治策略不完善。本文从流行病学、损伤机制、临床表现、围手术期管理、缓解策略及预防等方面进行综述，旨在关注纽扣电池食管异物的综合管理，预防为主，降低并发症发生。.

Button Battery Ingestion in Children: A Dangerous Foreign Body

Pediatric morbidity and mortality related to button battery ingestion has increased since the introduction of lithium batteries inside common household electronics. Larger-diameter button batteries are more likely to result in esophageal impaction in children < 6 years old, resulting in tissue damage. Updated 2018 treatment recommendations include administering honey en route to the hospital for children > 1 year of age and the injection of acetic acid after the removal of the battery. In 2022, legislation was signed into law requiring the Consumer Product Safety Commission to implement specific consumer product safety standards on products that use button batteries.

Corrosive and Button Battery Ingestion in Children

Corrosive and Button Battery Ingestion in Children

Magnet and button battery ingestion in children: multicentre observational study of management and outcomes.

BackgroundMagnets and button batteries (BBs) are dangerous ingested foreign bodies in children. The scale and consequences of this public health issue in the UK are unknown. This study aims to report the current management strategies and outcomes associated with paediatric magnet and BB ingestion in the UK.MethodsThis multicentre, retrospective observational study involved 13 UK tertiary paediatric surgery centres. Children aged under 17 years, admitted between 1 October 2019 and 30 September 2020, following magnet, or BB ingestion were included. Demographics, investigations, management, and complications were recorded.ResultsIn total, 263 patients were identified, comprising 146 (55.5 per cent) magnet, 112 (42.6 per cent) BB, and 5 (1.9 per cent) mixed magnet BB ingestions. Median (interquartile range) age was 4.8 (2.0–9.1) years and 47.5 per cent were female. In the magnet group, 38 (26.0 per cent) children swallowed single magnets, 3 of whom underwent endoscopic retrieval for oesophageal or gastric impaction. Of the 108 (74.0 per cent) children who swallowed multiple magnets, 51 (47.2 per cent) required endoscopic or surgical intervention, predominantly for failure of magnets to progress on serial imaging. Bowel perforations occurred in 10 children (9.3 per cent). Younger age and ingestion of greater numbers of multiple magnets were independently associated with surgery. BB ingestion caused morbidity in 14 children (12.5 per cent) and life-threatening injuries in two (1.8 per cent); the majority were caused by oesophageal BBs (64.3 per cent).ConclusionMultiple magnet and BB ingestions are associated with significant morbidity. Action must be taken at an international level to regulate the sale of magnets and BBs, and to raise awareness of the risks that these objects pose to children.

Clinical profile and outcome of button battery ingestion in children- an institution-based experience from South India

Button batteries are increasingly becoming a common foreign body ingested by children, thanks to their ubiquitous presence in the multitude of common household articles /devices. Unwitnessed button battery ingestions pose a diagnostic challenge, in that, the symptoms mimic that of a GI upset. The diagnosis may be missed/ delayed unless there is a high index of suspicion. A multidisciplinary approach involving primary care Pediatricians, Pediatric gastroenterologists and Pediatric surgeons is often needed to effectively manage these children. Timely intervention can avert serious complications. Keywords: Button battery, Children, accidental ingestion, x-ray, Esophagus, Endoscopy.

Button battery ingestion in children: Experience from a tertiary center on 56 patients.

