Preventive Paediatrics

EDITOR'S WORD

2024-03-19T05:59:05+01:00

The 10th jubilee volume of the journal Preventive Pediatrics is in front of you. From this year, the journal of the Association of Preventive Pediatrics of Serbia is aimed as younger adolescent and as you will see in the journal, the target group of many papers are adolescents. We tried in the first decade, and I hope we will continue to follow the news and achievements of our and then foreign authors. It is our particular pleasure to collaborate with young and ambitious authors and colleagues and to be part of their professional and scientific development.

I would like to express my most sincere gratitude to all authors from the very beginning, to all reviewers, committee members, technical support and logistic for their commitment, help, advice and their hard work above all.

AN INTRODUCTION TO NIRSEVIMAB

2024-03-19T05:42:26+01:00

Respiratory syncytial virus (RSV) is a dominating respiratory infection worldwide. It is responsible for infecting millions of children worldwide each winter through highly contagious droplets and secretions. Over 2.1 million of these children require some form of medical attention during illness. Due to this high disease burden, the development of new agents to prevent or reduce the spread of RSV has been a top priority. Recently, nirsevimab, a new monoclonal antibody was introduced for the 2023-2024 winter season that holds promise for limiting the spread, morbidity, and mortality associated with RSV.

INTERNET AS A SOURCE OF INFORMATION FOR PARENTS OF CHILDREN WITH DEVELOPMENTAL DISABILITIES AND/OR CHRONIC ILLNESSES

2024-01-02T21:50:33+01:00

Introduction: Studies indicate that the internet has become an important source of information for parents of children with developmental disabilities/chronic illnesses as they search for specific information concerning children’s health/condition and development.

Objective: The aim of this research is to assess the way parents use the Internet and their approach in finding information regarding the children’s condition or health and means of support for the whole family.

Methods: The online questionnaire, made for the purposes of this research, was filled out by 104 participants, ages 18 to 45, which consists of 35 questions organized in five sections: information about parents; information about the child; information about internet research; information about the professional that parents are in contact with; information about the society.

Results: The most frequent searched information are the ones related to the process of rehabilitation and raising the child. The results also show the lead expert from whom parents get the most information is the doctor. The characteristic trait of expert which parents value the most is shared involvement in the decision making process. Furthermore, the experience and recommendations from society have a significant influence on parents.

Conclusion: It is necessary to promote the importance of open communication between parents and health workers that is based on trust. It is also important to promote parental involvement in all aspects of child rearing.

IMMUNIZATION AGAINST HUMAN PAPILLOMA VIRUS IN BELGRADE COMMUNUTY

2024-01-02T22:05:51+01:00

Introduction: Infection with human papillomavirus (HPV) is one of the most common sexually transmitted infections. In an effort to prevent diseases caused by HPV, a 9-valent HPV vaccine has been available in Serbia since June 2022. It is recommended for children aged 9 to 19 years.

Objective: This study aimed to determine the number of children and adolescents vaccinated against HPV, to assess if there is a gender difference in the number of vaccinated children in the municipality of Belgrade, and to evaluate the percentage of children who started vaccination versus those fully vaccinated in the municipality of Čukarica.

Method: The study utilized periodic reports from the immunization representative of the “Dr Simo Milošević” Health Center as the data source.

Results: In the period from June 2022 to November 2023, a total of 19,839 vaccine doses were administered across the municipalities of Belgrade. In most health centers, a significantly higher percentage of girls began vaccination, with the exception of Barajevo Health Center (50% vaccinated boys) and Savski Venac Health Center (36% vaccinated boys).

Conclusion: For the analyzed 18-month period, we can conclude that the 7% vaccination rate recorded in the municipality of Čukarica is disappointingly low. Similarly, the 3% of children who received the second or third dose is also small, as it implies that nearly half of those who started the vaccination process have not been fully vaccinated.

WHOOPING COUGH IS NOT FORGOTTEN DISEASE

2024-02-26T18:32:58+01:00

Introduction. Pertussis, also known as whooping cough, is an acute infectious respiratory disease caused by the bacterium Bordetella pertussis. It is the only vaccine-preventable disease that records an increase in the number of sufferers in the world, despite the high coverage of children by vaccination. Timely vaccination with a vaccine covering 95% of the population is the most effective measure of protection against pertussis. According to data from the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut", 909 cases of whooping cough were recorded in Serbia in 2023.

