Hyaline membrane disease of the neonate prolonged intubation in management: Effects on the larynx

Abstract

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.

Acquired paediatric subglottic cysts: A series from Manchester

“…This is similar process that occurs in subglottic stenosis [14][15][16][17] but the degree of fibrosis is far more representing a possible continuum of damage cased in the subglottis. Despite various hypothesis on pathogenesis of SGCs we know that they gradually increase in size leading to delayed onset of symptoms [2][3][4][5][6][7][8][9][10][11].…”

Incidence of severe acquired subglottic stenosis in newborns

“…Some studies have defined SGS when seen endoscopically, whilst others have defined it by the need for surgical intervention [9][10][11]. We defined severe acquired SGS as those requiring open surgical intervention either by tracheotomy or ACS, as regionally other procedures are not used to manage severe SGS.…”

Management of subglottic cysts with Mitomycin-C—A case series and literature review

“…If an endotracheal tube does not fit or is too large, trauma is most likely to occur in the subglottis [3][4][5][6]; however, cysts can be seen with appropriate sized tubes because the endotracheal tube abuts and irritates the subglottic mucosa. In addition, infants also have a higher quantity of submucous glands than adults in their subglottis, further predisposing them to subglottic cysts [8]. Subglottic trauma has been studied histologically and is thought to be the inciting factor in the pathophysiology of subglottic cysts.…”

“…Histopathologically, SGC formation begins following intubation-induced mucosal damage [8,9]. Subglottic ulceration and squamous metaplasia follows.…”