Best management of ultra-small tracheobronchial foreign bodies in neonates

ObjectivesTo develop (1) a practical and comprehensive algorithm of instruments and techniques available to treat neonates with tracheobronchial foreign bodies, based on the patient's subglottic diameter and (2) primary and secondary prevention strategies for neonatal tracheobronchial foreign bodies.Methods(1) Analysis of the case of a severely premature infant who presented with the incidental radiological finding of a 2 cm suction catheter tip, which, over a two week period, had migrated between her main bronchi; the foreign body was removed with a previously unreported combination of instruments: a 3 French (F) flexible urological forceps through the side port of a 2.5 mm rigid bronchoscope. (2) In vitro testing of typical foreign bodies and readily available endoscopic instruments.ResultsWe have developed a practical and comprehensive algorithm for the treatment of neonates with tracheobronchial foreign bodies, as well as primary and secondary prevention strategies.ConclusionsThe treatment algorithm and prevention strategies may reduce morbidity and mortality from neonatal tracheobronchial foreign bodies.