Necrotizing tracheobronchitis in intubated newborns: a complication of assisted ventilation

This report describes a newly recognized iatrogenic lesion in newborns that we have termed necrotizing tracheobronchitis (NTB). Although it is related to assisted ventilation, it is different from previously described tracheal lesions in that it is most severe distal to the tip of the endotracheal tube and manifests a characteristic basophilic necrosis of the tracheal mucosa. Sloughing of tracheal mucosa, which occurs in the later stages, can cause respiratory obstruction. The lesion occurs over a wide range of gestational ages and birth weights as well as ventilatory rates, pressures, and supplemental oxygen concentrations. The severity of the lesion is related to the duration of ventilation. We believe NTB to be related to airflow through the endotracheal tube rather than to the effects of the tube itself because the lesion is worst beyond the end of the tube and extends into the major bronchi. A grading system is presented.