Necrotising Enterocolitis

Foreign body aspiration is inhalation of an object into the larynx, trachea or bronchial tree. It is most common in children younger than 4 years and is frequently unwitnessed.

Nuts, seeds, popcorn, food fragments and small toy components are common aspirated objects.

A normal examination or normal chest radiograph does not exclude airway foreign body.

Acute aspiration may cause:

• Sudden choking
• Coughing
• Gagging
• Stridor
• Wheeze
• Cyanosis
• Respiratory distress

Laryngeal or tracheal obstruction can cause rapid complete airway compromise and cardiac arrest.

Bronchial foreign bodies may present later with:

• Persistent focal wheeze
• Unilateral reduced air entry
• Chronic cough
• Recurrent pneumonia in the same lobe
• Persistent consolidation
• Haemoptysis
• Localized bronchiectasis

A characteristic history is sudden choking while eating or playing followed by persistent respiratory symptoms.

Maintain a high index of suspicion.

Chest radiograph may show:

• Unilateral hyperinflation
• Air trapping
• Atelectasis
• Mediastinal shift
• Focal consolidation
• Radio opaque foreign body

Most aspirated food objects are radiolucent.

Inspiratory and expiratory films or lateral decubitus views may demonstrate air trapping.

A normal radiograph does not rule out aspiration.

Definitive diagnosis and treatment are usually achieved by bronchoscopy.

Complete airway obstruction

Treat immediately using age appropriate foreign body airway obstruction manoeuvres.

Do not perform blind finger sweeps.

If the child becomes unconscious, commence CPR and inspect the airway during ventilation attempts.

Stable suspected aspiration

Keep the child fasting.

Avoid unnecessary agitation.

Arrange urgent ENT, respiratory or paediatric surgical assessment.

Rigid bronchoscopy remains the definitive method for removal of most significant airway foreign bodies in children.

Do not discharge a child with convincing aspiration history purely because examination or chest radiography is normal.

Delayed removal can lead to pneumonia, abscess, granulation tissue and bronchiectasis.