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Life threatening airway obstruction in a newborn following ingestion of sterilising tablet
  1. S BANERJEE,
  2. R W EVANS
  1. Department of Paediatrics, Prince Charles Hospital
  2. Merthyr Tydfil CF47 9DT, UK
  3. Robert.Evans{at}nglam-tr.wales.nhs.uk

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    Editor,—Sterilising tablets have been marketed and widely used to sterilise infant feeding bottles for the past 25 years.1 Accidental ingestion commonly results in mild gastrointestinal irritation.2 Severe airway obstruction has been reported in an older infant.3Recently a 4 day old infant presented to our hospital with features of acute upper airway obstruction following accidental ingestion of sterilising tablets. The mother had found her struggling to breathe, with profuse secretions and smelling of sterilising tablets. She required prompt endotracheal intubation and mechanical ventilation for 48 hours. Massive swelling of the epiglottis, tongue, and arytenoids was noted at intubation. Severe stomatitis and oral ulcerations followed, requiring nasogastric feeding for two weeks. In addition to ventilation, treatment involved airway toileting to clear secretions, a short course of corticosteroids, and nutritional support.2Upper gastrointestinal contrast studies excluded oesophageal stricture. The tablet was given to her by her 4 year old sibling, who was very keen to share babycare since the birth of her little sister. She later admitted to having managed to retrieve the tablets from the kitchen cabinet, unwrap the foil, and feed the baby while her mother was asleep. To our knowledge this is the youngest case reported.

    Sterlising tablets are available as paper or foil wrapped strips with dichloroisocyanurate and sodium bicarbonate as their active ingredients. They produce an exothermic and effervescent reaction in contact with water, resulting in production of hypochlorite. The combined thermal and chemical injury in situ causes severe oedema of the epiglottis and arytenoids, resulting in airway obstruction. In both our case and a previous report,3 an enthusiastic older sibling was able to unwrap the tablets and feed the baby.

    There is an urgent need to deliver these tablets in childproof containers and increase parental awareness in order to prevent potentially fatal complications.

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