Primary Respiratory Diseases Research Articles

A Novel Standardized Method for Aiding to Determine Left Atrial Enlargement on Lateral Thoracic Radiographs in Dogs.

Left atrial enlargement indicates severe cardiac disease. Although the gold standard for determining left atrial size is echocardiography, many veterinary practices lack the necessary equipment and expertise. Therefore, thoracic radiography is often used to differentiate cardiogenic pulmonary edema from primary respiratory diseases and to facilitate distinguishing dogs with stage B1 and B2 mitral valve degeneration. The goal was to test a new standardized method for identifying radiographic left atrial enlargement. On a lateral radiograph, a straight line was drawn from the dorsal border of the tracheal bifurcation to the crossing point of the dorsal border of the caudal vena cava and the most cranial crus of the diaphragm. If a part of the left atrium extended this line dorsally, it was considered enlarged. Echocardiographic left atrial to aortic ratio (LA:Ao) was used as a reference. Thirty-nine observers with various levels of experience evaluated 90 radiographs, first subjectively, then applying the new method. The new method moderately correlated with LA:Ao (r = 0.56-0.66) in all groups. The diagnostic accuracy (72-74%) of the subjective assessment and the new method showed no difference. Though the new method was not superior to subjective assessment, it may facilitate learning and subjective interpretation.

AN EFFECTIVE ACTION RECOGNITION APPROACH USED IN PHYSICAL EXERCISE FOR COPD PATIENTS

This study was conducted to evaluate the effect of computer vision-based respiratory rehabilitation. Chronic obstructive pulmonary disease (COPD) is one of the primary respiratory diseases worldwide. Recently, image-capturing devices are increasingly used for physical therapy during rehabilitation treatment. Among these technologies, Action recognition plays a critical role in physical exercise and rehabilitation evaluation. This study aimed to propose an action series of a respiratory training program consisting of six actions. A video camera was placed in front of the participants to record their movements. Then, a hybrid algorithm combined with a convolution neural network and long short-term memory models was employed for action recognition from a video recording. The results indicated that the model achieved a reliable classification level of 82.35% on six actions. This demonstrated the validity of the proposed approach for multi-category action recognition. It was effective for action evaluation without medical guidance under home-based rehabilitation. Furthermore, the model for weight estimation was light-weight, with no need to consider the processing time.

Clinical impact of obesity on respiratory diseases: A real-life study.

Background:Obesity has become an epidemic that affects Mexico; significantly interferes with respiratory physiology by decreasing lung volumes, therefore, might be considered as a relevant risk factor associated with the development of respiratory diseases.Objective:Our primary outcome was to analyze the frequency and risk factors between obesity and respiratory disease in the Mexican population.Materials and Methods:An observational, single-center, descriptive study, which included the totality of patients who were referred for medical attention at the Respiratory and Thorax Surgery Unit at the Hospital Regional de Alta Especialidad de la Península de Yucatán during the period from January 2015 to December 2018. The cases were grouped based on the existence or not of respiratory disease and the presence or absence of obesity (body mass index [BMI] >30 kg/m2).Results:A total of 1167 patients were included; about 39% of the population had average BMI 36.5 kg/m2. The primary respiratory diseases in obese patients were Obstructive Sleep Apnea Syndrome (OSAS, 19%) and asthma (15%). The logistic regression analysis showed a direct association between the presence of obesity with respiratory disease (odds ratio 1.58, 95% confidence interval 1.22–2.03, P < 0.001), the strength of this association was related with asthma and OSAS.Conclusion:The presence of obesity is an independent risk factor for respiratory disease, primarily for OSAS and asthma.

A multidisciplinary chronic lung disease team in a neonatal intensive care unit is associated with increased survival to discharge of infants with tracheostomy.