Case series outline. This paper describes a series of seven confirmed cases of pertussis in primary pediatric practice, during October and November 2023. Two of the seven patients are infants, one of whom was unvaccinated and the other who received only one dose of the petovalent vaccine. Four patients are school-aged children, regularly vaccinated for their age, but more than ten years have passed since their last dose of vaccine. All of them had symptoms of cough with paroxysms and posttussive vomiting, and their complete blood count showed leukocytosis with predominant lymphocytosis. Five patients were diagnosed with PCR diagnostics, and two patients with serological analyses. Two unvaccinated and incompletely vaccinated infants required hospitalization. In all patients there was a gradual and complete regression of symptoms during the six weeks.

Conclusion. Whooping cough is not a forgotten disease. Prevention, early detection and recognition of the infected as a source of infection are of essential importance in suppressing the pertussis epidemic.

HEALTH STATUS AND HEALTH PRACTICES OF MONTENEGRIN FAMILY PHYSCIANS

2023-09-22T10:47:04+02:00

Introduction: Physicians have lower mortality rates than general population, but similar rates of chronic diseases.

Aim: The aim was to investigate health status and heath practices of family medicine doctors in Primary Health Care Center Podgorica, Montenegro and compare it to high school teachers.

Method: A total of 104 (69.3%) physicians and 40 teachers (50%) responded to a questionnaire about their health status and health practices.

Results: A total of 45% of practitioners and 45% of teachers self-reported at least one disease without significant difference in the incidence and type of disease (p=0.162). There was also no difference in using sick leave (p=0.633). Both groups tended to work when sick, but significantly more physicians worked when tired (p=0.026). Most of respondents were registered with a general practitioner, but only teachers tended to visit their physician when ill (p<0.001). Thirty minutes of daily physical activity was reported by 16.3% of the physicians and 15.0% of the teachers without a significant difference (p=0.915).

Conclusion: Compared to the teachers Montenegrin physicians have similar health status and health practices. However, physicians more often tend to work when they are tired and to selfcare when they are ill. Physicians need to pay attention to the lifestayle habits and to follow the recommendations for themselves what they provide to their patients.

IMPORTANCE OF EDUCATION FOR IMPLEMENTATION CHILDRENS RIGHTS IN HEALTH CARE

2024-02-20T19:09:20+01:00

Introduction: The implementation of children's rights in health care in terms of proper application in practice represents the introduction of new standards and the need for additional education of health professionals, children and their parents.

Aim: The aim of the research work is to indicate the necessity of daily application of children's rights in pediatric practice.

Methodology: The sample consisted of 104 parents of child-patients and 69 health workers and associates who work with children at KBC "Dr. Dragiša Mišović-Dedinje".

Results: The results indicate that a very large percentage of parents, as much as 77.9%, do not have adequate information about children's rights in the health care system. Our results on children's rights in the field of healthcare show that 91.3% of parents think that education is necessary, while 3.8% of them think that this type of education is not necessary. The vast majority of health workers and associates, 78.3%, do not have adequate knowledge about the rights of child patients.

Conclusion: Our analyses on guaranteed children's rights and legal position of children in the health care system in the Republic of Serbia, confirmed the full importance and need for the introduction of new standards, including additional education of children, their parents and health workers and associates.

PERTUSIS - CURRENT SITUATION

2024-03-21T07:23:57+01:00

Pertussis, or whooping cough, is a contagious acute respiratory infection caused by the bacterium Bordetella pertussis. Before the widespread immunization, pertussis was one of the most common infectious causes of morbidity and death. Despite widespread immunization, the pathogen continues to circulate in the population with cyclical outbreaks. Recent data from the Institute of Public Health of Serbia "Dr Milan Jovanović Batut" for the territory of the Republic of Serbia reveals a significant rise in pertussis cases in the last year, which creates a need for careful analysis of the current epidemic. The aim of our study was to show the current epidemiological situation related to pertussis illness, along with an analysis of patients hospitalized at the Children's Hospital for Pulmonary Diseases and Tuberculosis, Clinical Hospital Center "Dr Dragiša Mišović" from August 2023 to February 2024, who were laboratory confirmed with B. Pertussis infection. During this period, 23 patients were hospitalized with confirmed B. Pertussis infection. The laboratory method for isolating the bacterium was a nasopharyngeal swab that was sent for PCR analysis. The average age of hospitalized children was 4.6 months, with the majority being 2 months old. The youngest infants were 1 month old, while the oldest patient was 35 months old. B. Pertussis infection was confirmed in children who were either not vaccinated or were incompletely vaccinated due to their age. The most commonly associated conditions with B. Pertussis infection were acute bronchiolitis and pneumonia, with SARS COV-2 virus isolated in two cases. Based on the results of our analysis and data from the literature, we observed an increase in the number of pertussis cases. Although vaccination has significantly contributed to reducing the incidence of pertussis, this analysis highlights challenges and the need for continued following of the epidemiologic situation. Additionally, it is crucial to consider factors contributing to the resurgence of the epidemic to develop more effective strategies for disease control and prevention.

