Recurrent lobar atelectasis due to acquired bronchial stenosis in neonates

Bronchial obstruction by granulation tissue caused atelectasis in ten infants who required frequent suctioning and mechanical ventilation for more than 20 days. The endotracheal suctioning had been performed with a No. 6 or No. 8 French catheter with multiple end and side holes at the tip. Bronchoscopic examination revealed nodular and polypoid granulation at the level of the carina and bronchus, more often on the right side. In five infants, atelectasis was treated with gentle, less frequent suctioning and vigorous pulmonary toilet. Two of these infants died of severe atelectasis and chronic lung disease. Five infants underwent excision or cauterization of granulation tissue. Histopathologic examination of this tissue disclosed inflammation, fibrosis, and squamous metaplasia in each of the five specimens. Eight of the ten infants are alive without symptoms, the oldest being 27 months. Prevention may require critical analysis of suction techniques and the catheter tips employed. Whistle tip catheters should be avoided. Mild obstructive lesions can be managed by gentle and less frequent suctioning and aggressive pulmonary care, but severe obstruction, as determined by a compromise of the lumen of greater than 20%, may require excision or cauterization.