Clinical Briefs Indian J Pediatr 1999; 66 : 288-289

Foreign Body Airway in Neonates

Ishwar Singh 1, Geeta Gathwala 2, S.ES. Yadav 3 and Anita Sharma 4

Departments of Otolaryngology ~ and Pediatric Medicine a', Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak

Abstract. Two cases of foreign body in neonates less than one month of age are reported. Although foreign bodies in neonates are unknown but the possibility should not be overlooked even in neonates especially with sudden onset of respiratory distress, cough or hoarseness in absence of fever. (indian J Pedlatr 1999; 66 : 288-289)

Key words : Foreign body; Respiratory distress.

Foreign bodies in the respiratory tract are commonest in 1-3 years age group 13. These are however, almost unknown in the neonates. We report two such cases.

CASE REPORTS

Case 1

A 20 days old male baby was brought with breathlessness, cyanosis and inability to accept feeds of four hours duration. There was no history of fever, cough or hoarse cry. On examination, there was marked respiratory distress with a respira- tory rate of 68/rain., central and peripheral cyanosis and a loud inspiratory stridor. X- ray soft tissue neck revealed a radio- opaque foreign body in the laryngo-phar- ynx, overlapping and almost completely obstructing the larynx (Fig. 1). An emer- gency direct laryngoscopy was done and a 2.5 x 1.5 cm. folded waste iron scrap sheet was removed with dramatic relief. On in- terrogation the baby's 6 year old sib con-

Reprint requests : Ishwar Singh, 9J/50, Medi- ca] Enclave, Rohtak - 124001.

fessed putting the iron band into the baby's mouth while playing with him.

Fig. 1. X-ray soft tissue neck showing the radio- opaque foreign body almost completely obstructing the airway

Vol. 66, No. 2, 1999 FOREIGN BODY AIRWAY IN NEONATES 289

Case 2

A one month old male child was brought to ENT emergency services for sudden onset of hoarse cry of 3 days dura- tion. There was no preceding history of fe- ver, cough or rhinorrhoea. Clinical exami- nation showed apparently healthy child. There was no respiratory distress or cyanosis. X-ray neck lateral view revealed a radio-opaque hook in the glottic region. Immediate direct laryngoscopy was under- taken. A metallic hook was seen astride both the true vocal cords which was re- moved using the foreign body forceps. The hoarse cry disappeared instantaneously. On repeated interrogation it was revealed that the five years old brother had put the hook into the baby's mouth.

DISCUSSION

The initial symptoms of foreign body in the respiratory tract are choking, gagging, coughing and wheezing often followed by a symptomless interval. Initial choking or other manifestations may sometimes escape notice 1. This is possibly what happened in the second case, whereas there was constant respiratory distress in the first case due to the sheer size of the foreign body. Foreign bodies are suspected only in a child old enough to put objects in to his mouth. The youngest child reported in most large series is 4-6 months old 2"s. Two recent reports described babies in the age group of 6 months 6 and 18 months: with foreign bodies lodged in the larynx. A case report similar t o ours has been described in a neonate earlierL The first case in the present s tudy is the youngest child reported in literature. Direct laryngo- scopy/bronchoscopy are standard techni-

ques for removal of foreign bodies from the airways. Direct laryngoscopy was done to remove the foreign bodies in the index cases too. However, the possibility of a foreign body in a neonate should not be overlooked merely on the assumption of these being beyond the reach of the neonates as it may have been actually put into the baby's mouth by a sib, either during playful activity or out of sibling rivalry.

R E F E R E N C E S

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