Tertiary Referral Pediatric Hospital Research Articles

Treatment of Tracheomalacia with Aortopexy in Children in Glasgow

The aim of this study was to assess outcomes of infants and children undergoing aortopexy and to try and establish which children would derive the greatest benefit from this complex intervention. Materials and This is a retrospective case series in a pediatric tertiary referral hospital between 1993 and 2012. A case sheet review was performed to collect demographic data and identify outcomes for each child. The effects of the subtype of tracheomalacia, weight at surgery, symptoms at presentation, surgical approach, and preoperative ventilation were considered. There were 30 children who underwent aortopexy during the study period. Of the 30 children in the study, 21 children (70%) were male. The gestational age at birth ranged between 25 and 41 weeks (9 children [30%] were preterm). Age at surgery was between 2 and 140 weeks (mean; 31.5 weeks, median; 26 weeks). The onset of symptoms was between birth and 18 months (mean; 3.8 months, median; 3.5 months). The presenting symptoms were stridor (n = 9; 30%), failed extubation (n = 4; 13%), death attacks (n = 8; 27%), and cyanosis (n = 9; 30%). The underlying pathology was primary in 10 children (33%) and secondary in 18 children. The diagnosis was made by bronchoscopy in 26 children (93%). Imaging was performed in 25 children (83%). Aortopexy in our institution is performed by general pediatric surgeons (n = 8; 27%) and cardiothoracic surgeons (n = 22; 73%). In the immediately postoperative period, 25 children (83%) were thriving. Of the children that required another procedure; 1 child was reintubated (3%), 2 children had a tracheostomy (6%), 1 child had a stent (3%), and 2 children died (6%). Clinical follow-up of these children was between 1 month and 12 years. Long term, in 22 children (73%) were asymptomatic. There were no clinical predictors of outcome identified, but aortopexy is a safe effective procedure for children with severe tracheomalacia.

Benign Radiographic Coronal Synostosis After Sagittal Synostosis Repair

Whether cranial vault remodeling surgery for nonsyndromic, isolated sagittal suture synostosis affects the patency of initially normal, unaffected sutures is unknown. The influence of coronal and lambdoidal suture patency after cranial vault remodeling on the trajectory of subsequent cranial growth is also unknown. Disruption of normal sutural anatomy during cranial vault reconstruction could influence the incidence of secondary craniosynostosis and need for reoperation in a small proportion of these patients.We performed a retrospective review of patients younger than 1 year with nonsyndromic sagittal synostosis treated at a single tertiary referral pediatric hospital from September 2005 to January 2010 by an interdisciplinary team. Computed tomographic images obtained preoperatively, immediately postoperatively, and 2 years postoperatively were evaluated for the occurrence of secondary synostosis of initially nonsynostotic sutures. Craniofacial disorders clinic and ophthalmologic follow-up records were also analyzed for the occurrence of radiographic cranial restenosis, clinical or ophthalmologic signs of intracranial hypertension (ICH), and reoperation.Fifty-one patients younger than 1 year underwent primary surgical repair of isolated, nonsyndromic sagittal suture synostosis during the study period. Thirty-seven of these patients (71%) had completed 2-year clinical and radiographic follow-up by the time of analysis, constituting the study population. The average age at surgery was 5.4 months (range, 3.1-11.5 months). Thirty-three (89%) of the 37 study patients showed radiographic evidence of bilateral secondary coronal synostosis (SCS). Five patients (15%) additionally showed partial lambdoid synostosis. One patient with radiographic SCS (3%) required reoperation for radiographic cranial restenosis, clinical signs and symptoms of ICH, and papilledema first noted 1 year after primary cranial vault reconstruction.There is a high incidence of secondary coronal suture synostosis following cranial vault remodeling for isolated, nonsyndromic sagittal synostosis. Postoperative SCS was only rarely associated with secondary radiographic cranial stenosis, clinical or ophthalmologic signs of ICH, and the need for reoperation.

Ocular and systemic associations of against-the-rule astigmatism in children from tertiary ophthalmology clinic

Ocular and systemic associations of against-the-rule astigmatism in children from tertiary ophthalmology clinic

Perceived and actual paracetamol dosing in overweight and obese children

ObjectivesTo determine what dose of paracetamol a group of carers and pharmacists would administer to an overweight or obese child, and to observe the paracetamol doses administered to children that...

