Size of Endotracheal Tube and Neonatal Acquired Subglottic Stenosis

Abstract

Risk factors for acquired laryngotracheal stenosis in newborn infants are poorly known. The extreme scarcity of acquired laryngotracheal stenosis in young infants in France, compared with the published rate in the English literature, suggested that these patients may be treated in a different way in France. A prospective study was performed to analyze local features. Six-month multicenter inception cohort study. Seven neonatal intensive care units of referral centers in the area of Paris, France. A total of 247 intubated surviving neonates in a consecutive sample during 6 months. A file was completed with sex, birth weight, gestational age, underlying disease, and every feature concerning the intubation period and the outcome. All the collected data were compared with those available from previous studies in the English literature. After extubation, respiratory outcome was uncomplicated in 242 cases. The five patients with dyspnea were treated medically and recovered. A much higher rate of extubation difficulties was reported in the English literature. The rate of stenosis in this series was significantly lower than in previously reported studies. The differences between this and other series seem to be higher birth weights, shorter duration of intubation, and, most important, a smaller tube size (2.5 mm in neonates weighing less than 2500 g and 3.0 mm in those weighing 2500 g or more). Although this is a limited series and many unknown variables can differ from those in previous studies, the size of the endotracheal tube appears to be a major risk factor for acquired laryngotracheal stenosis in the neonate. Further studies seem necessary to point out additional factors.