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[Laryngeal complications in newborns following intratracheal intubation (author's transl)]
Abstract:
Histological and bacteriological findings in comparison to clinical data concerning intubation for 38 dead premature infants and newborns were studied to elucidate conditions complicating intratrachial intubation at the laryngeal level. The larynx was intact in 3 cases. Slight lesions of mucosa (epithelabrasion, hemorrhage) were found in 13, moderately severe lesions (necrosis of epithelium, ulcers, pseudomembranes) in 11, and severe lesions (deep necrosis, perichondritis with sceletisation) in 10 cases. 1 case showed a stage of regeneration. The narrow passage between the two processus vocales is a site of predilection for tubus-induced lesions, the epithelium bein immediately adjacent to the cartilage. Successful bacteriological demonstration of the infectious agent correlated with the rising degree of mucosal lesions, and increasing duration of intubation. 3 cases, however, already had severe lesions after short-time-intubation. Formal and causal pathogenesis are described. Essential causes are: trauma of intubation, irritation by the tubus in situ, duration of intubation, and infection. Regenerative power of the infantile laryngeal mucosa is strong. Permanent lesions may occur as scarred stenosis. Careful indication, accurate and careful technology of intubation, choice of the smallest possible diameter of tubus, good care for the tubus, and generous prophylaxis against infections are to be demanded.
Insights
Intubation in premature infants and newborns can cause laryngeal lesions, with severity increasing with duration and infection. Careful technique and infection prophylaxis are crucial to prevent permanent stenosis.
Area of Science:
- Pediatric Pathology
- Laryngology
- Neonatal Intensive Care
Context:
- Intratracheal intubation is a common procedure in neonatal intensive care.
- Laryngeal complications can arise from intubation in vulnerable infant populations.
- Understanding these complications is vital for improving patient outcomes.
Purpose:
- To investigate the histological and bacteriological findings of laryngeal lesions in intubated premature infants and newborns.
- To correlate these findings with clinical data and identify risk factors.
- To describe the pathogenesis and suggest preventive measures for intubation-related laryngeal injury.
Summary:
- Histological examination of 38 deceased infants revealed varying degrees of laryngeal mucosal lesions, from simple abrasions to severe necrosis and perichondritis.
- The narrow laryngeal passage between the processus vocales is a predilection site for injury.
- Lesion severity correlated with intubation duration and infection, though severe lesions occurred even with short intubation times.
- Essential causes identified include trauma, irritation, intubation duration, and infection.
Impact:
- Highlights the vulnerability of the infantile laryngeal mucosa to intubation-related trauma and infection.
- Emphasizes the potential for permanent sequelae, such as scarred stenosis.
- Recommends careful indication, precise intubation technique, appropriate tube selection, and infection prophylaxis to minimize risks.