2
38
Unlike in adults where ingestion is13deliberate, most in-
gestions by children are accidental. Globally, children
represent 80% of the corrosive ingestion injury popula1-4
was 160 bpm, regular, and heart sounds were normal.
There were no abnormal abdominal findings.
8
tion with children less than 5 years most affected.
Fig 1: Container
with sulphuric acid
Corrosive ingestion ac1c5o-u19nted for 0.5% of paediatric
admissions in Nigeria.
The probability of ingestion
of a caustic agent is low in the newborn period and new-
born caustic burns have been reported in16f,r1e7quently in
Nigeria and globally and remains a rarity.
We report
a case of a newborn with accidental sulphuric acid in-
gestion within the first hour of life a rare and sparsely
reported occurrence.
A diagnosis of accidental corrosive ingestion with com-
plications of upper gastrointestinal (GI) bleeding and
chemical pneumonitis was made. She was commenced
on supportive therapy including: Nil per oral, oxygen
therapy at 1.5L/ min via nasal catheter, intravenous flu-
ids, parenteral antibiotics (crystalline penicillin, metroni-
dazole and gentamicin), steroids (hydrocortisone for 48
hours), intravenous ranitidine and a nasogastric tube
Case report
Baby JZ, a 6 hour old term baby girl, was rushed to the
Special Care Baby Unit of Ahmadu Bello University
Teaching Hospital Zaria following accidental ingestion
of acid 5 hours prior to presentation. The acid, mistaken
for holy water, ruwan zam zam was administered by the
paternal grandmother who had taken the baby home for
a bath while the mother was still in the hospital. Her 8
year old step sister was asked to get the holy water but
accidentally brought the acid stored in an unlabeled,
small, white, plastic keg similar to the one containing
the holy water (fig 1) kept in an unlocked drawer in the
mother’s bed room. The acid was given directly from
the container to the baby. She began to choke after tak-
ing about two sips, and started coughing and retching
repeatedly. She vomited blood twice, about 20-25 mls
per bout and subsequently developed difficulty with
breathing which persisted till presentation. There was no
intervention at home. Baby was rushed to the Primary
Healthcare Centre (PHC) where she was delivered and
was then referred to our facility immediately but arrived
about five hours later due to transportation logistics.
There was no fever and no bleeding from any other bod-
ily orifices.
(
NGT) was passed. Chest x-ray (Fig 2) done at admis-
sion showed diffuse patchy opacity while her serum urea
and electrolyte were normal. Within 24 hours of admis-
sion, she developed massive upper GI bleeding with
abdominal distension, severe pallor, cold extremities,
thready peripheral pulses and unrecordable BP, and
NGT was draining fresh blood. She was resuscitated
with normal saline and received multiple blood transfu-
sions in aliquots on account of the bleeding which lasted
rd
for about 72 hours. On the 3 day of life, she developed
fever, worsened abdominal distension, tenderness and
guarding, with hypoactive bowels.
Erect abdominal x-ray (Fig 3) showed air under the dia-
phragm. A diagnosis of bowel perforation with peritoni-
tis was made. Baby was managed conservatively for
bowel perforation with improvement in clinical condi-
tion. She was on partial parenteral nutrition of 7.5%
dextrose in 0.18 saline and amino acid infusion at
0
.25mg/kg/day with daily potassium maintenance in 24
Pregnancy was supervised in a private hospital anrdd
mother had pregnancy induced hypertension in the 3
trimester which was controlled with antihypertensives (α
hour fluid. Baby did not have NGT feeding asndshe devel-
oped repeated bilious vomiting from the 2 week on
admission. She was still opening her bowel and passing
bile stained stools. She could not have early endoscopy
however, gastrograffin contrast study showed normal
oesophagus. She was planned for exploratory lapara-
tomy and feeding jejunostomy, but her clinical condition
deteriorated as she developed widespread petechiae rash,
severe pallor, difficulty with breathing, severe
–
methyl dopa and amiloride HCl – hydrochlorothiazide
combination). Delivery was at a PHC via spontaneous
vertex delivery annd d baby cried immediately after birth.
Baby was the 2 child of the mother who is a 22 year
old house wife. Father is a 35 year old commercial mo-
tor cycle rider who also sells perfumes. They both have
primary education. Marriage setting is polygamous with
two wives and six children. They reside in a 4-room
apartment. The battery liquid was being used by the fa-
ther to refill his motorcycle battery acid.
electrolyte derangement and died in the course of resus-
citation at the age of 24 days. The parents declined post-
mortem.
At presentation, baby was ill-looking, wheezing, pale,
tachypnoeic and dyspnoeic SPO was 86%. There was
2
Fig 2: Chest X - ray.
no petechiae rash. She was conscious but irritable, ante-
rior fontanelle was normotensive, had normal tone but
the primitive reflexes were depressed. Mouth examina-
tion showed dried blood on the lips, there was no hyper-
aemia, swellings or ulcerations on lips, buccal mucosa
or tongue. Respiratory rate was 80 cpm (tachypnoea)
with wide spread crepitation and rhonchi. Her heart rate