Hip pain in children with normal radiographs

Abstract: Introduction:An acutely painful hip in a child can be the presenting symptom in a number of conditions. One of the most important conditions of which is septic arthritis of the hip for which early diagnosis and treatment is essential. The focus of management in acute hip pain in a child is to rule out septic arthritis as the penalty for missing a diagnosis of septic arthritis of the hip in a child has serious consequences .The purpose of our study is to add to the available pool of data on hip pain, validate the predictive values published by preceding authors. We also hope that by presenting the breadth and scope of patients presenting with an acutely painful hip with normal radiographs, we can assist the physician in decision-making when confronted with this common diagnostic challenge. Methods: Retrospective review of all the patients who were admitted to our tertiary referral pediatric hospital with complains of hip pain and pain referable to the hip between January 1997 and December 2003. A total of 207 patients 162 patients with normal x-ray were reviewed retrospectively with evaluation of history, physical examination, laboratory studies. Patients whose diagnoses were defined as transient synovitis were made by the attending physician based on result of a combination of some or all of the Laboratory tests.( presence of fever, full blood count, Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) levels, negative blood culture, and effusion on ultrasound, and clinical picture of early resolution. Patients whose diagnoses were defined as septic arthritis or probable septic arthritis were made based on the findings of elevated ESR, CRP, positive blood culture or hip aspiration culture. Results: The 162 patients included 42 females and 120 males, with an age range from 6 months to 14 years. Of our cohort of patients admitted for hip pain, 111 patients were diagnosed as transient synovitis. 56 patients who were diagnosed as transient synovitis underwent ultrasound examination of the affected hip. 89.3% (50/56) had an effusion with a mean joint space thickness of 6.6mm. 10.7% (6/56) of the patients who underwent ultrasound examination had no demonstrable effusion. Conclusions: In patients with septic with hip pain and normal radiograph, the commonest diagnosis was transient synovitis comprising 67.9% of patients.Septic arthritis is the most important diagnosis to exclude and should be suspected if there is fever, inability weight bear and highly elevated levels of ESR and CRP needed

Benchmarking Pain Outcomes for Children with Sickle Cell Disease Hospitalized in a Tertiary Referral Pediatric Hospital

Painful vaso-occlusive crisis (VOC) is the most common reason for hospitalization in children with sickle cell disease. To benchmark pain outcomes in sickle cell disease, including process outcomes (eg, pain assessment and documentation practices, pain management interventions) and clinical outcomes (eg, pain intensity over hospital stay), to identify areas for improvement. A retrospective study was conducted on electronic charts of children hospitalized with a primary diagnosis of VOC between July 2007 and August 2008. A convenience sample of 50 admissions was used. In terms of clinical outcomes, patients presented to the emergency department with an initial median pain intensity of 9⁄10 (interquartile range 8⁄10 to 10⁄10). Forty-three per cent had not used opioids for pain relief at home. The mean (± SD) length of stay was 4.0±2.3 days. For most patients, median scores for highest daily pain intensity remained moderate to high throughout hospitalization, although scores did decrease significantly per day of hospitalization. In terms of process outcomes, pain intensity was assessed according to hospital standards on 25% of days in both the emergency department and the ward. There was no discrepancy between prescribed and administered opioid doses and medication use. In 95% of cases, strong opioid use was in a subtherapeutic or low therapeutic dosage range. The results showed three areas to target for improvement: improved pain assessment and documentation using valid pain tools; more aggressive multimodal management for peak VOC pain; and better education and support for pain management at home. Further studies are required to evaluate optimal pain treatment practices.

