Neonatal iatrogenic nasal obstruction.
OBJECTIVE
To define the etiology, management and prevention of iatrogenic neonatal nasal obstruction caused by intra-nasal synechia (INS).


METHODS
Case series retrospectively reviewed, years 2001-2002.


METHODS
Tertiary care children's hospital.


METHODS
Four neonates, ages 2 weeks to 3 months, evaluated for nasal obstruction and consequent respiratory distress. Endoscopic findings were of intra-nasal synechia caused by previous intra-nasal invasive interventions.


METHODS
The procedures inciting the formation of synechia, possible management problems leading to synechia formation, clinical presentation, treatment and results of treatment were documented.


RESULTS
Initial incorrect diagnosis and management with an inappropriate intervention was found to be a possible cause of nasal obstruction due to synechia formation in three of these patients (two with associated craniofacial anomalies). In one patient complete nasal obstruction due to synechia was a result of continuous positive airway pressure (CPAP) intra-nasal catheters. Treatment including endoscopic synechiolysis resulted in an improved airway but not a complete cure. All patients required multiple procedures to attain a satisfactory nasal airway.


CONCLUSIONS
Careful initial diagnosis and management of neonatal nasal obstruction may prevent severe complications caused by synechia in the nasal cavity.
DeRowe
Ari
A
Pediatric Otolaryngology Unit, "Dana" Children's Hospital, Tel-Aviv Medical Center, 6 Weitzman St., Tel-Aviv 64239, Israel. aderowe@post.tau.ac.il
Landsberg
Roee
R
Fishman
Gadi
G
Halperin
Doron
D
Fliss
Dan
D
D004106:Dilatation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007231:Infant, Newborn; D007440:Intubation / Q000009:adverse effects*; D015508:Nasal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015607:Stents / Q000009:adverse effects*