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Peroral endoscopy in neonates
Insights
Endoscopic examinations in neonates are safe and reveal diverse conditions like vocal cord palsies and laryngomalacia. General anesthesia is often unnecessary for these essential diagnostic procedures.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Medicine
- Diagnostic Endoscopy
Background:
- Neonatal airway issues are complex and require accurate diagnosis.
- Endoscopic evaluation is crucial for identifying congenital and acquired laryngeal pathologies in infants.
- A variety of conditions necessitate specialized examination in the neonatal population.
Purpose of the Study:
- To evaluate the safety and indications of endoscopic examinations in neonates.
- To identify the spectrum of airway diseases diagnosed via endoscopy in this age group.
- To assess the necessity of general anesthesia for neonatal endoscopic procedures.
Main Methods:
- Retrospective review of 100 neonates undergoing 171 endoscopic procedures over a 5-year period.
- Detailed analysis of diagnoses, including vocal cord palsies, laryngomalacia, laryngeal stenosis, cardiovascular anomalies, and foreign bodies.
- Documentation of procedures performed, anesthesia use, and patient outcomes, including tracheotomy rates and mortality.
Main Results:
- Vocal cord palsies (36), laryngomalacia (24), and laryngeal stenosis (13) were common findings.
- Tracheotomy was required in 28 neonates, often associated with vocal cord palsies, laryngeal stenosis, or cardiovascular disease.
- Endoscopic procedures were safely performed, with general anesthesia used in a minority of cases (18 for tracheotomy, 7 for repeat procedures).
- Three deaths occurred, all attributed to underlying conditions, not the procedures themselves.
Conclusions:
- Endoscopic examinations are safe and valuable for diagnosing a wide range of conditions in neonates.
- The findings underscore the diverse indications for neonatal endoscopy.
- General anesthesia is not always mandatory for successful neonatal endoscopic evaluations.
Abstract:
A study was made of 100 neonates examined by 171 procedures in a 5 year period. Thirty-six patients had vocal cord palsies: unilateral, bilateral, complete or incomplete. Twenty-four infants had laryngomalacia of which 5 had concomitant problems of multiple congenital anomalies or palsies of varying severity. Laryngeal stenosis was encountered in 13 patients. Four of these were congenital, and two required tracheotomy; 8 of the 9 patients with acquired stenosis required tracheotomy. Nine infants had cardiovascular anomalies. Three were seen following TEF repair. Esophageal foreign bodies (endotracheal tube) were removed from two infants. Of the 28 neonates who had tracheotomies, 13 had vocal cord palsies, 10 had laryngeal stenosis and 8 had congenital cardiovascular disease. In the 171 procedures, anesthesia was used 18 times for tracheotomy and 7 times for repeated procedures. There were 3 deaths in this series, all related to the underlying disease. This study indicates that endoscopic examinations of the neonate can be accomplished safely. It further indicates the diverse diseases for which endoscopy is indicated. General anesthesia is not mandatory for such examinations.