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Subglottic ulceration and healing following endotracheal intubation in the neonate: a morphometric study
Insights
Neonatal endotracheal intubation can cause subglottic stenosis. However, infant larynx healing progresses rapidly, with most ulcers healing within 30 days, even with prolonged intubation.
Area of Science:
- Pediatric Medicine
- Otolaryngology
- Neonatology
Background:
- Acquired subglottic stenosis is a serious complication in neonates following endotracheal intubation.
- It is primarily caused by posttraumatic fibrosis of the infant larynx.
Purpose of the Study:
- To investigate the timeline and extent of laryngeal injury and healing following endotracheal intubation in neonates.
- To assess the relationship between intubation duration and the progression of subglottic injury and fibrosis.
Main Methods:
- Morphometric assessment of 78 infant larynges (75 intubated) with varying gestational ages and survival times.
- Quantification of acute epithelial loss and subglottic ulcer healing using metaplastic squamous epithelium coverage.
Main Results:
- Acute subglottic epithelial loss is common, occurring up to 100% within hours of intubation.
- Injury progression is short-lived; ulcer healing begins within days and is largely complete by 30 days.
- Long-standing acute injury is rare, even with the endotracheal tube in situ.
Conclusions:
- Neonatal subglottic injury from intubation heals relatively quickly.
- The potential for long-term acute injury appears limited, suggesting a favorable healing capacity in the infant larynx.
- Findings challenge the assumption that prolonged intubation invariably leads to severe, persistent subglottic stenosis.
Abstract:
In neonates, acquired subglottic stenosis is the most serious long-term complication of endotracheal intubation and is due primarily to posttraumatic fibrosis of the infant larynx. We have examined 78 larynges, 75 of which were intubated, from infants ranging in gestation from 22 to 40 weeks, and who survived from a few hours to up to 300 days. Each larynx was morphometrically assessed for the extent of acute injury, indicated by the percentage of epithelial loss, and healing, indicated by the percentage of a subglottic ulcer covered by metaplastic squamous epithelium. Results show that acute injury is almost invariable, and up to 100% of the subglottic epithelium may be lost within a few hours of intubation, but that progression of injury is relatively short-lived. Ulcer healing starts after a few days, rapidly progresses from day 10, and in the majority of cases is complete after 30 days. This study suggests that long-standing acute injury in the subglottis is the exception rather than the rule, even with the endotracheal tube remaining in place.