ObjectiveTo determine if multidisciplinary team-based care of severe BPD/CLD infants improve survival to discharge.Design/methodsRetrospective review of severe BPD/CLD infants cared for by dedicated multidisciplinary CLD team using consensus-driven protocols and guidelines.ResultsTotal of 267 patients. Median gestational age was 26 weeks (IQR 24, 32); median birth-weight was 0.85 (IQR 0.64, 1.5). Twenty-four percent were preterm with severe BPD, 46% had other primary respiratory diseases (none BPD diseases). Total number of patients, proportion of patients with tracheostomy, prematurity, and genetic diagnoses increased over time. 88.8% survived to discharge. Unadjusted logistic regression showed that tracheostomy was not associated with odds of death; secondary pulmonary hypertension was associated with odds of tracheostomy (OR = 1.795 p value = 0.0264), or death (OR = 8.587 p value = <0.0001), or tracheostomy + death (OR = 13.58 p value = 0.0007).ConclusionsOver time, mortality improved for infants with tracheostomy cared for by a multidisciplinary severe BPD/CLD team. Secondary pulmonary hypertension was associated with tracheostomy, or death, or tracheostomy + death.

English

This survey explored the ethnobotanical uses of selected medicinal plants; Adiantum raddianum C. Presl. (Pteridaceae), Lippia alba (Mill.) N. E. Brown (Verbenaceae) and Coronopus didymus (L.) Sm. (Brassicaceae) used for respiratory diseases in Southern Santa Catarina (Brazil). This is timely as the incidence of respiratory disease is increasing in this state. Information was obtained through both interviews using a semi-structured questionnaire administered to 368 people and evaluation of published literature on these plants from scientific peer reviewed journals. The age profile of participants ranged from 20 to over 89 years, with females representing 75% of interviewees. Regarding their use of the medicinal species, 53% reported being users of one of the three plants. Approximately, 52% of users preferred to utilize L. alba, 40% C. didymus and 8% A. raddianum. The primary respiratory diseases reported for use by the plants included&nbsp;&nbsp; cough, flu or cold, lung disorders, bronchitis and asthma. There was also more scientific literature available to support the use of L. alba for treatment of respiratory diseases. This study contributes to the documentation of the medicinal and popular uses of L. alba, C. didymus and A. raddianum in Southern Brazil, in ways that respect and support their conservation. Further studies are warranted to evaluate the biochemical and pharmacological activities of C. didymus and A. raddianum. Key words:&nbsp; medicinal plants, Coronopus didymus, Adiantum raddianum, Lippia alba, respiratory problems, ethnobotanical survey.

The impact of outdoor air pollutants on outpatient visits for respiratory diseases during 2012\u20132016 in Jinan, China

BackgroundFew studies have investigated the associations between outdoor air pollution and outpatient visits for respiratory diseases (RDs) in general population.MethodsWe collected daily outpatient data of primary RDs from five hospitals in Jinan during January 2012 and December 2016, as well as daily measurements of air pollutants from the Jinan Environmental Monitoring Center and daily meteorological variables from the China Meteorological Data Sharing Service System. A generalized additive model (GAM) with quasi-Poisson regression was constructed to estimate the associations between daily average concentrations of outdoor air pollutants (PM2.5,PM10, SO2, NO2, CO and O3) and daily outpatient visits of RDs after adjusting for long-time trends, seasonality, the “day of the week” effect, and weather conditions. Subgroup analysis stratified by gender, age group and the type of RDs was conducted.ResultsA total of 1,373,658 outpatient visits for RDs were identified. Increases of 10 μg/m3 in PM2.5, PM10, NO2, CO and O3 were associated with0.168% (95% CI, 0.072–0.265%), 0.149% (95% CI, 0.082–0.215%), 0.527% (95% CI, 0.211–0.843%), 0.013% (95% CI, 0.003–0.023%), and 0.189% (95% CI, 0.032–0.347%) increases in daily outpatient visits for RDs, respectively. PM2.5 and PM10 showed instant and continuous effects, while NO2, CO and O3 showed delayed effects on outpatient visits for RDs. In stratification analysis, PM2.5 and PM10 were associated with acute RDs only.ConclusionsExposure to outdoor air pollutants including PM2.5, PM10, NO2, CO and O3 associated with increased risk of outpatient visits for RDs.