THE IMPACT OF THE COVID-19 PANDEMIC ON THE CONSUMPTION OF ALCOHOL AND CIGARETTES AMONG ADOLESCENTS IN THE TERRITORY OF THE MUNICIPALITY OF DOLJEVAC

2024-02-10T22:22:57+01:00

Introduction: The social distancing measures during COVID-19 pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco and alcohol.

Aim: To examine the incidence of tobacco and alcohol consumption due to the isolation of COVID-19 in 2020 in the group of adolescents in the final grade of elementary school in the territory of the municipality of Doljevac.

Material and methods: Two studies were conducted in the period from October to November 2022 after the COVID19 pandemic, the frequency of cigarette use, and frequency of alcohol use among a sample of eighth-grade elementary school students, both sexes, a total of 82 respondents.

Results: Cigarettes were tried by more than a quarter of respondents, 26.18%. Currently, 2.44% of the surveyed students use cigarettes. Almost 63.41% of respondents have tried alcohol, 23.18%, while the experience of drunkenness was reported by 12.02% of the examined children.

Conclusion: Our data indicate that the situation with COVID-19 has affected the social life of young people, specially consumption alcohol and cigarretes. It can be concluded that it is necessary to implement preventive programs in order to reduce the use of tobacco and alcohol among adolescents. Young people, their parents and other important people from their environment, educators, social community, media, should have been active in emphasising the harmfulness of alcohol and tobacco consumption.

E CIGARETTES AND ADOLESCENTS

2024-03-19T06:31:47+01:00

Adolescent lung disease associated with vaping EVALI has attracted considerable attention in recent years, since 2019, when it emerged as a serious health problem that primarily affects young individuals who use e-cigarettes or vaping products.

While the exact cause and mechanism of action is still under investigation, the fact is that it is associated with the use of vaping products and the use of e-cigarettes that contain nicotine and other substances. Use can lead to severe lung damage, including acute respiratory distress syndrome, a life-threatening condition. EVALI has initiated numerous public health actions at local, national and international levels. Health organizations issue warnings about the potential risks of vaping, especially for young people, and recommend avoiding vaping products. In response to the EVALI epidemic, it is necessary to introduce regulatory measures regarding the safety and regulation of vaping products. These measures include stricter regulations on the sale and marketing of e-cigarettes and vaping liquids, as well as efforts to raise awareness of the potential risks associated with vaping.

Education and awareness campaigns have been launched to inform the public, especially adolescents and young adults, about the potential health risks of vaping. It is important for adolescents, parents, teachers and healthcare professionals to be informed about the risks associated with vaping and to promote healthy behaviors and strategies.

NON – IgE – MEDIATED GASTROINTESTINAL FOOD ALLERGY IN CHILDREN

2024-03-20T04:08:57+01:00

Nutrition allergy is unfavorable immune response to food proteins. Non-IgE-mediated gastrointestinal food allergy includes spectrum of disorders which are more uncommon that IgE- mediated food allergies. Their diagnosis is mainly done by clinical features cause the absence of specific biomarkers. Non-IgE-mediated food allergies include: food protein-induced enterocolitis sydrome (FPIES), food-protein induced allergic proctocolitis (FPIAP), food-protein induced allergic enteropathy (FPE), food protein induced dysmotility disorders (GERD) and mixed type diseases for examp. Eosinophilic esophagitis (EoE). In most cases non-IgE-mediated food allergy have a good prognosis and resolving during childhood.