The ubiquitous use of portable electronic devices has resulted in an increased incidence of button battery (BB) ingestion in children. BB ingestion represents a distinct category of ingested foreign body due to the associated high morbidity and mortality. The aim of this study was to report our experience in the management of BB ingestion in children. We reviewed the clinical and endoscopic characteristics of 56 children (≤ 18 years) who presented to our hospital emergency department (ED) with BB ingestion between December 2016 and November 2019. Data with respect to patient demographics, time of presentation to ED to endoscopic retrieval of BB, the endoscopic findings, and complications, if any, were collected. We encountered a total of 56 children with BB ingestions. While 10 BBs passed off spontaneously without any complication, 27 BBs were extracted endoscopically from the stomach. A total of 19 BB impactions occurred: 9 at the cricopharynx/upper esophageal sphincter (UES), 5 in the mid esophagus, 4 in the lower esophagus, and one at the pyloric ring. All impactions occurred with larger BBs (diameter ≥ 10 mm). Complications occurred in 3 children (5.35%) following retrieval; 2 developed upper esophageal strictures on follow-up, which were treated with serial dilations and one experienced esophageal perforation and peritonitis requiring laparotomy. There was no mortality in our study. A vast majority of ingested BBs pass off spontaneously or require minimal endoscopic intervention. Serious complications arise in a small minority especially in BBs > 10 mm in size with a potential for esophageal impaction.

Bilateral vocal cord paralysis caused by accidental button battery ingestion in children: A case report and literature review.

Button battery ingestion in pediatric populations is a common occurrence with severe sequelae. Multiple case reports have established the occurrence of death, fistula formation, mucosal erosion, esophageal perforation, and bleeding post-ingestion of button batteries. However, there is a gap in the literature on the occurrence of bilateral vocal cord paralysis post-lithium battery ingestion. We present a case in which a 12-month-old male developed bilateral vocal cord paralysis following ingestion of a button battery. We compare our case to eleven other reports that exist in the literature based on age, sex, time until removal, clinical presentation, day upon which vocal cord paralysis developed, anatomic location, and post-operative course. We conclude that bilateral vocal cord paralysis is a time-sensitive complication which requires prompt diagnosis. Any child with stridor following button battery ingestion should undergo consultation with pediatric otolaryngology immediately. In addition, long-term follow-up is necessary to evaluate return of normal vocal cord function.

Cylindrical and button battery ingestion in children: a single-center experience.

The purpose of our study was to perform a comparative analysis of the examination and treatment outcomes of children with cylindrical and button batteries (BB) ingestion depending on their size and anatomical locations. This study was a retrospective analysis of 124 children aged from 1month to 18years who ingested batteries and were treated in a tertiary care center from January 1, 2014 to March 31, 2019. The data studied included age, sex, presenting symptoms at the time of evaluation, type and size of battery and modality of management. Twenty-three (18.5%) patients ingested cylindrical batteries (CBs), and 101 (81.5%) ingested BBs. The duration of hospital stay was significantly longer (p = 0.004) in the group of children who ingested BBs larger than 20mm. Endoscopic removal was performed in 75 (60.5%) children, 46 (37.1%) were followed up and three (2.4%) underwent open surgeries. Children with CBs ingestion, in 55% of cases, had gastric mucosal injuries. Children with BBs impacted in the esophagus in 96% cases had visible severe mucosal damage, whereas patients with gastric BB ingestion 19.5% had superficial gastric mucosal damage. Performing timely endoscopic retrieval in children who are admitted early to the hospital will reduce the risk of damage to the gastrointestinal mucosa, especially in the stomach. Unlike BBs, CBs, despite their large size, have advantageous shapes, uneventfully pass the esophagus and are more often retained in the stomach; thus, mucosal injuries are more often observed in the stomach. Consequently, endoscopic extraction is the treatment of choice for children with BB ingestion.

Vocal cord paralysis following lithium button battery ingestion in children.

