Consequences of NICU Intubations: Incidence, Identifications, and Interventions

Area of Science:

• Neonatal intensive care
• Pediatric otolaryngology
• Respiratory medicine

Background:

• Prolonged intubation in neonates, particularly those with prematurity and congenital defects, is a significant risk factor for laryngeal injuries such as subglottic stenosis (SGS).
• Identifying neonates at risk within the neonatal intensive care unit (NICU) is crucial for timely intervention and management.

Purpose of the Study:

• To identify intubation risk factors associated with laryngeal injuries in neonates.
• To characterize the types of laryngeal injuries observed.
• To calculate the incidence of interventions required for these injuries.

Main Methods:

• Retrospective case review of intubated neonates in a quaternary pediatric referral center from April 2020 to 2023.
• Analysis of electronic medical records for demographics and intubation details.
• Categorization of patients into intubation-only or intervention groups (direct laryngoscopy and bronchoscopy [DLB], tracheostomy).

Main Results:

• Of 441 intubated neonates, 94 (21%) underwent DLB.
• Risk factors for intervention included older gestational age, genetic syndromes, and congenital heart disease.
• Significant predictors for intervention were older age at first intubation, recurrent intubation events, longer intubation duration, and larger endotracheal tube (ETT) diameter.
• Subglottic stenosis incidence was 2.95%, with 6.4% requiring balloon dilation.
• Two-thirds of neonates undergoing DLB ultimately required tracheostomy.

Conclusions:

• Older age at first intubation, increased intubation events, prolonged intubation duration, and larger ETT size are significant risk factors for laryngeal interventions.
• Birth weight and the number of intubation attempts were not significant risk factors.
• The majority of neonates requiring DLB eventually necessitate further procedures, highlighting the severity of these intubation-related injuries.