NEW COMPLICATION OF ASSISTED VENTILATION IN THE NEONATE: STRICTURE AFTER NASOTRACHEAL INTUBATION

Abstract

The purpose of this paper is to report a potentially serious complication of nasotracheal intubation in the neonate, not previously reported. In our nurseries over the last 1½ years, 130 surviving infants received ventilatory support with a Bournes respirator and nasotracheal airway. Primary diagnosis was idiopathic respiratory distress syndrome (IRDS) in 98, meconium aspiration in 9, sepsis in 2, diaphragmatic hernia in 5, apnea in 3, post operative support in 13. Four infants developed unilateral nasal strictures. All weighed less than 1600 grams, were intubated in the first 4 days of life with 3.0 mm or 3.5 mm portex tubes, for duration of intubation 3, 3, 8 and 48 days respectively. Only one tube change was required and that in the 48 day baby. Etiology of the stricture is unknown. Three have been seen in follow up at 4 or 6 months; the involved nasal passageway was patent but very diminished in size. There have been no apparent problems associated with the strictures to date. These findings are particularly important to those using any form of ventilatory support involving both nares because development of bilateral nasal strictures in infants who are obligate nose breathers could potentially be lethal.