Complications of airway management in very-low-birth-weight infants.
OBJECTIVE
To define the incidence of complications of endotracheal intubation and the factors associated with these complications.


METHODS
During a 22-month period, 227 intubated infants weighing <1,501 g were followed prospectively in a neonatal intensive care unit. Detailed records of events associated with airway management were kept after every intubation, in addition to clinical data.


RESULTS
Eleven infants (4.8%) developed respiratory stridor after extubation which was treated with either systemic corticosteroids, racemic epinephrine and/or reintubation for respiratory failure. Four infants were submitted for bronchoscopy, mild subglottic stenosis with tracheal edema was found in 1 patient, granulation tissue and airway edema were noted in 3 infants. Traumatic intubation, prolonged ventilation, multiple intubations and bacterial colonization of the endotracheal tube were the factors associated with postextubation stridor.


CONCLUSIONS
Subglottic stenosis is an infrequent complication of endotracheal intubation with current airway management of very-low-birth-weight infants. Less severe complications are still common, but they are usually amenable to clinical treatment. Bronchoscopy should be performed selectively only in infants with clinical evidence of airway obstruction after extubation.
da Silva
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Department of Pediatrics, St. Joseph's Health Centre, University of Western Ontario, London, Ont., Canada. odasilva@julian.uwo.ca
Stevens
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D
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000402:Airway Obstruction / Q000209:etiology; D001049:Apnea / Q000628:therapy; D001724:Birth Weight; D001919:Bradycardia / Q000628:therapy; D001997:Bronchopulmonary Dysplasia / Q000209:etiology; D001999:Bronchoscopy; D004837:Epinephrine / Q000627:therapeutic use; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D011446:Prospective Studies; D064705:Racepinephrine; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012135:Respiratory Sounds / Q000209:etiology; D018805:Sepsis / Q000150:complications; D013203:Staphylococcal Infections / Q000209:etiology
D000305:Adrenal Cortex Hormones; D064705:Racepinephrine; D004837:Epinephrine