Prospective follow-up study on battery ingestion in children in the Netherlands

Purpose: In the 1990-2000s, several large North-American studies increased the awareness about the risks of button ingestion in children. Identified risk factors for severe complications were lithium-type button batteries, large diameter cells and age <4 years. We aimed to study the current frequency and circumstances of (severe) complications after battery ingestion in children in the Netherlands, in recent years. Methods: A prospective follow-up study was conducted in 2011-2015 at the Dutch Poisons Information Center (DPIC). All consecutive cases of battery ingestion in children <6 years were included. Follow-up was performed by using a standardized questionnaire, over the telephone. The primary outcome was the occurrence of major complications (i.e. severe symptoms and/or death). Results: During a 4-year period, 1026 cases of human battery exposure were reported to the DPIC (annual incidence of 15.3 potential battery ingestion per million population). N = 405 exposures in which the patient was <6 years and had ingested (witnessed or suspected) at least one battery, were included in the study. In 229 children (57%), a battery was detected (spontaneous passage, positive X-ray or endoscopic removal). Button batteries with a diameter <15 mm were most often involved (54% of the batteries). Batteries with a diameter ≥15 mm were more often located in the oesophagus/throat than batteries with a smaller diameter (p < 0.001). All button batteries with a diameter ≥15 mm located in the oesophagus/throat were endoscopically removed (N = 8). No severe complications or fatalities were reported; the confidence interval (CI) for the occurrence of a severe complication was [0%, 1.3%]. Local injury was noticed in 9 patients (3.9%; CI: [1.9, 7.6]). Conclusions: In this study, the annual incidence of battery ingestion per million population in the Netherlands is comparable to the North-American annual incidence reported between 1985 and 2009 (between 6.3 & 15.1). Batteries with a diameter ≥15 mm are more often located in the oesophagus/throat than batteries with a smaller diameter and therefore pose a higher risk for local injuries or severe complications. The frequency of occurrence of severe complications after battery ingestion in children is low, but not negligible.