This study reports on vocal cord paralysis caused by esophageal button battery (BB) ingestion in children. Medical records of children with vocal cord paralysis and esophageal BB ingestion treated at a tertiary referral institute between January 2016 and March 2020 were reviewed. Five patients aged 9-58months were identified; three were male. Each patient had accidentally swallowed a 20-mm-diameter lithium battery (3 CR2032 type and 2 CR2025 type). One battery was removed within 4h after ingestion, and three batteries were removed within 12h. Removal of the battery was achieved with rigid esophagoscopy in four patients and direct laryngoscopy in one patient. Four patients had bilateral, and one had unilateral vocal cord paralysis. Three patients underwent tracheotomy; two were tracheotomy-dependent until follow-up, while the third patient died of multiple organ dysfunction syndrome a month after surgery. The two cases without tracheotomy remain under close follow-up.Conclusion: Accidentally ingested button batteries should be removed promptly to avoid severe complications. Respiratory support and neurotrophic treatment in the early stage of vocal cord paralysis may be beneficial for recovery of vocal cord movement. What is Known: • Button battery ingestion in children is extremely harmful, especially when the diameter of the button battery exceeds 20mm. • Esophageal button battery impaction can cause serious complications such as esophageal perforation, mediastinal infection, tracheoesophageal fistula, vocal cord paralysis, and life-threatening bleeding. What is New: • Vocal cord paralysis in children with button battery ingestion plays an early warning role for identifying the severity of the disease. • Early neurotrophic drugs and glucocorticoid therapy may be helpful for the recovery of vocal cord movement, thereby avoiding tracheotomy.

Anesthetic Implications of Button Battery Ingestion in Children

Button battery ingestion in children has been associated with significant morbidity and mortality. The mechanisms of injury, potential complications, mitigation strategies, and the underlying urgent need for battery removal are reviewed.

Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children.

Button battery ingestions result in significant morbidity and mortality in children-before, during, and even after removal. The injuries created by a button battery lodged in the esophagus develop rapidly and can be severe. The current of the button battery, conducted through saliva and the tissue drives a highly alkaline caustic injury, leading to liquefactive tissue necrosis. In June 2018, new guidelines were released from the National Capital Poison Center, which include the use of preoperative protective, pH-neutralizing and viscous barrier interventions with honey and/or sucralfate administered within 12 h of ingestion. In addition, the use of postremoval irrigation of the esophagus with 50-150 mL 0.25% acetic acid is done in the operating room to help neutralize the site of tissue injury. Given that anesthesiologists play an important role in the management of esophageal foreign body removal, the entire specialty needs to be aware of the supporting data behind this and general perioperative considerations for management and potential complications of button battery ingestion.

Endoscopic Findings Associated With Button Battery Ingestion in Children: Do We Need to Change the Protocol for Managing Gastric Location?

Ingested button batteries (BB) can cause corrosive damage of digestive mucosa within minutes. Immediate endoscopic removal of esophageal BB has been clearly established, but the management of BB located in the stomach is still controversial. To describe demographic, clinical, radiologic, and endoscopic characteristics of a series of pediatric patients evaluated for BB ingestion. Retrospective analysis of clinical charts belonging to children younger than 15 years, who underwent endoscopic removal of BB at Clínica Alemana of Santiago, between November 2007 and November 2011. Twenty-five patients subjected to upper endoscopy were analyzed; median age, 31 months; 15 were male (60%), and 11 patients (46%) were symptomatic after ingestion. The BB ingestion was confirmed by radiograph. Endoscopy revealed 10 patients with BB in the esophagus, 12 patients in the stomach and 3 distal to duodenum. Range time between ingestion and endoscopy was 2 to 10 hours for esophageal BB and 2 hours to 3 days for gastric BB. Eight of the 22 BBs removed had a diameter of 20 mm or greater, 6 of them were located in the esophagus and 2 in stomach. The BB color changes were observed in 14 of the 22 BBs. Breakage of battery edges was present in 11 of the 22 batteries. All patients with esophageal BB and 6 of those 12 with gastric BB presented mucosal damage. Esophageal BB cause damage within hours. The BB located in the stomach may also cause damage early. Extraction of gastric BB before 48 hours should be considered.

Clinical Profile and Outcome of Esophageal Button Battery Ingestion in Children: An 8-Year Retrospective Case Series.