AN OVERVIEW OF CURRENT VACCCINES FOR THE PROPHYLAXIS OF BACTERICAL INFECTIONS

2024-02-21T19:18:34+01:00

Antibacterial vaccines play a central role in modern medicine by providing an effective approach to combating infectious diseases caused by bacteria. The importance of these vaccines lies in their ability to stimulate the immune system to recognise and neutralise bacterial pathogens, or exotoxins produced by them, thereby preventing, or mitigating the severity of bacterial infections. The development and widespread use of antibacterial vaccines have contributed significantly to reducing the global burden of diseases such as pneumonia, meningitis, and sepsis.

Today, the global increase in vaccine-preventable diseases is a worrying trend that is closely linked to the emergence and advocacy of anti-vaccination policies. According to the latest World Health Organisation report, vaccination coverage in Serbia has declined over the past decade, jeopardising the collective immunity and led to recent outbreaks of vaccine-preventable diseases such as whooping cough and measles. Understanding the significance of antibacterial vaccines underscores their importance in promoting individual and community immunity, which ultimately leads to a healthier population and the prevention of antibiotic resistance.

This paper summarises the main characteristics of the different types of antibacterial vaccines, such as whole cell vaccines, subunit vaccines and toxoid vaccines, and provides an overview of the types of bacterial antigens contained in vaccines available for mandatory immunisation (vaccines against tuberculosis, diphtheria, tetanus, pertussis, Haemophilus influenzae and pneumoccus) or for non-mandatory immunisation (meningococcal vaccine, typhoid vaccine, cholera vaccine).

CERVICAL CANCER PREVENTION

2024-01-13T14:11:31+01:00

In addition to developed prevention and modern, successful treatment modalities, cervical cancer still represents a major social and epidemiological problem in the world, especially in underdeveloped and developing countries. According to the cervical cancer incidence and mortality, Serbia has been at the top of the list of European countries for decades.

The proven central role of chronic HPV infection and the persistent presence of viral DNK in the genetic material of the cells of the cervical mucosa has led to the development of successful prevention measures.

Primary prevention is presented through HPV immunization of the population in childhood/early adolescence. Secondary prevention is presented through screening to detect asymptomatic premalignant changes or early stages of invasive disease.

It has been shown that the population benefit from vaccination is achieved when the level of immunization exceeds 50%. In Serbia, the nine-valent HPV vaccine is currently available, although the vaccination itself is not mandatory but at the level of recommendation, which with insufficient information about HPV infection, combined with the already widespread negative opinion towards vaccination in general, results in a low overall percentage. Also, there is still no adequately developed organized screening, it is most often carried out as opportune screening, based on colposcopy with PAP testing, while HPV testing is carried out on a much smaller scale, all of which represent the reasons for the high incidence and mortality from cervical cancer in Serbia.

PROBIOTICS FOR THE PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA

2023-11-22T07:25:37+01:00

Ventilator-associated pneumonia is associated with a high rate of all-cause mortality and a prolonged duration of mechanical ventilation and intensive care unit stay. Ventilator associated pneumonia accounts for about half of all antibiotics given in the intensive care unit. Plenty of studies have assessed various kinds of prevention strategies, including pharmacological and non-pharmacological interventions, to prevent ventilator-associated pneumonia over the years. An emerging number of studies has assessed the non-antibiotic approaches for the prevention of ventilator-associated pneumonia in the last few years. One of the frequently used strategy is addition of probiotics in the preventive measures list. Regular consumption of probiotics can modulate immune responses and metabolic processes as well as antioxidant and anti-inflammatory effects. The strongest evidence in favor of probiotics lies in the prevention or treatment of necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and infant colic. The beneficial effects of probiotics in the prevention of ventilator-associated pneumonia were not yet entirely clarified. Multiple pieces of evidence indicate that the bacteria that populate the gut efficiently modulate the immune response. Treatment with probiotics have shown promising preliminary results to attenuate systemic inflammation, especially in postoperative infections and ventilation performance. This review aims to summarize latest data on the use probiotics to prevent ventilator-associated pneumonia in critical care unit.

MANAGEMENT OF CEREBRAL PALSY THROUGH THE CHILDHOOD: HOW DOES IT WORK IN SERBIA?

