Size of endotracheal tube and neonatal acquired subglottic stenosis. Study Group for Neonatology and Pediatric Emergencies in the Parisian Area
P. Contencin and P. Narcy
Department of Otorhinolaryngology, Hopital Robert Debre, Faculte de Medecine Xavier Bichat, University of Paris VII, France.
OBJECTIVE--Risk factors for acquired laryngotracheal stenosis in newborn
infants are poorly known. The extreme scarcity of acquired laryngotracheal
stenosis in young infants in France, compared with the published rate in
the English literature, suggested that these patients may be treated in a
different way in France. A prospective study was performed to analyze local
features. DESIGN--Six-month multicenter inception cohort study.
SETTING--Seven neonatal intensive care units of referral centers in the
area of Paris, France. PATIENTS--A total of 247 intubated surviving
neonates in a consecutive sample during 6 months. INTERVENTION--A file was
completed with sex, birth weight, gestational age, underlying disease, and
every feature concerning the intubation period and the outcome. MAIN
OUTCOME MEASURES--All the collected data were compared with those available
from previous studies in the English literature. RESULTS--After extubation,
respiratory outcome was uncomplicated in 242 cases. The five patients with
dyspnea were treated medically and recovered. A much higher rate of
extubation difficulties was reported in the English literature. The rate of
stenosis in this series was significantly lower than in previously reported
studies. The differences between this and other series seem to be higher
birth weights, shorter duration of intubation, and, most important, a
smaller tube size (2.5 mm in neonates weighing less than 2500 g and 3.0 mm
in those weighing 2500 g or more). CONCLUSIONS--Although this is a limited
series and many unknown variables can differ from those in previous
studies, the size of the endotracheal tube appears to be a major risk
factor for acquired laryngotracheal stenosis in the neonate. Further
studies seem necessary to point out additional factors.
