Pediatric Aerodigestive Tract Research Articles

Disc battery in the pediatric oesophagus

The wide usage of disc batteries in toys, in the late seventies presented a new problem. In the form of accidental lodgements in the pediatric aerodigestive tract. The physico-chemical nature of the disc battery necessitates an early removal, so as to avoid a fatal outcome if missed and retained for a long duration. Management of one such case is reported with radiographic documentation.

Management and Outcomes of Button Batteries in the Aerodigestive Tract: A Multi-institutional Study.

To describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children. Retrospective case series. This multi-institutional study, endorsed by the American Society of Pediatric Otolaryngology research consortium, is a retrospective medical record review, including all children at five tertiary-care institutions presenting with button batteries impacted in the aerodigestive tract between January 2002 and December 2014. Battery type/size, duration and location of impaction, presenting symptoms, treatment, complications, and outcomes were examined. Eighty-one patients were included (64.2% male), with ingestion witnessed in 20 (24.7%). Median age at presentation was 3 years (range, 1 week-14 years). Median time from diagnosis to removal was 2.5 hours (range, 0.4-72 hours). Locations included the esophagus (n = 48), hypopharynx (n = 1), stomach (n = 6), nasal cavity (n = 22), and ear canal (n = 4). Most common symptoms for esophageal/hypopharyngeal impactions included dysphagia (26.5%), nausea/vomiting (26.5%), drooling (24.5%), cough (18.4%), and fever (18.4%). Most common symptoms for nasal impactions included epistaxis (54.6%), rhinorrhea (40.9%), nasal pain (27.3%), and fever (22.7%). Almost all esophageal impactions were from 3-V (89.5%), 20-mm (81.8%) lithium batteries. Severe esophageal complications included stricture (28.6%), perforation (24.5%), tracheoesophageal fistula formation (8.2%), pneumothorax (4.1%), and bilateral true vocal fold paresis (4.1%). Nasal complications included necrosis (59.1%), septal perforation (27.3%), and saddle nose deformity (4.5%). Duration of impaction correlated with an increased likelihood of persistent symptoms only for nasal batteries (P = .049). Button batteries in the upper pediatric aerodigestive tract or ear canal should be considered a surgical emergency, requiring urgent removal and careful vigilance for complications. 4 Laryngoscope, 131:E298-E306, 2021.

Airway management and anatomical development of the pediatric aerodigestive tract (ADT): current knowledge and clinical applications

Pediatric airway management can be difficult and especially hazardous due to a number of anatomical features of the developing aerodigestive tract (ADT), which is so different from the adult. Such differences have been presented annually since 2013 at EB meetings (Micham and Laitman, 2013; Curcio et al., 2014; Curcio and Laitman, 2015; Meaike et al., 2016; Gupta et al., 2016; Curcio et al., 2017, Curcio and Laitman, 2018). Particularly in regards to clinical applications involved in airway management procedures, our attention has been drawn to bedside tests that have been used to predict difficult intubation and difficult laryngoscopy in infants and young children. In stage 1 of this study we compiled a multi‐field database review of the mostly used bedside tests that predict difficult intubation of infants under 5 months of post‐natal life. We verified that ease of tracheal tube passage depends on the size of the cricoid ‐ the circular or near circular cartilage located at the inferior most portion of the funnel‐shaped infant larynx. We also selected the Laryngoscore (Piazza et al. 2014; 2018; Incandela et al, 2018), the frontal plane to chin distance, and the FPCD/weight ratio (Mansano et al., 2016) to be included in the next stages of this study. Our hypothesis is that it might be possible to adapt and increase the accuracy of such bedside tests and protocols that predict difficult intubation and laryngoscopy in infants and young children. This study is part of a larger project designed by our Brazilian‐US joint research team that seeks to explore possibilities and optimize airway management in elective procedures, critical and emergency care of pediatric patients under 5 months of age.Support or Funding InformationIn conjunction with the Building Bridges initiatives. Funded in part by CNPq ‐ Brazilian National Counsel of Technological Development.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Button Battery Injuries in the Pediatric Aerodigestive Tract

Children with a button battery impaction present with nonspecific symptoms that may account for a delay in medical care. We conducted a retrospective study of the clinical presentation, management, and complications associated with button battery ingestion in the pediatric aerodigestive tract and to evaluate the associated long-term morbidity. We reviewed the medical records of 23 patients who were treated for button battery impaction at our tertiary care children's hospital from Jan. 1, 2000, through July 31, 2013. This population was made up of 14 boys and 9 girls, aged 7 days to 12 years (mean: 4 yr). Patients were divided into three groups based on the site of impaction; there were 9 impactions in the esophagus and 7 each in the nasal cavity and stomach. We compiled information on the type and size of each battery, the duration of the impaction, presenting symptoms, treatment, and outcomes. The mean duration of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. We were able to identify the specific type of battery in 13 cases; 11 of these cases (85%) involved a 3-V 20-mm lithium ion battery, including all cases of esophageal impaction in which the type of battery was identified. The most common presenting signs and symptoms were vomiting (n = 7 [30%]), difficulty feeding (n = 5 [22%]), cough (n = 5), and bloody nasal discharge (n = 5); none of the presenting signs and symptoms predicted the severity of the injury or the outcome. The median length of hospital stay was far greater in the esophageal group (12 days) than in the nasal and stomach groups (1 day each; p = 0.006). Battery impaction in the esophagus for more than 15 hours was associated with a significantly longer postoperative hospital stay than impaction for less than 15 hours (p = 0.04). Esophageal complications included strictures (n = 5), perforation (n = 3), and tracheoesophageal fistula formation (n = 2). Clinicians should consider battery impaction in the upper aerodigestive tract as an emergency that can lead to significant long-term morbidity, and therefore immediate surgical intervention is required.

