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Midfacial hypoplasia associated with long-term intubation for bronchopulmonary dysplasia
A Rotschild1, P J Dison, D Chitayat
1Department of Pediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Prolonged nasotracheal intubation in preterm infants with bronchopulmonary dysplasia may cause midfacial hypoplasia. This condition presents as facial structure deformities, with the long-term impact on growth yet to be determined.
Area of Science:
- Pediatric Medicine
- Neonatology
- Otolaryngology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
- Long-term endotracheal intubation is sometimes necessary for managing BPD.
- Facial development in neonates is sensitive to external pressures and airflow changes.
Observation:
- Six preterm infants (24-35 weeks gestational age) with BPD underwent nasotracheal intubation for 68-243 days.
- Endotracheal tube sizes ranged from 2.5 to 4.0 mm, adjusted for growth.
- Infants exhibited midfacial hypoplasia: depressed nasal bridge, small nose, long philtrum, underdeveloped malar areas, and carp-like mouth.
Findings:
- The observed midfacial hypoplasia is a novel finding associated with prolonged nasotracheal intubation in premature infants.
- Potential mechanisms include direct tube compression, altered airflow to nasal passages/sinuses, and reduced facial muscle activity.
- The long-term impact of these deformations on facial growth requires further investigation.
Implications:
- This study highlights a potential iatrogenic complication of long-term intubation in vulnerable preterm infants.
- Clinical awareness is needed to monitor for and potentially mitigate these craniofacial changes.
- Further research should explore preventative strategies and the extent of spontaneous catch-up growth.
Abstract:
Six preterm infants with bronchopulmonary dysplasia were nasotracheally intubated for 68 to 243 days. Gestational age at birth ranged from 24 to 35 weeks. Endotracheal tube size was changed to account for growth and varied from 2.5 to 4.0 mm. These infants developed features of midfacial hypoplasia, namely, depressed nasal bridge, small-tipped nose, long philtrum, underdeveloped malar areas, and carplike mouth. These features have not been associated with long-term intubation in premature infants. We suggest that features of prolonged nasotracheal intubation, such as direct compression by the tube and the method of tube fixation, decreased air flow through the developing nares and sinuses and reduced faciomuscular activity, resulting in the observed midfacial hypoplasia. The degree to which growth corrects these deformations is unknown.