Letters to the Editor
Indian Pediatrics 2002; 39:314-315
|Foreign Body in the Larynx of a One-Day-Old Baby Presenting on Day 15 of Life|
A 15-day-old male baby was brought with cough, breathlessness, inability to feed, cyanosis and marked intercostal recession. There was no history of fever. On examination, respiratory rate was 70/min with marked suprasternal and intercostal recession, central cyanosis and a loud inspiratory stridor. All routine blood examinations were normal. X-ray showed pile of coins in the larynx (Fig. 1). An emergency laryngoscopy was done and coins were removed with dramatic relief. On interrogation, the babyís mother confessed that she had put the coins in the babyís mouth.
Fig.1. X-ray of chest showing pile of coins.
One of the greatest causes of mortality in the developing countries is still illiteracy and superstition. In the present case this baby was the 3rd son, first two died due to some unknown illness within a week of birth. The two daughters of the lady were alive and healthy. A priest in the village told the mother that the sons in her family would not survive unless she puts these coins in the babyís mouth within an hour of birth and then one coin every day for 6 to 8 days. She followed the priestís advice and was very happy that her son was alive.
The initial symptoms of a foreign body in the respiratory tract like choking, coughing and wheezing are often followed by a symptomless interval. The initial choking or other manifestations may sometimes escape notice(3), which happened in our case.
The symptoms were mild initially but became progressive later with secondary laryngeal edema. Foreign body aspiration is one of the leading causes of accidental death in children(6). Food items are the common items aspirated in infants and toddlers, whereas, older children aspirate non-food items. Children below three years of age are most vulnerable and the majority of the patients are male(5). The commonest foreign body is peanut. Only a few case reports have been described in the neonates(1,2). The present case is the youngest child reported in literature as the coin was introduced within an hour of birth. Direct laryngoscopy is the standard technique for removal of foreign bodies from the larynx.
We, therefore, suggest that the clinician must remember foreign body in the larynx in a neonate with respiratory distress and should not assume that it is beyond the reach of neonates.
Utpal Kant Singh,