2024-01-30T23:42:02+01:00

Cerebral palsy (CP) is the most common physical disability in childhood, with prevalence in the general population of 1.5 to 3.0 cases per 1000 live birth. The complete causal pathway to CP is unclear in approximately 80% of cases, but risk factors can often be identified from history of conception, pregnancy, birth, or post-neonatal period. CP is not just a physical disability, so comorbidities are commonly present. It is not only the physical development that is at risk, but also the optimal development of children with CP as a whole, including their psychological, social, emotional and cognitive development. CP impacts not only the child, but also the whole family, in a complex, long-term and multi-factorial manner. Historically, the diagnosis has been made between the ages of 12 and 24 months, but now it can be made before 6 months corrected age. Early diagnosis includes neuroimaging, neurological and motor assessments. Early diagnosis is crucial for immediate referral to specific early intervention, which is very important for optimizing infant`s motor and cognitive plasticity, as well as for preventing secondary complications. CP is a life-long condition, and the treatment is long-lasting. Physical therapy takes a central place in managing CP. It focuses on function, movement, and optimal use of the child`s potential.

OVERVIEW OF THE LIPID ABNORMALITIES IN THE HEART FAILURE

2024-02-20T18:29:06+01:00

A complicated clinical disease known as heart failure (HF) comes on by anatomical or functional anomalies in the heart that compromise blood flow. This review article presents a comprehensive examination of the role of lipid profiles in the HF. It specifically focuses on the serum levels of traditional lipid parameters, such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in the development and progression of the HF. To conduct this review, several databases such as Google Scholar, PubMed, and Science Direct were utilized. Specific keywords used in the search include “heart failure”, “lipid profile”, “triglycerides”, “total cholesterol”, “high-density lipoprotein cholesterol”, and “low-density lipoprotein cholesterol”. The language for clinical investigations included in this review were limited to those set to English. The findings suggest that lower levels of TG may be associated with elevated pulmonary artery pressure, tricuspid regurgitation, and increased dimensions of the right side of the heart. These associations indicate impaired liver function due to right-sided HF in the chronic HF patients. Dysfunctional HDL-C is believed to contribute to the occurrence and advancement of HF. Additionally, serum TC levels have been identified as a potential prognostic factor in individuals with advanced HF. On the other hand, lower LDL-C levels seem to indicate worse prognosis for HF patients. However, further research is required to determine the precise mechanisms by which these lipid profiles influence the development and progression of the HF.

VACCINATION TIMELINESS IN PRETERM INFANT

2023-12-04T16:48:17+01:00

Premature babies have always been a significant population of global public health, morbidity and mortality, and their prevention and vaccination is of great importance. Premature babies have a higher risk of developing neonatal and infectious diseases due to the immaturity of the immune system and poor transfer of protective maternal antibodies, which can be prevented by vaccines. However, the biggest problem in the country and abroad is untimely and incomplete vaccination of premature babies. The review of the literature tried to obtain the latest data through professional research, influencing factors and protocols for solving the timeliness of vaccination of premature babies, with the aim of improving timely and complete vaccination of premature babies.

OLIGOARTICULAR JUVENILE IDIOPATHIC ARTHRITIS: EARLY DIAGNOSIS AND TREATMENT IN ORDER TO PREVENT CHRONIC JOINT DAMAGE

2024-03-20T05:38:01+01:00

The oligoarticular subtype of juvenile idiopathic arthritis (JIA) clinically defines the presence of arthritis in fewer than five joints in the first six months of the disease. If arthritis affects less than five joints thought the disease, then we are talking about persistent oligoarthritis. If arthritis affects 5 or more joints after 6 months from the disease onset, we are talking about an extended form of oligoarthritis. In recent decades, JIA etiopathogenesis novelties and genetic engineering improvement enabled new therapeutic strategies which have improved the disease course and clinical outcome. The modern concept of treatment ensured better quality of life, reduced disease activity and subjective complaints, enabled normal children growth, preserved joint functionality and prevented onset of disability and work incapacity. The modern concept of JIA treatment tends to individualize treatment approach. Compared to other subtypes of JIA, the oligoarticular form has the best prognosis, especially if we are talking about the persistent subtype of oligoarthritis.

THE IMPORTANCE OF PRECISION MEDICINE AND PHARMACOGENOMICS IN PREVENTIVE PEDIATRICS

2024-02-20T18:23:16+01:00

Disease prevention includes all activities that could be used to prevent the occurrence and manifestation of disease manifestations, to detect the disease early and to apply appropriate therapy in a timely manner.

Implementation of precision medicine strategies include genetic analyses, factors of the external environment as well as the way a person lives, to precisely select the treatment that is most appropriate and effective for that person.

