Paediatric Otolaryngology Head and Neck Surgery Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
Paediatric Allergy and Immunology Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Epworth Allergy Specialists & Centre for Paediatric Allergies, Epworth Hospital, Richmond, VIC, Australia.
J Allergy Clin Immunol Pract. 2021 Aug;9(8):3140-3146.e2. doi: 10.1016/j.jaip.2021.03.052. Epub 2021 Apr 20.
Pediatric airway foreign bodies (FBs) are a surgical emergency, and peanuts and tree nuts (PN/TNs) can pose a significant aspiration risk in young children. In 2015, the Learning Early About Peanut allergy (LEAP) trial established that early introduction of peanuts in high-risk infants reduced the risk of developing a peanut allergy. Infant feeding guidelines were subsequently modified to actively encourage the introduction of allergenic foods for all infants. The impact of this shift in feeding advice on the incidence of PN/TN inhalation has not been previously studied.
To determine the incidence of PN/TN inhalation presentations to a quaternary pediatric hospital between 2008 and 2018.
A retrospective cohort study of children who were diagnosed with an airway FB by rigid bronchoscopy.
There were 200 cases of FB inhalation (35% PN/TN, 34% other foods, and 31% inorganic material). There was a rise in the total incidence of FB inhalation over the study period (incidence ratio rate [IRR], 1.09; P < .001). The rise was due to PN/TN (IRR, 1.16; P < .002) and other food inhalation (IRR, 1.12; P = .01), with no significant increase in inorganic FB aspiration (IRR, 1; P = .94). Between pre-LEAP (2008-2014) and post-LEAP (2015-2018) periods, there was a trebling, doubling, and no increase in the rate of PN/TN, other food, and inorganic FB inhalation, respectively.
Since the publication of the LEAP study, there has been a rise in PN/TN and other hard solid food inhalation at our institution. This study highlights the urgent need to engage the public to promote safe introduction of hard foods in young children.
小儿气道异物（FB）是一种外科急症，花生和坚果（PN/TN）在幼儿中存在显著的吸入风险。2015 年，花生过敏早期预防（LEAP）试验证实，高危婴儿早期摄入花生可降低花生过敏的风险。随后，婴儿喂养指南进行了修改，积极鼓励所有婴儿引入致敏食物。这种喂养建议的转变对 PN/TN 吸入的发生率的影响尚未被研究过。
确定 2008 年至 2018 年期间，一家四级儿科医院因 PN/TN 吸入而就诊的病例发生率。
对通过硬性支气管镜诊断为气道 FB 的儿童进行回顾性队列研究。
共有 200 例 FB 吸入病例（35%为 PN/TN，34%为其他食物，31%为无机物）。在研究期间，FB 总吸入发生率呈上升趋势（发病率比[IRR]，1.09；P <.001）。这种上升归因于 PN/TN（IRR，1.16；P <.002）和其他食物吸入（IRR，1.12；P =.01），而无机物 FB 吸入无显著增加（IRR，1；P =.94）。在 LEAP 研究之前（2008-2014 年）和之后（2015-2018 年），PN/TN、其他食物和无机物 FB 吸入的发生率分别增加了两倍、两倍和无增加。
自 LEAP 研究发表以来，本机构 PN/TN 和其他硬固食物吸入的发生率有所上升。本研究强调了迫切需要让公众参与进来，以促进幼儿安全引入硬食物。
