Subglottic stenosis in newborns after mechanical ventilation

Mechanical ventilation in the neonatal period is sometimes followed by difficulty in removal of the endotracheal tube although the patient does not need further respiratory support. This problem results from subglottic stenosis consequent on prolonged use of endotracheal tubes. We found this complication in 5 patients among 854 newborns who required artificial respiration. A further patient was admitted from another hospital because of extubation problems. Our clinical diagnosis was confirmed by endoscopy. Drug therapy with steroids and anti-inflammatory agents was tried in all six patients and was successful in two. In four patients conservative management failed and laser surgery was performed; three of these infants required tracheostomy. In two decannulation has already been performed at the age of 2 1/2 years.

five of six patients were treated successfully, and one 3-year-old patient is still being treated. In the light of reports from other authors, this approach can be recommended for the management of acquired subglottic stenosis.