Button battery ingestion in children: A long term challenge

TORONTO: A report published in Pediatrics, claims that prolonged button battery (BB) impaction in children who seek medical attention is a risk factor for vascular problems and death.

Due to the extensive use of BBs in domestic appliances, both the frequency of BB ingestions and the severity of injuries have been trending upward. With BBs >20 mm in diameter and in children 5 years old, the risk of impaction and ensuing problems rises. Unfortunately, a lot of BB ingestions go unreported or go unnoticed. The primary objectives of initial management for esophageal BB impaction, which is a surgical emergency, are to quickly diagnose the ingestion and then hasten surgical removal to reduce damage and the risk of sequelae.

"Despite the surge in BB ingestions and the publication of many case reports, complications are still uncommon," they added.

In addition to discussing associated outcomes, the authors of the study sought to describe the traits of young patients with vascular problems following BB impaction.

For this objective, cases included in the National Capital Poison Center (NCPC) BB registry from 1977 to December 2021 were searched for reports of serious and death consequences following BB intake. All articles, including case studies, describing under-18-year-olds who ingested BBs and experienced vascular, esophageal, airway, or death-related issues were considered. They gathered information on the publication date, the child's age and gender, the battery size and type, the length and site of impaction, complications, follow-up interventions, and the time between battery removal and death.

Conclusive points of the study:

• In 361 cases, consuming BB resulted in severe problems or death (321 cases from the National Capital Poison Center registry database, 40 additional cases from PubMed).
• 19% (69 of 361) resulted in fatalities, and 14% (51 of 361) had vascular injuries.
• Aorto-esophageal fistulas made up 75% of vascular complications, and 82% of vascular injuries were fatal.
• In comparison to survivors, fatal vascular cases showed a larger range of presenting characteristics and a substantially longer median impaction time (96 hours versus 144 hours).

In order to describe the relationships between risk variables and outcomes, the researchers concluded that a thorough review of vascular complications following esophageal BB impaction is necessary.

"Children who exhibit hematemesis following BB impaction must be treated with a high index of concern, and they must be transferred as soon as possible to a tertiary center where vascular surgical intervention may increase their chances of survival," asserted the authors.

REFERENCE

Olugbenga Akinkugbe, Adrian L. James, Olivia Ostrow, Tobias Everett, Nikolaus E. Wolter, Nicole K. McKinnon; Vascular Complications in Children Following Button Battery Ingestions: A Systematic Review. Pediatrics August 2022; 150 (3): e2022057477. 10.1542/peds.2022-057477