Bronchial hypersecretion in preterm neonates.

Abstract

SUMMARY During an 18-month period, 11 pieterm infants with birthweights between 700 and 1560 g (mean 12 kg) developed excessive tracheobronchial secretions during intensive care. No single obstetric factor was incriminated. Copious, viscous, tracheobronchial secretions were noted at about 5 days during mechanical ventilation via endotracheal tube causing recurrent segmental collapse, hypoxia, and hypercapnia (median peak Pco2 13-5 kPa). All infants were treated with frequent bronchial lavages and continued intermittent positive pressure ventilation, together with high concentrations of oxygen. No infant died, but morbidity was high. Tracheostomy was performed on 2 infants (one at age 3 months, because of severe croup) and 2 others had clinical or physiological evidence of upper airways narrowing. Follow-up studies showed that this group had more problems of airways obstruction throughout the first year of life as well as increased lung stiffness. The hypersecretion group showed a higher incidence of chronic lung disease. Likely aetiological factors were sought. Contamination of the mechanical ventilation equipment by detergent and activated glutaraldehyde was found; this could have been a contributory factor.

Current strategies for treating infants with severe bronchopulmonary dysplasia

“…A tracheotomy also make it easier to clear secretions [20], allows children to feel more comfortable with less sedation, and improve glottis function, thus reducing the likelihood of aspiration. The overall complication rate associated with atracheotomy is relatively low in adult patients [21].…”