Laryngeal oedema in neonatal apnoea and bradycardia syndrome (a pilot study).
OBJECTIVE
Some preterm infants in general good health continue to present recurrent apnoeas, bradycardias and desaturations (ABD) despite usual treatments. These events may lead to transitory brain hypoxia and to further neurological injury. The purpose of this study has been to evaluate the role of laryngeal oedema in this symptomatology and to assess corticoid treatment.


METHODS
Twelve preterm babies born at a median age of 28.5 weeks (range: 26-35 weeks) already showed signs of ABD at a median age of life of 28.5 days (range: 9-80 days). Fiberoptic laryngeal endoscopy was performed on these babies at a median postconceptional age of 34 weeks (range: 31-38 weeks) to detect a possible involvement of the larynx in their ABD.


RESULTS
Each patient presented a severe laryngeal oedema compatible with potential obstructive breathing. Half of the cohort (n=6) received inhaled corticosteroids initiated with a short oral dexamethasone treatment for 3 to 5 days (group 1). All the babies improved. The other half (n=6) received only an inhaled topic corticosteroid treatment (group 2). Four of the six babies improved and two needed oral dexamethasone. Laryngoscopic endoscopy was carried out after 1 week of treatment. The picture corresponded with clinical improvement. Recurrence of ABD occurred in 3/12 (25%) of the babies after stopping dexamethasone. No immediate side effects of the procedure or the treatment were observed.


CONCLUSIONS
Laryngeal oedema may be a cause of ABD in preterm newborns. It may arise from oesophageal reflux and/or presence of the feeding tube. It can be diagnosed by atraumatic fiberoptic fibroscopy and successfully treated with corticosteroids.
Vermeylen
Danièle
D
Neonatal Intensive Care Unit, Erasmus Hospital, Free University of Brussels (ULB), Brussels, Belgium. dvermeyl@ulb.ac.be
Franco
Patricia
P
Hennequin
Yves
Y
Pardou
Anne
A
Brugmans
Muriel
M
Simon
Patricia
P
Hassid
Sergio
S
D000280:Administration, Inhalation; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D001919:Bradycardia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D002110:Caffeine / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004294:Domperidone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000209:etiology* / Q000628:therapy; D007819:Laryngeal Edema / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial; D012891:Sleep Apnea Syndromes / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D002110:Caffeine; D004294:Domperidone; D003907:Dexamethasone