Subglottic dilatation in extremely preterm infants on prolonged mechanical ventilation

Area of Science:

• Neonatal intensive care
• Pediatric pulmonology
• Medical imaging

Background:

• Airway injuries, including subglottic stenosis, are a concern in preterm infants with bronchopulmonary dysplasia.
• Prolonged mechanical ventilation is a potential risk factor for airway complications in neonates.

Purpose of the Study:

• To investigate the association between prolonged ventilation and subglottic dilation in extremely preterm infants.
• To assess the reliability of point-of-care ultrasonography (POCUS) in evaluating subglottic dilation.

Main Methods:

• A cohort of extremely preterm infants (<29 weeks) requiring invasive ventilation was studied.
• Infants were categorized into control (≤7 days ventilation) and prolonged ventilation (≥28 days) groups.
• Tracheal size was measured using POCUS, with intra- and inter-observer variability assessed.

Main Results:

• Infants requiring prolonged ventilation showed significant subglottic dilation compared to the control group (4.51 ± 0.04 mm vs 4.17 ± 0.02 mm, p < 0.01).
• Intra- and inter-observer correlations for tracheal measurements were high (0.97 and 0.83, respectively).
• Prolonged ventilation was associated with higher risks of infections, bronchopulmonary dysplasia, and longer hospital stays.

Conclusions:

• Extremely preterm infants undergoing prolonged ventilation are susceptible to subglottic dilation.
• POCUS offers a reliable method for measuring subglottic dilation in this vulnerable population.