Etiology, diagnosis and treatment in childhood atelectasis

Abstract

Correspondence (İletişim): Emine Atağ, M.D. Medipol Universistesi, Cocuk Gogus Hastaliklari Bilim Dali, Istanbul, Turkey Phone (Telefon): +90 533 685 00 87 E-mail (E-posta): emineatag@gmail.com Submitted Date (Başvuru Tarihi): 17.06.2020 Accepted Date (Kabul Tarihi): 24.07.2020 Copyright 2021 Haydarpaşa Numune Medical Journal OPEN ACCESS This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 140 Atağ et al., Etiology, Diagnosis, and Treatment in Childhood Atelectasis / doi: 10.14744/hnhj.2020.97059 cause of morbidity and mortality in children with underlying diseases such as neurological diseases, early diagnosis and treatment are of great importance[3]. There are very few studies in the literature evaluating atelectasis in children, and there is no study on atelectasis detected in hospitalized children. In this study, clinical and demographic characteristics and factors associated with atelectasis were evaluated in pediatric patients with atelectasis who were hospitalized in the ward and intensive care unit of a tertiary pediatric clinic. Materials and Methods A total of 36 patients who were followed up in the pediatric service and pediatric intensive care unit of our clinic between December 1, 2018, and June 1, 2019, and who were found to have atelectasis radiologically were evaluated retrospectively. Clinical and demographic data of the patients were recorded. The hospitalization causes and underlying diseases of the patients were determined. Posteroanterior and lateral chest radiographs were obtained in all patients for atelectasis diagnosis. Patients who could not be diagnosed with chest radiography were also evaluated with thoracic tomography and ultrasonography. Radiological localization (upper, middle, lower, and multiple zones), extent of the involved area (segmental and subsegmental, lobar, and total), and post-treatment radiological response were evaluated by the same pediatric radiologist. Regression of respiratory signs and symptoms in patients was defined as clinical response, and regression in radiological findings was defined as radiological response. Flexible bronchoscopy was performed in patients who did not develop a clinical or radiological response. Factors affecting clinical and radiological response and length of stay were investigated. SPSS 23 program was used for statistical analysis. Categorical measurements were recorded as numbers and percentages; and among the numerical measurements, data which showed parametric distribution as mean and standard deviation and data which showed non-parametric distribution as median (25th–75th percentile). Subgroup analysis was performed by dividing the patients’ hospitalization, clinical, and radiological response times into two subgroups, as long and short, according to median values. Mann–Whitney U-test and Chisquare analysis were performed to evaluate the relationships between data. The study was conducted in accordance with good clinical practice and the Declaration of Helsinki. The families were informed about the study and their consent was obtained. The study was approved by the ethics committee of our hospital (Ethics Committee approval number: 0.01/171). Results About 50% of the patients were females. The median age was 1.85 years (1.0–7.37). Thirty patients were hospitalized for pneumonia (83%), two patients for neurological causes (6%), and two patients for asthma attack (6%). Except for two patients, all patients had an underlying disease that increased the risk of atelectasis. While five (14%) patients had a single underlying disease, 29 patients (81%) had more than one underlying disease. While the most common underlying diseases were neurological diseases (n=12, 36%), bronchopulmonary dysplasia and anatomical airway abnormalities (malacia, intrabronchial obstruction, and anatomical variation) were in the second place (n=6, 17%), and asthma and congenital heart diseases were at the third place (n=5, 14%). Fourteen of our patients (38.9%) had cough, nine (25%) had tachypnea, nine (25%) had low saturation, and three (4%) had pathological auscultation findings in respiratory system examination. General characteristics of our patients are shown in Table 1. In patients who could not be diagnosed by chest radiography or who did not respond to treatment appropriately, thoTable 1. General characteristics of our patients