ДИНАМИКА И РЕГИОНАЛЬНЫЕ ГРАДИЕНТЫ ЗАБОЛЕВАЕМОСТИ НАСЕЛЕНИЯ БОЛЕЗНЯМИ ОРГАНОВ ДЫХАНИЯ НА ТЕРРИТОРИИ ДАЛЬНЕВОСТОЧНОГО ФЕДЕРАЛЬНОГО ОКРУГА

There was done analysis of epidemiological monitoring of respiratory diseases (RD) on the territory of the Far Eastern Federal District (FEFD), which allows to assess the levels, structure and regional features of the spread of pathology among different populations and territorial formations, the dynamics of the disease and its relationship with the environmental factors of the region. To organize the study, the methods of cluster, structural and comparative analysis, predictive modeling, dynamic series analysis, statistical and information-analytical methods, databases of the Ministry of Health of the Russian Federation, the Federal State Statistics Service of the Russian Federation were used.&#x0D; The epidemiological analysis of the main indicators of RD level and dynamics in the FEFD territory indicates the presence of regional differences in the registered morbidity, the degree of which is due to the natural-climatic and socio-demographic characteristics of the habitat. 77.8% of the region's subjects are in the zone of low morbidity. At the same time, the values of maximum and minimum levels of general and primary RD morbidity in the region differ by 2.2 and 2.4 times, respectively, becoming the most pronounced among the adult population (by 3.6 times). In chronic bronchitis and COPD, the regional gradients of the registered morbidity are 10.9 and 9.8 times, respectively. It was found that the values of the primary RD morbidity in children's population in the FEFD are 14.4% higher than at the federal level, and among the adult population the gradient of values has the opposite indicators: 24.9% lower. At the same time, if the incidence of pneumonia in the region is 15.2% higher than the incidence of pneumonia in the Russian Federation as a whole, the incidence of chronic forms of RD in the region is 17.3-28.9% lower than at the federal level.&#x0D; The level of primary RD morbidity in 2005-2016 in the Far Eastern Federal District increased by 23.3%, including bronchial asthma (by 20.3%) and COPD (by 47.7%), and the incidence of pneumonia significantly decreased. At the same time, the average annual rate of increase in primary RD morbidity is higher than in the Russian Federation as a whole. This is shown by the predictive model of morbidity dynamics, the linear trends of which are more progressive in the FEFD compared to the dynamics at the federal level. The rate of positive dynamics of morbidity, significantly exceeding the same rate of morbidity growth at the federal level, indicates an increase in the level of availability and quality of medical care for patients with pulmonological profile, timely and early detection of chronic forms of respiratory diseases, positive motivation of the population for treatment in medical organizations. These trends in the dynamics of the registered morbidity are due to the active introduction of effective methods of diagnosis and treatment of chronic respiratory diseases, preventive and educational programs implemented both at the federal and regional level.

079 OUTCOMES EVALUATION OF PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION WITH CONCOMITANT CONTINUOUS RENAL REPLACEMENT THERAPY

Category: RRT Applications and Targeted Interventions Presenter: Mr PETER CHI KEUNG LAI Keywords: Extracorporeal Membrane Oxygenation, Concomitant Continuous Renal Replacement Therapy Patients on Extracorporeal Membrane Oxygenation (ECMO) often have acute kidney injury or fluid overload requiring Continuous Renal Replacement Therapy (CRRT). There was evidence that ECMO patient requiring CRRT had higher mortality due to increased severity of illness, but it is uncertain how CRRT affects outcomes of ECMO patients. To explore the characteristics of ECMO survivors who underwent concomitant CRRT. Retrospective chart review of 27 adult ECMO patients with CRRT in a university-affiliated hospital in 2015 - 2016. 12 patients had veno-venous ECMO and 15 had veno-arterial ECMO. Indications for ECMO were hypoxemic respiratory failure refractory to conventional therapy, cardiogenic shock associated with myocardial infarction, myocarditis and cardiac arrest. Mean age was 49.4±14.8 years. 9 ECMO-CRRT patients survived and 18 died. There were more patients with primary respiratory diseases in survivor group (77.8% vs 17.8%, p=0.01). Similar findings were observed between survivors and non-survivors for ECMO blood flow rate (3.96±0.56 vs 3.5±0.6, p=0.06), ECMO duration (16.7±14.1 vs 13.8±16.1, p=0.64) and length of stay in intensive care unit (ICU) (29.3±25.6 vs 15.0±17.0, p=0.16). CRRT-ECMO configuration was the same for all cases, except for one case in which CRRT was conducted with non-tunneled dialysis catheter. Indications for CRRT treatment included acute kidney injury, fluid overload and metabolic disturbance. 23 patients received systemic ECMO anticoagulation with unfractionated heparin infusion at 12-18unit/kg/hour while 4 patients in non-survivor group received regional citrate anticoagulation for CRRT. Baseline creatinine before CRRT was 327.7±233.9umol/L and percentage creatinine change was 41.4±21.2%. CRRT treatment hours (151.6±191.1 hours), total fluid removal with CRRT (12.9±18.1 liters) and number of hemofilter change (5.0±4.6) were not associated to increase in mortality. In this series of 27 patients managed with ECMO and concomitant CRRT in an adult ICU, survival to ICU discharge was 33.3%. Mortality risk was increased in patients with circulatory failure but not it was not associated with CRRT treatment modality.

