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The Rigid Tube as an Alternative in Controlling the Problematic Airway
Published on: June 6, 2020
Congenital airway abnormalities in patients requiring hospitalization
K W Altman1, R F Wetmore, R R Marsh
1Department of Otolaryngology, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, 19104, USA.
Insights
Severe congenital airway abnormalities in hospitalized children often require tracheotomy. Prematurity and gastroesophageal reflux are significant contributing factors to severe respiratory issues in these pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Congenital Abnormalities
- Respiratory Medicine
Background:
- Congenital airway abnormalities are a spectrum of conditions affecting infants and children.
- Hospitalization for respiratory status indicates a more severe presentation of these abnormalities.
Purpose of the Study:
- To identify the causes of congenital airway abnormalities in pediatric patients requiring hospitalization.
- To understand the factors contributing to severe respiratory compromise in this population.
Main Methods:
- A 5-year retrospective chart review was conducted at a tertiary care center.
- 174 pediatric patients hospitalized for respiratory issues due to congenital airway abnormalities were analyzed.
Main Results:
- The majority of patients (80%) presented with multiple symptoms, most commonly stridor (74%).
- Laryngeal abnormalities (80%) were more frequent than tracheal abnormalities (37%). Laryngomalacia was the most common laryngeal issue.
- Prematurity (26%) and gastroesophageal reflux (28%) were notable comorbidities. 19% of patients required tracheotomy.
Conclusions:
- Hospitalized pediatric patients with congenital airway abnormalities often have severe respiratory compromise and a higher likelihood of tracheotomy.
- Prematurity and gastroesophageal reflux are significant comorbid factors associated with severe respiratory issues in this group.
Objective:
To determine the cause of congenital airway abnormalities in pediatric patients requiring hospitalization for their respiratory status.
Design And Setting:
Case series in a tertiary care center.
Patients:
A 5-year retrospective chart review was conducted at our institution. A total of 174 patients were identified who required hospitalization for their respiratory status as a result of a congenital airway abnormality.
Results:
Of the 174 patients, 114 (65.5%) were male and 60 (34.5%) were female. Eighty patients (47%) presented within the first 3 months of life. Forty-six patients (26%) were born prematurely, and 49 patients (28%) were diagnosed as having gastroesophageal reflux. The majority of patients (139 [80%]) had multiple presenting symptoms or signs. Stridor was the most common (129 [74%]), followed by accessory respiratory effort, cyanosis, apnea, and failure to thrive. Diagnosis was made at the time of surgical evaluation in 91% of the patients, with the remaining diagnoses made using radiological findings and/or clinical evaluation. Sixty-five patients (37%) had multiple sites of airway abnormalities; laryngeal abnormalities were noted almost 3 times as often as tracheal abnormalities (161 vs 62, respectively). Of the laryngeal abnormalities, laryngomalacia was the most common, followed by glottic web, subglottic stenosis, vocal-cord paralysis, and subglottic hemangioma. Tracheomalacia was the most common tracheal abnormality, followed by external compression and tracheal stenosis. Thirty-three patients (19%) required tracheotomy for management of recurrent respiratory decompensation.
Conclusions:
While congenital airway abnormalities are usually self-limited, those patients requiring hospitalization represent a group with a more severe respiratory status who have a greater chance of requiring tracheotomy. The recognizable percentage of patients with gastroesophageal reflux and prematurity accounts for comorbid factors in the need for hospitalization for respiratory issues related to congenital airway abnormalities.
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