PEDIATRICS Vol. 95 No. 4 April 1995, pp. 567-572
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Downing, G. J.
Right arrow Articles by Kilbride, H. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Downing, G. J.
Right arrow Articles by Kilbride, H. W.

Evaluation of Airway Complications in High-Risk Preterm Infants: Application of Flexible Fiberoptic Airway Endoscopy

Gregory J. Downing DO, PhD1 and Howard W. Kilbride MD2

1 NICHD Endocrine and Reproductive Research Branch, National Institutes of Health, Bethesda, Maryland
2 The Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, Missouri

Objectives. We sought to determine factors that would predict the development of subglottic stenosis (SGS) and tracheomalacia (TM) in preterm infants. The utility of a semiquantitative measurement of airway dimensions was assessed in relation to signs of airway complications. We also sought to determine from a high-risk population of infants those likely to have abnormal findings identified by bronchoscopic examination.

Methods. Prospective airway endoscopy was performed for preterm infants who were intubated for 7 days or more or who demonstrated chronic oxygen needs beyond 28 days after birth and 36 weeks postconceptional age. Subjects were 117 preterm (less than 36 weeks' gestation) infants from two level III intensive care nurseries. Endoscopy was used to classify the type and degree of airway injury. Subglottic stenosis was defined subjectively and compared with an objective measurement using subglottic spatial relations described as a trans- subglottic/vocal cord ratio (TSG/VC). Clinical signs and symptoms and other risk factors were evaluated as significant predictors of SGS and TM, identified by bronchoscopy.

Results. Moderate or severe airway abnormalities were identified in 32 patients (27.3%); 13 with SGS, 17 with TM, and 2 with both. All but one infant with TSG/VC less than 0.83 had signs and symptoms of airway dysfunction. Variables more commonly found in patients with SGS included greater number of intubations, use of inappropriately large endotracheal tubes, and longer duration of intubation. Higher averaged mean airway pressure during the first week after birth and lower gestational age were clinical features associated with TM.

Conclusions. Flexible bronchoscopic evaluation of a high-risk population demonstrated a higher incidence of moderate or severe SGS or TM than previously suspected. Subglottic stenosis and TM appear to have different etiologies based on different factors associated with their development. The TSG/VC ratio correlated well with obstructive symptoms and may represent a means to quantitate clinically subglottic narrowing. Infants with chronic lung disease who have persistently elevated partial pressure of carbon dioxide, apnea, or phonation abnormalities are most likely to have airway abnormalities identifiable by bronchoscopy.

Submitted on February 7, 1994
Accepted on July 15, 1994




This article has been cited by other articles:


Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
S Cunningham
Two imaging techniques to find too flexible an airway: looking for malacia
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2005; 90(4): F284 - f285.
[Full Text] [PDF]

Home page
 ChestHome page
K. A. Carden, P. M. Boiselle, D. A. Waltz, and A. Ernst
Tracheomalacia and Tracheobronchomalacia in Children and Adults: An In-depth Review
Chest, March 1, 2005; 127(3): 984 - 1005.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. Okazaki, S. Isono, H. Hasegawa, M. Sakai, Y. Nagase, and T. Nishino
Quantitative Assessment of Tracheal Collapsibility in Infants with Tracheomalacia
Am. J. Respir. Crit. Care Med., October 1, 2004; 170(7): 780 - 785.
[Abstract] [Full Text] [PDF]

Home page
 Arch Otolaryngol Head Neck SurgHome page
K. D. Pereira, A. R. MacGregor, C. M. McDuffie, and R. B. Mitchell
Tracheostomy in Preterm Infants: Current Trends
Arch Otolaryngol Head Neck Surg, December 1, 2003; 129(12): 1268 - 1271.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
Statement on the Care of the Child with Chronic Lung Disease of Infancy and Childhood
Am. J. Respir. Crit. Care Med., August 1, 2003; 168(3): 356 - 396.
[Full Text] [PDF]

Home page
 NeoReviewsHome page
T. H. Shaffer, A. B. Cullen, and M. R. Wolfson
Clinical Assessment of Airway Function in Health and Disease
NeoReviews, July 1, 2002; 3(7): e131 - 136.
[Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
F. F. Nievas and V. Chernick
Bronchopulmonary Dysplasia (Chronic Lung Disease of Infancy): An Update for the Pediatrician
Clinical Pediatrics, March 1, 2002; 41(2): 77 - 85.
[Abstract] [PDF]

Home page
 ChestHome page
A. D. Slonim and F. P. Ognibene
Amnestic Agents in Pediatric Bronchoscopy*
Chest, December 1, 1999; 116(6): 1802 - 1808.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
I. J M Doull, Q. Mok, and R. C Tasker
Tracheobronchomalacia in preterm infants with chronic lung disease
Arch. Dis. Child. Fetal Neonatal Ed., May 1, 1997; 76(3): 203F - 205.
[Abstract] [Full Text]