Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T19:12:26.399Z Has data issue: false hasContentIssue false

Long term pathological sequelae of neonatal endotracheal intubation

Published online by Cambridge University Press:  29 June 2007

S. J. Gould*
Affiliation:
Department of Histopathology, University College and Middlesex School of Medicine, Rockefeller Building, University Street, London WC1E 6JJ
J. Graham
Affiliation:
Department of Ear, Nose and Throat Surgery, Royal Ear Hospital, University College Hospital, Capper Street, London WC1E 6JJ.
*
Dr. S. J. Gould, Department of Histopathology, University College and Middlesex School of Medicine, Rockefeller Building, University Street, London WC1E 6JJ.

Abstract

In neonates, acquired subglottic stenosis (SGS) is the most serious long term complication of endotracheal intubation. In this case report, we describe the pathological changes in the larynx of a child who died two years after successful treatment, involving corrective surgery, for neonatally acquired SGS. Stenosis, due to dense fibrous connective tissue, was still present at death. However, there was evidence that there had been growth of the laryngeal cartilages. Disruption of the laryngeal cartilages was present anteriorly due to the antecedent surgery but major cricoid cartilage injury secondary to intubation was not seen. The crico-arytenoid joints demonstrated ankylosis and to this was attributed the abnormal quality of voice noted in the child at follow-up. The pathological changes are considered in relation to the pathology of endotracheal intubation and pathogenesis of acquired subglottic stenosis.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aboulker, P., Sterkers, R. and Denaldent, E. (1966) Modifications apportees a l'interventionale Rethi. Annales d'Oto-laryngologie (Paris). 83: 98106.Google Scholar
Bozic, C. (1969) Lesions dues a l'intubation endotracheale des nouveau-nes. Helvetica Paediatrica Acta, 24: 458462.Google Scholar
Cotton, R. T. (1978) Management of subglottic stenosis in infancy and childhood. Annals of Otology, Rhinology and Laryngology, 87: 649657.CrossRefGoogle ScholarPubMed
Cotton, R. T. and Seid, A. S. (1980) Management of the extubation problem in the premature child: anterior cricoid split as an alternative to tracheostomy. Annals of Otology, Rhinology and Laryngology, 89: 508511.CrossRefGoogle Scholar
Evans, J. N. G. and Todd, G. B. (1974) Laryngotracheoplasty. Journal of Laryngology and Otology, 88: 589597.CrossRefGoogle ScholarPubMed
Fearon, B. and Cotton, R. (1974) Surgical correction of subglottic stenosis of the larynx in infants and children. Progress report. Annals of Otology, Rhinology and Laryngology, 83: 428431.CrossRefGoogle ScholarPubMed
Gould, S. J. (1988) The pathology of neonatal endotracheal intubation and its relationship to subglottic stenosis. Journal of Laryngology and Otology Supplement 17: p. 37.Google ScholarPubMed
Gould, S. J. and Howard, S. (1985) The histopathologyd of the larynx in the neonate following endotracheal intubation. Journal of Pathology, 146: 301311.CrossRefGoogle ScholarPubMed
Gould, S. J. and Graham, J. M. (1985). Acquired subglottic stenosis in neonates. Clinical Otolaryngology, 10: 299302.CrossRefGoogle ScholarPubMed
Hawkins, D. B. (1978) Hyaline membrane disease of the neonate, prolonged intubation in management, effects on the larynx. Laryngoscope, 88: 201224.CrossRefGoogle ScholarPubMed
Joshi, V. V., Mandavia, S. G., Stern, L. and Wigglesworth, F. W. (1972) Acute lesions induced by endotracheal intubation. Occurrence in the upper respiratory tract of newborn infants with respiratory distress syndrome. American Journal of Diseases of Children, 124: 646649.CrossRefGoogle ScholarPubMed
Papsidero, M. J. and Pashley, N. R. T. (1980) Acquired stenosis of the upper airway in neonates. Annals of Otology, Rhinology and Laryngology, 89: 512514.CrossRefGoogle ScholarPubMed
Quiney, R. E. and Gould, S. J. (1985) Subglottic stenosis: a clinicopathological study. Clinical Otolaryngology, 10: 315327.CrossRefGoogle ScholarPubMed
Quiney, R. E., Spencer, M. G., Bailey, C. M., Evans, J. N. G. and Graham, J. M. (1986) Management of subglottic stenosis: experience from two centres. Archives of Disease in Childhood, 61: 686690.CrossRefGoogle ScholarPubMed
Rasche, R. F. H. and Kuhns, L. R. (1972) Histopathologic changes in airway mucosa of infants after endotracheal intubation. Pediatrics, 50: 632637.CrossRefGoogle ScholarPubMed
Ratner, I. and Whitfield, J. (1983) Acquired subglottic stenosis in the very-low-birth-weight infant. American Journal of Diseases in Children, 137: 4043.Google ScholarPubMed
Supance, J. S., Reilly, J. S., Doyle, W. J., Bluestone, C. D. and Hubbard, J. (1982) Acquired subglottic stenosis following prolonged endotracheal intubation. Archives of Otolaryngology, 108: 727731.CrossRefGoogle ScholarPubMed