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Prognostic factors in the management of pediatric subglottic stenosis

Sarah Debs1, Aasif A Kazi1, Dustin Bastaich2

  • 1Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA.

International Journal of Pediatric Otorhinolaryngology
|October 3, 2021
PubMed

Insights

Pediatric subglottic stenosis (SGS) management often requires multiple interventions, including laryngotracheal reconstruction (LTR). Prematurity and higher stenosis grade are risk factors for needing LTR, guiding treatment decisions.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Airway Surgery
  • Pediatric Respiratory Medicine

Background:

  • Subglottic stenosis (SGS) is a significant cause of pediatric airway obstruction.
  • Management of pediatric SGS is complex and often requires surgical intervention.
  • Identifying factors predicting the need for open airway reconstruction is crucial for optimizing patient care.

Purpose of the Study:

  • To evaluate outcomes of endoscopic interventions for pediatric subglottic stenosis (SGS).
  • To identify factors associated with progression to open airway reconstruction (laryngotracheal reconstruction - LTR).
  • To inform treatment strategies for pediatric SGS to minimize interventions and improve outcomes.

Main Methods:

  • Retrospective cohort review of pediatric patients with SGS treated between 2012-2020.
  • Data collected included patient demographics, gestational age, intubation duration, comorbidities, and number of interventions.
  • Comparison of factors between patients undergoing LTR versus those managed with endoscopic procedures.

Main Results:

  • 47 pediatric patients with SGS were analyzed; 49% required laryngotracheal reconstruction (LTR).
  • Decannulation was successful in 25/32 (78%) of tracheostomized patients.
  • Lower gestational age, higher initial stenosis grade, and more interventions predicted the need for LTR (p < 0.05).

Conclusions:

  • Pediatric subglottic stenosis is a challenging condition necessitating potentially multiple interventions.
  • Gestational age, initial stenosis severity, and cumulative intervention count are key predictors for requiring laryngotracheal reconstruction.
  • These findings can guide clinical decision-making to optimize management of pediatric SGS.
Abstract

Keywords:
Acid refluxAirway reconstructionBronchopulmonary dysplasiaChromosomal abnormalitiesDirect laryngoscopyEndoscopic proceduresLaryngotracheal reconstructionPediatricSubglottic stenosis

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