title: Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury.
abstract: BACKGROUND
  Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury.
  
  
  OBJECTIVE
  To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness.
  
  
  METHODS
  LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome.
  
  
  RESULTS
  Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P < 0.001; multiple r(2) = 0.44) and subglottic (P < 0.001; multiple r(2) = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure.
  
  
  CONCLUSIONS
  LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates. Clinical trial registered with www.clinicaltrials.gov (NCT 00544427).
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery.|2 Beckman Laser Institute.
authors.forename: Giriraj K
authors.initials: GK
authors.lastname: Sharma
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery.|3 Division of Otolaryngology and.
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Ahuja
authors.affiliation: 2 Beckman Laser Institute.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Wiedmann
authors.affiliation: 4 Department of Medicine.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Osann
authors.affiliation: 2 Beckman Laser Institute.
authors.forename: Erica
authors.initials: E
authors.lastname: Su
authors.affiliation: 5 Department of Biomedical Engineering, and.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Heidari
authors.affiliation: 2 Beckman Laser Institute.|5 Department of Biomedical Engineering, and.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Jing
authors.affiliation: 5 Department of Biomedical Engineering, and.
authors.forename: Yueqiao
authors.initials: Y
authors.lastname: Qu
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Frances
authors.initials: F
authors.lastname: Lazarow
authors.affiliation: 2 Beckman Laser Institute.
authors.forename: Alex
authors.initials: A
authors.lastname: Wang
authors.affiliation: 2 Beckman Laser Institute.
authors.forename: Lidek
authors.initials: L
authors.lastname: Chou
authors.affiliation: 6 Division of Neonatology, University of California Irvine, Irvine, California; and.
authors.forename: Cherry C
authors.initials: CC
authors.lastname: Uy
authors.affiliation: 7 Division of Neonatology, CHOC Children's Hospital of Orange County, Orange, California.
authors.forename: Vijay
authors.initials: V
authors.lastname: Dhar
authors.affiliation: 6 Division of Neonatology, University of California Irvine, Irvine, California; and.|7 Division of Neonatology, CHOC Children's Hospital of Orange County, Orange, California.
authors.forename: John P
authors.initials: JP
authors.lastname: Cleary
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery.|3 Division of Otolaryngology and.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Pham
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery.|3 Division of Otolaryngology and.
authors.forename: Kevin
authors.initials: K
authors.lastname: Huoh
authors.affiliation: 2 Beckman Laser Institute.|5 Department of Biomedical Engineering, and.
authors.forename: Zhongping
authors.initials: Z
authors.lastname: Chen
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery.|2 Beckman Laser Institute.|5 Department of Biomedical Engineering, and.
authors.forename: Brian J-F
authors.initials: BJ
authors.lastname: Wong
mesh_terms: D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007829:Laryngostenosis / Q000175:diagnosis*; D008297:Male; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: diagnostic imaging; intubation injury; neonate; optical coherence tomography; subglottic stenosis