China Medical University Children’s Hospital

Department of Pediatric Pulmonology Critical Care and Neonate Vice Superintendent Wen-Jue Soong

Taiwan’s humanitarian medical rescue does not stop during the pandemic period.  In cooperation with the rigorous control of the Ministry of Health and Welfare, a Vietnamese infant suffering from “Bilateral Tracheobronchomalacia” was transferred to the China Medical University (CMU) Children's Hospital via medical transport for medical treatment. Under proper pandemic prevention and treatment conducted by the inter-professional team, the infant is now cured and returned to Vietnam. The mother of the infant expressed: “We really appreciate the treatment from the CMUH Children’s Hospital team and we now have a healthy baby and happy family.” The infant has been depending on the ventilator and oxygen in Vietnam for livelihood but has not recovered due to pneumonia. He could not receive effective treatment even after receiving the open thoracotomy. It took a long time for the infant to receive treatment from CMUH Children’s Hospital and despite of the hardship, the mother of the infant believed that it was all worth it.  　

Born in Ho Chi Minh City, Vietnam, the infant weighed 2.9KG at birth. At the age of 5 month old, he suffered from recurrent pneumonia and breathing difficulty and failure. He has been admitted to the two local hospitals for various examination and treatment but all have failed. The Chest CT revealed main bronchus and bilateral tracheobronchomalacia. The infant has received tracheal surgery but did not show any improvement. His condition deteriorated and relied on endoscopic intubation and ventilator for livelihood, and his was terminally ill.

Balloon dilation using flexible bronchoscopy to place stent for tracheal stenosis treatment. Treating laryngomalacia with laser laryngomicrosurgery.

The local Vietnamese doctor admired the sophisticated the tracheal respiratory medicine of CMUH Children’s Hospital – Division of Pediatric Pulmonology and Critical Care Medicine and Division of Neonatology, Vice Dean Wen-Ju Song. After discussion between medical teams from both sides and intensive administrative procedures, the case was finally accepted by the Ministry of Health and Welfare with special permit for medical treatment in Taiwan. Since this case occurred during the pandemic period, the CMUH Infection Control Center Vice Dean Gao-Bin Huang formed the inter-professional pandemic prevention team to bring the patient safely to Taiwan by minimizing the risk of infection. Vice Dean Gao-Bin Huang indicated that “Medicine and humanitarian rescue surpasses the border and the stringent compliance of pandemic prevention regulations from the Ministry of Health and Welfare will keep the public and international patient safe.” When the patient and family took the rescue flight from Ho Chi Minh City to Taichung Airport, CMUH Children’s Hospital dispatched the pediatric rescue team, led by Dr. Jie-He Chen to pick up the patient at the hospital. The patient was first admitted to the isolation ward upon arrival to the hospital, who was screened for safety before conducting professional bronchoscopy and treatment. 　

Vice Dean Wen-Ju Song mentioned that the infant was diagnosed with left and right severe bronchial stenosis, using “flexible bronchoscopy” upon arrival to CMUH. Particularly, the left diameter was smaller than 2mm (normally 6-7 mm). The infant underwent left tracheal dilation and successful placement of metallic stent (7x17 mm) to treat the symptoms of “bronchial flexible stenosis.” The infant’s breathing conditions immediately and significantly improved after the surgery, who eventually disengage in oxygen supply and could breathe naturally without obstruction.

Special Pediatric Bronchoscopy Center in Taiwan with small wound from flexible bronchoscopy and exemption for traditional surgery; treating critically ill young patients in Taiwan and abroad  　

The Pediatric Flexible Bronchoscopy Center of CMUH Children’s Hospital can conduct various airway examination (Note 1) and treatment (Note 2). It is the first “Pediatric Bronchoscopy Treatment Center” in Taiwan. Currently the center can treat about 30~40 cases while the sick children are mostly difficult cases transferred from medical center or hospitals. Vice Dean Wen-Ju Song mentioned that the adoption of “flexible bronchoscopy” and treatment has the advantages in small wounds and avoidance of traditional open heart surgery. For lesions that could not be treated with operation, such examination has excellent treatment effect. For babies suffering congenial (acquired) airway anomalies, long-term dependence or could not disengage ventilators, flexible bronchoscopy is the relatively safe and simple medical device with precision diagnosis and effective treatment. For infants with critical condition, the familiar operation of flexible bronchoscopy treatment can immediately improve symptoms, reduce endotracheal intubation the use of ventilator, and avoid surgery with tremendous injury and save life, which merits wide promotion for application.  

Note 1: Indications for diagnostic bronchoscopy: paradoxical breathing and difficulty in breathing; chronic cough and Hemoptysis; suspicion of foreign body in the airway; confirmation of endotracheal intubation, Tracheostomy and intubation position; Airway and pulmonary obstruction assessment, bronchoalveolar lavage; bronchial and lung tissue biopsy; continuous atelectasis, pulmonary lesion; and infants with critical congenital heart defect.

Note 2: Indications for Bronchoscopy: Breathing difficulty (airway) treatment, endotracheal Intubation, Laryngomalacia, tracheobronchomalacia, removal of granulation tissue, tracheal stent placement, Endoscopic foreign body retrieval, pneumorrhagia, and atelectasis.