Button Battery Injuries in the Pediatric Aerodigestive Tract

Objectives: (1) Describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children. (2) Evaluate the long-term morbidity associated with button battery impaction. Methods: This study is a retrospective medical record review involving 23 consecutive patients who presented to a tertiary care childrens hospital between January 1, 2000, and July 31, 2013, with button batteries impacted in the nasal cavity (n = 7), esophagus (n = 9), and stomach (n = 7). Battery type/size, duration of impaction, presenting symptoms, treatment, and outcomes were examined. Results: Average time of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. 3V lithium batteries accounted for 84% of battery injuries and were responsible for all cases of esophageal impaction. Most common presenting symptoms were vomiting (30.4%), fever (26%), and cough (21%). Presenting signs and symptoms did not predict severity of injury or outcomes. Average length of hospitalization was greater for esophageal impactions (43.0 days) than for nasal or stomach impactions (2.0 days; P = .009). Batteries in the esophagus for >15 hours led to a longer postoperative hospital course and were associated with higher rates of transmural necrosis compared with those impacted for <15 hours ( P = .04). Esophageal complications included perforation (n = 3), tracheoesophageal fistula formation (n = 2), and strictures (n = 4). Conclusions: Button battery impactions in children present with nonspecific symptoms that may account for the delay in medical care. Clinicians must consider battery impaction in the upper aerodigestive tract as a surgical emergency that may lead to significant long-term morbidity.

Imaging of Pediatric Aerodigestive Tract Disorders

Imaging of Pediatric Aerodigestive Tract Disorders

The Safety of Aerodigestive Tract Flexible Endoscopy as an Outpatient Procedure in Young Children

Flexible endoscopy (FE) for the pediatric aerodigestive tract is an invasive and complicated procedure; therefore, it is usually performed under an inpatient setting. We investigated whether FE could be a safe procedure for outpatient young children (< 5 years old) and analyzed the findings. Outpatient FE records were retrospectively reviewed between 1996 and 2003. Patients aged less than 5 years were enrolled and allocated to 3 age groups: group A (<or=3 months), group B (4-12 months), and group C (1-5 years). Patients with or without previously known major airway anomalies were also grouped for analysis. A total of 728 children (479 boys, 249 girls) who underwent 834 FE procedures were collected. Of those without previously known airway anomalies, stridor was the most common symptom in group A (60.2%), and snoring in group B (34.1%) and group C (74.2%). Laryngomalacia was the most common FE finding in group A (60.2%) and group B (34.1%), and nasal adenoid hypertrophy in group C (69.6%). After FE, there were 57 admissions (6.8%), and higher in those aged less than 1 year or in those with major airway anomalies. Seven (0.7%) were complication-associated admissions. From this study, we conclude that FE is a safe, effective and tolerable outpatient procedure in the majority of young children, and serious complications were uncommon.

Acute airway distress from endotracheal intubation injury in the pediatric aerodigestive tract

Objectives Two unusual cases of pediatric aerodigestive tract trauma postintubation with subsequent complications are described. Pediatric retropharyngeal dissection from trauma has not been reported previously. Methods We conducted a retrospective chart review in a pediatric tertiary care center. Results A 6-year-old girl underwent attempted nasotracheal intubation. She sustained retropharyngeal dissection, receiving positive pressure ventilation before this injury was noted. She developed subcutaneous emphysema. The child was managed conservatively and did well. An 8-year-old boy sustained a 4-cm laceration of his posterior trachea, developing pneumomediastinum after intubation. On transfer to our institution, he underwent direct laryngobronchoscopy and was reintubated with the tip of the endotracheal tube distal to the laceration. Postoperatively, the child accidentally pulled his tube and coughed, resulting in severe subcutaneous emphysema with increased pneumomediastinum. An emergent tracheotomy was performed. The patient subsequently did well. Conclusion A higher index of suspicion with more careful surveillance may prevent further morbidity.

Advantages of video endoscopy in pediatric aerodigestive tract disorders

The naked eye examination of the larynx through the laryngoscope is inadequate for the examination of the minute anatomic structures and does not permit the visualization of the subglottic space or the trachea. A telescope coupled to a miniature television camera is advanced under precise visual control through the vocal cords and into the trachea. Oxygen is administered through the instrument to avoid fogging and provide diffusion oxygenation during the apneic phase. The procedure is safe, fast, and provides a simultaneous record. A vastly improved image allows the examination to be performed from the television screen. Electronic imaging has much to offer in the area of pediatric endoscopy. Video endoscopic examinations of the aerodigestive tract of 151 infants were successfully performed without any complications.