One hundred fifty-three children 3 years of age or younger who had tracheotomies performed during the past 15 years are reviewed. During this time, short-term endotracheal intubation for airway obstruction from acute infections and long-term intubation for patients on ventilators have replaced early tracheotomy for these conditions. The number of tracheotomies decreased during each of three 5-year periods, from 73 to 55 to 25, respectively. Improvements in medical management resulted in prolonged survival of children with multiple abnormalities and resulted in more prolonged tracheotomies. Early complications occurred in 12% of patients and late complications occurred in 26%. In spite of changes in the indications, basic fundamentals of pediatric tracheotomy management remain unchanged.

Two hundred fourteen patients admitted with a history of caustic ingestion are reviewed. Sixty-five had mucosal penetrating burns. Children five years of age and under accounted for 39% of admissions, but only 8% of burns requiring treatment. Adults accounted for 48% of admissions and 81% of burns requiring treatment. Complications associated with mucosal penetrating burns occurred in 31 patients; all but one were due to lye or acids. A three year prospective study evaluating methylprednisolone in the management of caustic burns is reported. This included 24 patients with mucosal penetrating burns due to lye or acids. The results of this study, and this review as a whole, indicate that methylprednisolone is beneficial in moderately severe burns due to lye, but is not indicated for severe burns from liquid lye, or for acid burns.

Fifty-four children with acute mastoiditis were managed at the Los Angeles County-University of Southern California Medical Center from 1972 through 1982. Our criteria for the diagnosis of acute mastoiditis are acute or subacute otitis media, postauricular swelling and erythema, protrusion of the auricle, and clouding of mastoid air cells on radiographs. Thirty-one (57%) recovered with conservative therapy consisting of early myringotomy and intravenous antibiotic, usually ampicillin. Twenty-three patients were managed surgically. The indication for surgery in each case was the clinical diagnosis of subperiosteal abscess; mastoid radiographs played no part in the decision to operate. Two of the 23 patients managed surgically had only incision and drainage of abscess; simple mastoidectomy was performed on 20 and radical mastoidectomy on one. Etiologic bacteria were cultured in 21 instances, S. pyogenes was cultured in 9, S. pneumoniae was cultured in 6, H. influenzae in 1, enterococci in 1, anaerobes in 2, and M. tuberculosis in 2.

Hyaline membrane disease, an illness of premature neonates, is associated with 20–30% of all neonatal deaths and 50–70% of premature deaths in the United States. Often related to perinatal hypoxia, its basic pathophysiology consists of surfactant deficiency with diffuse atelectasis, and pulmonary hypoperfusion. With expanding knowledge of hyaline membrane disease, methods of management evolved to the use of assisted ventilation with endotracheal tubes. One hundred twenty‐two surviving infants with hyaline membrane disease were intubated for periods of four to 112 days at the Los Angeles County‐USC Medical Center over a five‐year period. Their clinical courses, and effects of intubation on their larynges, are discussed. Autopsy examination of 30 neonatal larynges after intubation revealed a high incidence of ulcerations within the cricoid area. The neonate's tolerance of intubation must be due to resiliency of its cricoid cartilage. Microscopic changes in cartilage with growth are demonstrated. With growth, cartilage matrix increases; it becomes less hydrated, more fibrous, and more rigid. Neonates with normal larynges can tolerate long periods of intubation with polyvinyl chloride, uniform diameter, endotracheal tubes. With the use of principles successful in neonatal intubation, older patients can tolerate longer periods of intubation than was acceptable in earlier years; however, while intubation of neonates can be measured in weeks, in older patients it should still be measured in days.