Objective To present the clinical profile and outcomes of esophageal button battery ingestion cases treated at our institution over an 8-year period. Methods A total of 17 children who presented after ingesting a button battery and were treated at a tertiary care clinic over an 8-year period were included in this retrospective case series study. Data on patient demographics and esophageal location of the battery, time from ingestion to admission, symptoms, grade of mucosal injury, size of the battery, management, complications, and follow-up outcome were recorded. Results Median age was 29 months (range, 2–99 months). Boys comprised (n=11, 64.7%) of the study population. The most common location was the proximal esophagus (n=10, 58.8%). The median time from ingestion to admission was 6 h (range, 3–24 h). Hypersalivation alone (n=6, 35.3%) or together with vomiting (n=5, 29.4%) was the most common symptom. Grade IIA mucosal injury was noted in six (n=6, 35.3%) patients. The diameter of the battery was a median of 18.0 mm (range, 14–22 mm). We did not observe any correlation between the size of the battery and the grade of the injury. Early postoperative complications were encountered in one patient (n=1, 5.8%) and late postoperative complications were noted in eight patients (n=8, 47.1%) which required further esophageal dilatations, and follow-up revealed normal findings in eight patients (n=8, 47.1%) and mortality occurred in one patient. Conclusion The current case series study describing the clinical profiles and outcomes of 17 children who had ingested an esophageal button battery revealed male predominance, young patient age, and admission after a median of 6 h (3–24 h) of ingestion with nonspecific symptoms. Our findings confirm the success of rigid endoscopy to remove esophageal button batteries and indicate the likelihood of severe complications after removal.

Button Battery Ingestion in Children: A Specific Clinical Issue.

Button Battery Ingestion in Children: A Specific Clinical Issue.

Analysis of Complications After Button Battery Ingestion in Children.

Button battery ingestion (BBI) in children may cause severe complications. This analysis is a literature review of complications after pediatric BBI. Literature was searched on PubMed (1995-2015) using the terms "button battery," "ingestion," and "children." End points were age, type and diameter of battery, complications, affected organ, and fatality. A total of 31 publications were analyzed. Patients from 4 months to 19 years old were included (n = 136,191, with n = 102,143 or 75% aged <6 y). In 6262, the diameter of the battery was documented. Batteries of 20 mm or greater in size were more prone to complications (n = 226). With regard to the anatomy, BBI caused complications mainly in the esophagus (n = 88, 38.94%). Sixty-one fatal outcomes were reported. Children younger than 6 years are the most prone to BBI, with lithium batteries of 20 mm or greater in size associated with complications. Complications have been estimated at 0.165%, with lethality of 0.04%. The esophagus is the most affected organ, but vascular involvement is often fatal.

Serious complications after button battery ingestion in children

Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0–18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2–258) h. All children were ≤ 5 (median 1.4; IQR 0.9–2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%).Conclusion: Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required.What is Known:• Button battery ingestion may result in serious and fatal complications.• Serious and fatal complications after button battery ingestion are increasing worldwide.What is New:• Sixteen serious complications after button battery ingestion occurred during 2008–2016 in children in the Netherlands.• Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.

Button battery ingestion in children

As the demand for small electronics continues to grow so does the risk of oesophageal ingestion of button batteries. These small but powerful sources of energy are ubiquitous in every household and when swallowed, especially in small children, have been shown to create significant injury in a short amount of time leading to long-term morbidity and possible death. This review highlights the latest findings regarding epidemiology, pathophysiology, diagnosis and management of ingested button batteries. Updated epidemiology from the National Capital Poison Center, new bench research looking at injury patterns and possible mitigation strategies, updated ideas on management algorithms including the use of a trauma protocol, close-look second endoscopy and management of button batteries in the lower gastrointestinal tract are reviewed in this paper. Despite advances in the understanding of injury mechanics and innovations leading to early diagnosis and improved management of button battery ingestion, parental and provider education remain the most important tools to keep children well tolerated from the sequelae of these potentially fatal events. Collaboration between healthcare experts, public health and industry is essential to find a safe answer to this ongoing threat.