Avaliação endoscópica do sistema respiratório de bovinos sadios

O presente trabalho apresenta um estudo retrospectivo das endoscopias respiratórias realizadas em bovinos machos com dois dias a dois anos de idade, na Clínica de Bovinos e Pequenos Ruminantes da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, visando ao estabelecimento de um padrão de normalidade para esse exame em bovinos. Foram utilizados 45 animais submetidos em média a sete exames endoscópicos cada, totalizando 321 procedimentos. Foi observado todo o trato respiratório quanto à coloração e aparência das mucosas, presença ou não de secreção, edema e congestão, além do comprimento do aparelho respiratório e das suas características anatômicas. Essas informações auxiliam no diagnóstico, no tratamento e no estudo das principais doenças respiratórias que acometem os grandes animais. Além disso, por tratar-se de um exame que envolve tecnificação, ele deve ser adaptado à rotina para o fornecimento de informações seguras na justificativa da relação custo/benefício da técnica.

Domiciliary noninvasive positive airway pressure therapy in children.

There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.

Differentiating Nonrestorative Sleep from Nocturnal Insomnia Symptoms: Demographic, Clinical, Inflammatory, and Functional Correlates

Recent studies have suggested that nonrestorative sleep (NRS) symptoms may be distinct from nocturnal insomnia symptoms (NIS). However, there is limited information on the demographic, medical, and biologic correlates of NRS independent from NIS in the general population. This report presents the sociodemographic correlates, patterns of comorbidity with other sleep and physical disorders, C-reactive protein (CRP) levels, and general productivity associated with NIS and NRS in a nationally representative sample of US adults. National Health and Nutrition Examination Survey (NHANES). The 2005-2008 surveys of the general population in the United States. There were 10,908 individuals (20 years or older). N/A. Respondents were classified by the presence or absence of NIS and NRS. Compared with those without insomnia symptoms, respondents with NIS were older and had lower family income and educational levels than those with NRS. In addition, there was a significant association between NIS and cardiovascular disease, whereas NRS was associated with other primary sleep disorders (including habitual snoring, sleep apnea, and restless legs syndrome), respiratory diseases (emphysema and chronic bronchitis), thyroid disease, and cancer as well as increased CRP levels. In addition, the study participants with NRS only reported poorer scores on the Functional Outcomes of Sleep Questionnaire (FOSQ) than those without insomnia symptoms or those with NIS only. These findings suggest that there are substantial differences between NIS and NRS in terms of sociodemographic factors, comorbidity with other sleep and physical disorders, increased CRP level, and functional impairment. An inflammatory response might play a unique role in the pathogenesis of NRS.

EPIDEMIOLOGICAL ASPECTS OF PNEUMONIA IN CHILDREN OF PERM TERRITORY

Aim. To estimate a long-term dynamics of pneumonia morbidity among children aged 0–14 years in Perm Territory. Materials and methods. A long-term dynamics (1995–2010) of primary morbidity among children aged 0–14 years in Perm Territory was estimated on the basis of statistical data on the registered cases. The data concerning Perm Territory, Privolzhsky Federal District and the Russian Federation were compared. The obtained data proved increase in primary pneumonia morbidity rate in Perm Territory from 10,6 to 15,6% for 16 years. Results. Analysis of primary morbidity dynamics for 15 years detected 1,9-fold growth in prevalence of respiratory diseases and 1,6 – of pneumonia. The mean growth rate was 6,14, annually. Conclusion. Growth of pneumonia morbidity occurred against the background of increased general rate of primary respiratory diseases, with 18,6% reduction in the share of pneumonias in their structure. Pediatric morbidity indices in the region 1,5–2-fold exceed the mean rate in the Russian Federation and Privolzhsky Federal District.

