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Iatrogenic lesions of the upper airway in the newborn
Insights
Endotracheal intubation in infants can lead to lung collapse and tracheal issues. Younger gestational age, high oxygen, and prolonged intubation increase the risk of these complications.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Endotracheal intubation is a common procedure in neonatal intensive care.
- Complications associated with endotracheal tube therapy require careful monitoring and management.
Purpose of the Study:
- To identify the incidence and predisposing factors of endotracheal tube therapy complications in surviving infants.
- To analyze the relationship between specific clinical factors and the occurrence of lobar collapse or tracheal lesions.
Main Methods:
- Retrospective analysis of 140 infants who survived the first week of life and received endotracheal intubation.
- Statistical comparison between infants with and without complications.
Main Results:
- 65 out of 140 infants experienced complications, including lobar collapse (predominantly right upper lobe) and tracheal lesions with nasal necrosis.
- Factors predisposing to lobar collapse included younger gestational age, high oxygen concentration, and prolonged intubation duration.
- Endotracheal tube cultures did not correlate with complication rates.
Conclusions:
- Endotracheal intubation in neonates is associated with significant complication risks.
- Gestational age, oxygen exposure, and intubation duration are key risk factors for adverse outcomes.
- Further research may be needed to mitigate these risks in vulnerable infant populations.
Abstract:
A retrospective study of 140 babies who survived the first week of life and who had endotracheal intubation showed that 65 of them had either or both of the following complications of endotracheal tube therapy: (a) Collapse of one or more lobes with the tube in place or within the first two days following extubation and lasting less than 24 hours. When collapse lasted more than 48 hours, it often required repeated intubation for tracheal cleansing. The right lung, especially its upper lobe, was predominantly affected. (b) Tracheal lesions and nasal necrosis. A statistical comparison with intubated babies of similar age without complications showed the following factors to predispose to lobar collapse: younger gestational age, maximal high oxygen concentration administered, and prolonged duration of intubation. The results of endotracheal tube cultures bore no relation to the complication rate.