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Site of upper airway obstruction in preterm infants with problematical apnoea
1Department of Child Health, University Hospital, Nottingham.
Insights
Airway obstruction in preterm infants is often caused by laryngeal issues, specifically the closing of the epiglottis and arytenoid masses. This finding is crucial for understanding and treating apnoea of prematurity.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Otolaryngology
Background:
- Apnoea of prematurity is a common concern in neonates.
- Airway obstruction is a known risk factor for apnoea development.
- The specific laryngeal contribution to this obstruction requires further elucidation.
Purpose of the Study:
- To investigate the upper airway anatomy in preterm infants experiencing recurrent apnoea.
- To identify the precise location and nature of airway obstruction using fibreoptic endoscopy.
- To correlate observed laryngeal obstruction with different types of apnoea events.
Main Methods:
- Utilized an ultrafine fibreoptic scope for continuous upper airway visualization in 12 preterm infants.
- Recorded airway dynamics via videotape synchronized with cardiorespiratory monitoring.
- Observed laryngeal structures, including arytenoid masses and aryepiglottic folds, during apnoeic episodes.
Main Results:
- Laryngeal level obstruction was identified in 7 out of 12 infants studied.
- Observed obstruction involved the closure of arytenoid masses and aryepiglottic folds across the vocal cords.
- Laryngeal obstruction occurred during obstructive, mixed, and even apparently central apnoea episodes.
Conclusions:
- The larynx is confirmed as a significant anatomical site for upper airway obstruction in preterm infants.
- These findings support the role of airway obstruction in the pathophysiology of apnoea of prematurity.
- Direct visualization provides valuable insights into the mechanisms underlying apnoea in this vulnerable population.
Abstract:
Airway obstruction is an important factor predisposing to the development of apnoea in preterm infants. An ultrafine fibreoptic scope was used to examine the upper airway of 12 preterm infants with recurrent problematical apnoea. Continuous visualisation of the airway was possible and recorded on to videotape together with simultaneous cardiorespiratory monitoring to detect apnoeic episodes in 12 infants studied. In seven infants obstruction was observed at laryngeal level with the arytenoid masses and aryepiglottic folds closing across the vocal cords. This was not only observed in obstructive apnoea but also during mixed apnoea in periods where no respiratory effort was detectable and again in apparently pure central apnoea. The findings confirm the larynx as an anatomical site of upper airway obstruction. They agree with other indirect methods of assessing airway patency that obstruction has an important role in the pathophysiology of apnoea of prematurity.