Bronchial and alveolar airway nitric oxide levels in primary ciliary dyskinesia and other respiratory diseases

Background Patients with primary ciliary dyskinesia (PCD) have abnormal ciliary function and low nasal nitric oxide (nNO) and fractional exhaled NO (FeNO). Nitric oxide (NO) biosynthesis is dependent on nitric oxide synthases (NOS). Cilia line the bronchial but not the alveolar epithelium. It has been hypothesised that NOS function relies on normal ciliary function and that in PCD bronchial (JNO) but not alveolar (CalvNO) NO might therefore be reduced. The aim of this study was to compare JNO and CalvNO in children with PCD, cystic fibrosis (CF), asthma and healthy subjects.

Development and disease of the photoreceptor cilium

Primary cilia are microtubule-rich hair-like extensions protruding from the surface of most post-mitotic cells. They act as sensory organelles that help interpret various environmental cues. Mutations in genes encoding proteins involved in ciliogenesis or protein transport to the primary cilia lead to a wide variety of diseases commonly referred to as ciliopathies,which include primary ciliary dyskinesia, situs invertus, hydrocephalus, kidney diseases, respiratory diseases, and retinal degenerations. In the retina, the photoreceptor cells have a highly specialized primary cilium called the outer segment (OS), which is essential for photosensation. Development of the photoreceptor OS shares key regulatory mechanisms with ciliogenesis in other cell types. Accumulating evidence indicates that mutations that affect OS development and/or protein transport to the OS generally lead to photoreceptor degeneration, which can be accompanied by a range of other clinical manifestations due to the dysfunction of primary cilia in different cell types. Here, we review the general mechanisms regulating ciliogenesis, and present different examples of mutations affecting OS ciliogenesis and protein transport that lead to photoreceptor degeneration. Overall, we conclude that the genetic and molecular evidence accumulated in recent years suggest a clear link between the development and function of the primary cilium and various clinical conditions. Future studies aimed at uncovering the cellular and molecular mechanisms implicated in ciliogenesis in a wide variety of animal models should greatly increase our understanding of the pathophysiology of many human diseases, including retinal degenerations.

Zbrinjavanje pacijenata u okviru rada terenske službe Doma zdravlja

General practision in addition to ambulance work, and triage also takes care of patients with acute health disorders which are not capable to come to see md (medical doctor). Triage is done via phone, and md is seeing patients in their homes. Health disorders which are accepted as needable to intervene are; I. Respiratory disabilities, due to primary respiratory disease, in bronchial asthma, or as part of other medical. Respiratory disorders may be due to respiratory infections or egzacerbation of primary respiratory diseases. Also, malign neoplasma can in certain stadium take to respiratory distress. Therapy is modulated according to cause of disorder. In case of respiratory infection therapy would be antibiotics, and in other cases either simptomatic, or corticosteroides. II. Chest pain, most important to determine cause of pain. Pain could be cardial origin, respiaratory, gastrointestinal, or due to degenerative process in spine. Here the most important is pain due to AIM (acute miocardial infarction), hense this patient needs to be very carefully examined. If cause of pain is AIM patient needs to be stabilised, and as soon as possible transport to specialized hospital. III. Nausea and vomitus, also very important is do determine cause. This could be in different kind of poisoning (food, drug and others), further in AIM of inferior part, hypertensial crisis, increased intracranial pressure (due to dohemmorhage, tumor, or trauma), in migraenous attack and quite benign response to stress. IV. Hypertensive attack. Due to irregular drug intake, progressive cardiomyopathy, or comorbidithy, especially dangerous for elderly hence advanced arteriosclerosis. V. Increased body temperature in viral, bacterial infections, also in chronicle diseases. Therapy is modulated according to origin. If bacterial antibiotics are needed, if not then symptomatic. VI. Pain related with different medical entities. As such it often can be mistaken for some other entity. This is very important in pain therapy because if we don't threat cause of pain, all we have is symptomatic therapy available. Apart from prehospital managing of the patients, it also includes triage which patients are safe to continue house treatment, and for which is further diagnostic, or hospital management needed.

