Acquired and congenital subglottic stenosis in the infant

During the calendar year of 1974, the Intermountain Newborn Intensive Care Center at the University of Utah Medical Center had 603 admissions. A representative group of 293 charts were reviewed which indicated that 44% of these children were intubated from hours to weeks. The overall mortality rate for the 293 children was 29%. Eighteen of the 603 children were diagnosed as having subglottic stenosis. Fifteen of these children appeared to have acquired subglottic stenosis secondary to endotracheal intubation. Three children had congenital subglottic stenosis. Tracheostomy was necessary in the management of 15 patients. Ten of the 18 patients have survived and two of these patients still have tracheostomy tubes in place. The survival and thickness of the stenotic area are inversely proportional to the birth weight and the duration of intubation. Endoscopic excision, dilatation and stenting were techniques utilized in the treatment of these stenotic lesions. The extubation technique utilized is described. The factors involved in the production of acquired subglottic stenosis are presented along with suggestions to decrease the incidence of this problem in the intubated child.