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Subglottic stenosis in neonates and children. Clinical findings and therapy
1Department of Otolaryngology, University Central Hospital, Turku, Finland.
Insights
Acquired subglottic stenosis in infants, often linked to prolonged endotracheal intubation, can be effectively managed. Surgical interventions and follow-up show promising outcomes for pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Critical Care Medicine
Background:
- Acquired subglottic stenosis is a significant complication in infants.
- Prolonged endotracheal intubation for respiratory support is a primary risk factor.
Purpose of the Study:
- To evaluate the diagnosis and management of acquired subglottic stenosis in children.
- To assess the long-term outcomes of various treatment modalities.
Main Methods:
- Endoscopic confirmation of subglottic stenosis in 31 pediatric patients.
- Review of patient demographics, gestational age, birthweight, and associated conditions like respiratory distress syndrome.
- Analysis of treatment strategies including observation, endolaryngeal prosthesis, and laryngotomy with autogenous bone graft.
- Long-term follow-up to assess treatment efficacy.
Main Results:
- The majority of affected children were diagnosed before 12 months of age.
- Most patients required prolonged mechanical ventilation via endotracheal intubation.
- Surgical interventions, including prosthesis and bone grafting, were employed in some cases.
- A significant proportion of patients achieved good or excellent outcomes at long-term follow-up.
Conclusions:
- Acquired subglottic stenosis in infants is frequently associated with mechanical ventilation.
- While observation is suitable for mild cases, surgical interventions can yield favorable results for more severe stenosis.
- Long-term follow-up is crucial for assessing the effectiveness of management strategies in pediatric subglottic stenosis.
Abstract:
From 1978 through 1987, acquired subglottic stenosis was confirmed endoscopically in 31 children. The mean gestational age of the children was 32 weeks and mean birthweight 2,180 g. Of the children 84% were below 12 months of age at the time of diagnosis. Respiratory distress syndrome was confirmed in 17 children. Before diagnosis, 97% of the children had been treated by endotracheal intubation for ventilatory support, the mean duration of intubation being 37 days. In 10 children, subglottic stenosis was mild and mature and these children were followed up only. Endolaryngeal prosthesis was employed in 2 children and laryngotomy with autogenous bone graft in 5 children. Mean follow-up time was 5 years 4 months. At follow-up, 18 of the children showed good or excellent results.