Recurrent pneumonia caused by genetic immunodeficiency: a prophylactic and rehabilitative approach

Recurrent infections are a consequence of a series of genetic diseases characterized by deficiency in the immunological response. One of these diseases is the agammaglobulinemia, which is characterized by the basic defect in the maturation of lymphocytes B. The carrier of this kind of immunodeficiency, which is linked to the X (XLA) chromosome, has had primary pneumonias that have evolved into secondary pneumonias (chronic lungs with sequelae) after the third or fourth year of life. The clinical and rehabilitative quest for prophylaxis against the XLA immunodeficiency is accomplished in order to avoid the evolution of the bacterial infection into sequelae and loss of pulmonary function, which propitiates the recurrence of the disease and deteriorates the life quality of the patient. Forty cases of recurrent respiratory infections were studied. Some of them were associated with primary respiratory diseases without investigation of serum immunoglobulins and some were not. Casuistics was performed according to data from medical records with pertinent treatments collected from January 1997 to September 2004 at the Specialized Physiotherapy Center. Age average was 2.7 years of life. It is statistically impossible to precise results concerning only the immunosuppressed patients due to the lack of specific diagnosis. That is explained by the fact that recurrent XLA pneumonias may be attributed to the gastroesophageal reflux disease or to bronchial asthma. However, the improved results showed by the pulmonary function as preventive strategy were attributed to the respiratory physiotherapy, since intravenous immunoglobulin replacement therapies were not performed. Respiratory physiotherapy acts as a supportive factor in the healing process and occupies a fundamental role in the prophylaxis against recurrent respiratory clinical features, especially those of obstructive and secretionary characteristics.

Concentration- and time-dependent upregulation and release of the cytokines MIP-2, KC, TNF, and MIP-1alpha in rat alveolar macrophages by fungal spores implicated in airway inflammation.

Inhalation of fungal spores has been shown to cause primary or secondary infection and respiratory inflammation and diseases such as allergic alveolitis, atopic asthma, and organic dust toxic syndrome, which are rarely reported in the absence of predisposing factors. Biochemical and molecular markers of inflammation were measured in rat bronchial alveolar lavage cells (> 95% macrophages) following stimulation with fungal spores isolated from pathogenic and nonpathogenic fungi that have been implicated in airway inflammation. The results of this study demonstrate that mRNA transcripts for the C-X-C branch of the PF4 superfamily are differentially upregulated over those of the C-C mediators in a time- and concentration-dependent manner. Macrophage inflammatory protein (MIP)-2 and KC were differentially upregulated over the acute phase inflammatory cytokines MIP-1alpha and tumor necrosis factor-alpha (TNF-alpha) in rat alveolar macrophages stimulated with fungal spores from Aspergillus candidus, Aspergillus niger, Eurotium amstelodami, and Cladosporium cladosporioides. Spores from Aspergillus terreus and Penicillium spinulosum failed to stimulate an increase of any cytokine mRNA, whereas those from Aspergillus fumigatus stimulated the upregulation of MIP-2, KC, TNF-alpha, and MIP-1alpha mRNAs. Over time, A. fumigatus stimulated increasing KC production until 24 h, when production levels increased slightly, then leveled off when measurements ceased at 36 h. Latex spheres stimulated modest amounts of MIP-2 and transforming growth factor-beta only. These observations suggest that the inflammatory cytokines MIP-2 and KC may be involved in the inflammation arising from the inhalation of fungal spores in a time- and concentration-dependent manner.

Injuries to the neonatal larynx from long-term endotracheal tube intubation and suggested tube modification for prevention.

Since the early 1960's nasotracheal tubes have been used for neonates with primary respiratory diseases which necessitated positive pressure ventilation. This therapy may be required for extended periods of weeks to months meaning prolonged trauma to the neonatal larynx. The initial injury and long-term effects of the endotracheal tube in this age group have not been adequately investigated. The acute findings can be arytenoid and posterior commissure ulcerations and, in some cases, cartilage erosion. Long-term follow-up in these children to age 3.5 years showed a persistent arytenoid defect with chronic hoarseness. The consideration of a change in the structure of the endotracheal tube is suggested as a possible means of avoiding these injuries.