[Diagnosis and management of necrotizing tracheobronchitis]

Necrotizing tracheobronchitis has been described as a complication of mechanical ventilation of newborns with respiratory failure. Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction that causes 45% of mortality. The objective of our study is to analyze our experience in the management of these patients.

In the last three years we have treated eight patients with necrotizing tracheobronchitis The mean age was 0.84 +/- 0.95 months, gestational age of 37.43 +/- 2.3 weeks. The mean weight was 3.07 +/- 1.04 kg. Five patients had a congenital heat disease (62.5%) and three have a respiratory failure (37.5%). We have analyzed the contributing factors, symptoms, diagnosis, treatment and results.

All patients presented episodes of shock with treatment of drugs. Five patients have conventional ventilation (62.5%) while three have high frequency oscillatory ventilation (37.5%). There were not significant differences in the ventilator parameters of both groups (PMA, PIP, PEEP). Three patients were supported by ECMO when they developed necrotizing tracheobronchitis. The treatment was bronchoscopic removal of necrotic tissue. There was not any complication after the procedure. A patient suffered a stenosis in the left main bronchus. Three patients have died during follow-up for different causes. The time of pursuit is of 10.33 +/- 7.61 months.

Necrotizing tracheobronchitis may be increasing in the Neonatal Intensive Care Units, due to a bigger survival of patient with serious respiratory failure and shock. Hypotension and shock seems to be a major contributing factor in the development of this lesion. Bronchoscopy is necessary for treatment and survival of the patients.