Background: Since the outbreak of the Coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19, in comparison to the prior years. Methods: In this retrospective multicenter study, we compared the number of children that presented with FBA during the COVID-19 year (March 1st, 2020 to February 28, 2021), to the annual average of the years 2016-2019. We also compared the lockdown periods to the post-lockdown periods and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. Results: 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior four years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in post-lockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (Average of 15.4% vs 30.4%, p=0.001) Conclusion: There was no difference in the prevalence of FBA during the COVID-19 year. However, there were fewer cases during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision.

Background: Rigid bronchoscopy is the procedure of choice for removal of inhaled foreign bodies, with certain complication rate. Aim: to assess whether flexible bronchoscopy is an efficient and safe procedure in extraction of foreign bodies in children, compared to rigid bronchoscopy. Then, to further assess if it is associated with a shorter procedure time, and shorter length of stay in the hospital (LOS). Methods: a retrospective study including patients aged 0-18 years, that were hospitalized in Soroka University Medical Center throughout 2009-2019, and underwent flexible or rigid bronchoscopy for the removal of inhaled foreign body. The data were analyzed according to two time periods; 2009-2016 and 2017-2019. Results: from 2009-2019, 182 patients (median age of 24 months, 58% males) underwent an interventional bronchoscopy; 40 (22%) by flexible and 142 (78%) by rigid bronchoscopy. 88.73% of rigid and 95% of flexible bronchoscopies were successful in the removal of foreign bodies (p value=0.24). The rate of major complications was higher among rigid bronchoscopy (9.2 % vs. 0%, p =0.047). From 2017 onwards, after implementation of the flexible bronchoscopy for removal of foreign bodies, 64 procedures were performed; 33 (51.6%) flexible and 31 (48.4%) rigid. Procedure length was found to be shorter via flexible bronchoscopy (42 vs 58 minutes, p = 0.016). No significant difference was found in LOS. Conclusion: Flexible bronchoscopy is an efficient and safe method for removal of inhaled foreign bodies in children, with shorter procedure time. It may be the primary procedure for removal of inhaled foreign bodies.