Document Detail

Endoscopic examination of the neonatal larynx at extubation: a prospective study of variables associated with laryngeal damage.
MedLine Citation:
PMID:  2089018     Owner:  NLM     Status:  MEDLINE    
Despite postmortem and clinical studies, the etiological factors that determine why only a proportion of intubated neonates develop subglottic stenosis remain unclear. This prospective study was initiated to identify factors that were associated with laryngeal abnormalities secondary to intubation. Thirty neonates were examined at extubation by two independent observers blinded to the neonate's ventilatory history. Thirty-six possible prognostic indicators were recorded for each neonate. After screening by univariate (chi 2) analysis, 10 indicators were selected for further analysis. Of these 10 selected only two indicators showed an association with the laryngeal appearance. Active neonates had significantly more abnormalities in the supraglottis (P = 0.004) than those who were quiescent. Younger neonates had more abnormalities in the glottis though the significance level was marginal (P = 0.056). Other prognostic indicators, including birthweight, gestational age, duration of intubation and frequency of intubation, were not significantly related to laryngeal appearance. This study supports the hypothesis that the etiology of laryngotracheal stenosis is multifactorial, and has identified two possible etiological factors: age and neonatal activity. Neonatal activity has not been identified previously as an etiological factor. The contribution of individual factors may vary from one neonatal unit to another, as a result of variation in intubation, ventilation and extubation policy. This could explain the inconsistency in etiological factors identified by previous studies. It is therefore not yet possible to recommend a standard technique for the ventilation of premature neonates that would further reduce the incidence of laryngotracheal stenosis.
D M Albert; R P Mills; J Fysh; H Gamsu; J N Thomas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of pediatric otorhinolaryngology     Volume:  20     ISSN:  0165-5876     ISO Abbreviation:  Int. J. Pediatr. Otorhinolaryngol.     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1991-05-30     Completed Date:  1991-05-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8003603     Medline TA:  Int J Pediatr Otorhinolaryngol     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  203-12     Citation Subset:  IM    
ENT Department, Hospital for Sick Children, London, U.K.
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MeSH Terms
Erythema / epidemiology
Granuloma / epidemiology
Infant, Newborn*
Intubation, Intratracheal* / adverse effects
Laryngeal Diseases / epidemiology
Laryngeal Edema / epidemiology
Laryngostenosis / epidemiology*
Larynx / pathology*
London / epidemiology
Multivariate Analysis
Prospective Studies
Regression Analysis
Respiratory Sounds
Risk Factors
Ulcer / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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