Precision medicine also includes information obtained from genetic tests - the so-called. "OMICS" (GEN-omics, TRANSCRIPT-omics, EPIGEN-omics, METABOL-omics, PROTE-omics, MICRO-omics), i.e. technologies and data analyzes that provide accurate clinical, biological and molecular phenotype.

Precision medicine opens the chapter of health care, preventive medicine and preventive pediatrics.

Improving lifestyle and avoiding harmful environmental factors could affect gene function, and could be use in prevention and development of precise preventive health strategies.

KLIPPEL FEIL SYNDROME AND ASSOCIATED ANOMALIES

2024-02-27T18:39:38+01:00

Introduction: Klippel-Feil syndrome (KFS) is a rare genetic disorder characterized by abnormal the development of the cervical spine, which leads to the fusion of two or more cervical vertebrae. Incidence is 1:40 000 - 42 000. Inheritance is usually autosomal dominant. The gene mutation is most often found on the long arm of chromosome 8q22.1.The syndrome was first described by French physicians, Maurice Klippel and André Feil in 1912 with the classic clinical triad of manifestations consisting of a low posterior hairline, short neck, and limited neck range of motion. There may be skin folds on the neck - Pterygium colli, and the shoulder blades are high - Sprengel Deformity. Scoliosis is often present. Accompanying, hidden anomalies may be more important than neck deformity. A clinical finding with an objective examination is sufficient to suspect this syndrome. And then additional diagnostic methods are applied. Surgical intervention is carried out in the event of instability on the spine with the aim of eliminating it, as well as correcting scoliosis. Therapy of accompanying anomalies - kidney, neurological disorders, hearing disorders. Physical therapy is also recommended, which gives modest results. The life span of people with Klippel-Feil syndrome is shortened due to frequent anomalies of the internal organs.

Case report: The paper presents a girl aged 10 years and 10/12 months. Pronounced hypertelorism. On the upper lip, a scar after cleft lip and palate surgery, left. Teeth carious, irregularly arranged. Neck short with pterygium. Low hairline. Pronounced scoliosis. High position of the shoulder blades. Abdominal ultrasound shows agenesis of the right kidney. IVP - the right kidney is not shown, the left kidney is compensatory enlarged. A diagnosis of Klippel Feil syndrome was made in a tertiary institution. Parents refuse further tests and treatment.

Conclusion: In every child with Klippel-Feil syndrome, further examination and detection of accompanying, hidden anomalies that may be more important than the neck deformity is necessary.

DETECTION OF MEDICAL NEGLECT AND PREVENTION

2024-03-21T12:52:42+01:00

Neglect is defined as the chronic failure of parents (guardians) to provide the child with the basic conditions necessary for its growth and development: food, clothing, housing, medical care and protection, encouraging the child's development. Diagnosing neglect requires teamwork, knowledge of symptoms and signs, as well as family characteristics. Types of neglect: physical, emotional, educational, lack of medical care. In case of suspected neglect, the competent professional team should be notified. The goal is early prevention and early intervention in case of neglect.

RARE COMPLICATION OF A FOREIGN BODY ASPIRATION IN CHILDREN

2024-03-02T14:21:59+01:00

Introduction: foreign body aspiration (FBA) is life treathening condition with 64% of cases occured in children between 1 and 3 years of age.

Case outline: A 2- year old boy, was admitted due to cough, swelling of the neck, shortness of breath and agitation.. A month before the current hospitalization, the child was treated for acute upper respiratory tract infection. The child was aggitated, with permanent irritating cough, from time to time laryngeal. Swelling of the neck and upper chest, mainly on left side with fine crepitations were present. Physical examination revealed auscultatory asimetry in breathing sound, reduced air entry on the right side with monofonic wheeze on the same side. Lung X-ray: hyperinflation on the right with paracardial consolidation on the right and subcutaneous emphysema on the neck and chest. Laboratory analyses were within referent levels. Due to the suspicion of aspiration of a foreign body, a bronchoscopy was performed, a foreign body was seen in the entrance of bronchus for medium and lower right lobe and its extraction was performed. Afther successfully removal of foreign body, the child was clinically stabilized and discharged fron intensive care unit.

Conclusion: The clinical finding of foreign body aspiration depends on the level at which the airway obstruction occurred. The majority of patients exhibit a paroxysmal cough, while respiratory distress and cyanosis indicate obstruction of the major airway when urgent intervention is necessary. Sometimes, a prolonged finding on the lungs with clinical symptoms indicates the oversight of foreign body aspiration when complications can be expected.