Division of Pediatric Pulmonology at CMU Children’s Hospital
Attending Doctor Jie-He Chen
A one-year-old infant boy was playing at home but suddenly started racking cough, breathing difficulty and purple lips. A family member discovered his condition and rushed him to the local hospital emergency room. His oxygen saturation upon arrival to the hospital was only 70% (normal saturation should be 95-100%), the ER decided to place endotracheal tube urgently. X-ray examination showed left atelectasis and complication of severe mediastinal leaks and subcutaneous emphysema. The chest CT examination shows foreign objects on the intersection between main bronchus and left bronchus. After evaluation, the doctor of the hospital transferred the patient to the Pediatric ICU of CMU Children’s Hospital.
Upon receiving notice, the Pediatric Pulmonology team of CMU Children’s Hospital immediately underwent the Endo-Bronchoscopy. The team successfully removed the yellow foreign objects stuck in the left bronchi with flexible bronchoscope within 20 minutes. After laboratory analysis and visit to family home, the foreign object was a superabsorbent polymers” commonly known as “Orbeez.” The doctor suspected that the infant boy has swallowed the art craft materials from his brother studying at elementary school, out of curiosity. However, the texture may be poor that the infant boy carried out of anxiety and the foreign object aspirated into the respiratory tract. The infant boy recovered well after surgery with normal consciousness. The chest x-ray that day indicated left lung open, unobstructed breathing, the endotracheal tube can be removed successfully. The infant boy was transferred to pediatric ICU the next day and discharged from the hospital 3 days later.
Division of Pediatric Pulmonology Attending Doctor who executed the endo-bronchoscopy indicated that sudden racking cough, tachypnea, wheezing, and cyanosis, are most common symptoms. The acute airway obstruction caused by foreign objects blocking can be highly hazardous. Failure to clear the respiratory tract on time could cause hypoxic encephalopathy and even death, in some severe cases. Infants under the age of two are high-risk groups for foreign objects choking since their swallowing and chewing functions are still growing and at the training stage. Common foreign objects found in respiratory tract include gummy bear, jelly, nuts, fruit seeds, coins, and buttons.
In a foreign object choking is found at site, parents can use “Backrub and Chest Compression” for babies under 1 year old to have the baby face down, the body and two legs should lay across the arms of the adult. Carry the lower chin of the baby with a palm and use another palm to quickly slap the back should of the baby 5 times. If the baby does not cough out foreign object, turn the baby face up, use the index finger and middle finger of one hand to press the center of the chest bone (underneath the nipple) five times. The compression depth is between half inch and 1 inch. Wait until the baby recovers breathing. Patients over 1 year old may be rescued by “Heimlich maneuver.” Stand behind the child and place one foot slightly in front of the other for balance. Make a fist with the other and put your arms around the child. The rescuer shall make the first on the upper abdomen and in the middle, while the other hand shall pull the fist. Use both hands with force to repeatedly and quickly squeeze the patient upward on the upper abdomen, in addition to paying attention if any foreign object has been spitted out. Do so until the patient loses consciousness or until the foreign object has been ejected. If the foreign object could not be removed while the patient loses consciousness, lay down the patient and start performing CPR.
In comparison with commonly swallowed foreign objects, “Orbeez” contains substance of superabsorbent polymers, which is super-absorbent to water. Fortunately when orbeez is swallowed, it will absorb the mucus secretion from the trachea, dilating the volume even more and making it difficult to cough out. There have been cases of swallowing orbeez in Taiwan that block the intestines and cause severe bowel obstruction and hence need for urgent surgery. If there are pre-school children in a family, avoid storing such items to prevent any accident.
Division of Pediatric Pulmonology at CMU Children’s Hospital is a domestically and internationally well-known Center for Interventional Bronchoscopy. The center has rich clinical experiences and complete medical equipment. Using the unique “Soong’s Breathing Method” invented by Professor Wen-Jue Soong, the Center can conduct various flexible/rigid bronchoscopy without the placement of endotracheal tube, which is one great benefit for patients.