Predictive factors for difficult intravenous cannulation in pediatric patients at a tertiary pediatric hospital

It is generally believed that certain patient characteristics (e.g., Body Mass Index and age) predict difficulty of intravenous cannulation in children, but there is not much literature evaluating these risk factors. In this study, we investigated predictive factors for success rate at first attempt and time needed for intravenous cannulation. In a prospective cohort study, we observed characteristics of intravenous cannulations in pediatric patients at the operating room (n = 1083) and the outpatient care unit (n = 178) of a tertiary referral pediatric hospital. Time to successful intravenous cannulation, success at first attempt, and potential predictors for difficult cannulation (age, gender, skin color, BMI or weight-to-age z-score, the child being awake or anesthetized, operator profession and surgical specialty) were recorded. Regression models were constructed to find significant predictors. Success at first attempt was 73% and 81%, respectively. In the operating room age, operator and surgical specialty were predictive for a successful first attempt and time to successful cannulation. No significant predictive factors were found for the outpatient care unit. BMI or weight-to-age was not related to difficult intravenous cannulation. This study shows that in one-fifth to one-third of the patients, intravenous cannulation required more than one attempt. It is difficult to predict with accuracy the difficulty of intravenous cannulation solely with easily obtainable patient characteristics.

Predictors of postoperative complications in HIV-infected children undergoing surgery

BackgroundAn increasing number of HIV-infected children require a surgical procedure. The aim of this study was to investigate factors associated with the development of complications in HIV-infected children undergoing surgery. MethodsA prospective study of HIV-infected children younger than 60 months undergoing surgery at a tertiary referral pediatric hospital from July 2004 to July 2008 was performed. Children were followed postoperatively for the development of complications, length of stay, and mortality. ResultsEighty-two HIV-infected children, with a median age of 11.5 months (interquartile range, 6-24 months), were enrolled. Most (68; 82.9%) had World Health Organization stage 3 or 4 HIV disease, 72 (88%) had Centers for Disease Control and Prevention stage 2 or 3 disease, and 60 (73%) were taking highly active antiretroviral therapy. Half (41; 50%) were underweight, 37 (45.1%) underwent emergency surgery, 28 (34.2%) required major surgery, and 40 (48.7%) had surgical site contamination at the time of surgery. The median length of hospital stay was 4 days (interquartile range, 2-14 days), and in-hospital mortality was 6 (7%). Thirty-four (42%) children developed 37 complications. On univariate analysis, malnutrition, HIV stage, or type of surgery was not associated with development of complications. In contrast, young age (6 vs 13.5 months; P = .0004), low hemoglobin (9.6 vs 10.5 g/dL; P = .04), or having a major procedure (14 [42%] vs 9 [18%]; P = .03; relative risk, 2.2 [1.2-4.8]) was associated with complications. On logistic regression, younger age (odds ratio = 4.3; P = .004; 95% confidence interval, 1.6-11.9) and major surgery (odds ratio = 6.8; P = .001; 95% confidence interval, 1.5-31.4) were associated with development of a complication. ConclusionYoung age and major surgery were the main predicators of complications in HIV-infected children undergoing surgery.

Laryngotracheoplasty to Avoid Tracheostomy in Neonatal and Infant Subglottic Stenosis

To outline the authors' experiences with performing laryngotracheoplasty as an alternative to tracheostomy in neonates and infants with symptomatic subglottic stenosis (SGS). Case series with chart review. A tertiary referral pediatric hospital. Patients younger than 12 months undergoing single-stage laryngotracheoplasty for SGS at the authors' institution over a 3-year period. Ten patients (8 boys and 2 girls) underwent single-stage laryngotracheoplasty during the study period. There were 9 cases of acquired SGS and 1 case of congenital SGS. Eight patients had grade III SGS, and 2 patients had grade II SGS. In 9 of 10 patients, the procedure performed was an anterior cricoid split (ACS) and posterior cricoid split (PCS), with the placement of an anterior thyroid ala cartilage graft. One patient underwent ACS and PCS with the placement of a posterior rib cartilage graft, in combination with a right vocal cord lateralization. The mean period of intubation after surgery was 6.8 days (range, 5-9 days). Nine of 10 patients had a complete resolution of their airway symptoms following airway surgery, with a mean duration of follow-up of 305 days (range, 30-780 days). One patient required the placement of a tracheostomy tube 69 days postoperatively due to a failure to wean from ventilation in the setting of multiple comorbidities. Laryngotracheoplasty is a safe and effective alternative to long-term tracheostomy in infants and neonates with symptomatic SGS.

Abnormal Neuroimaging is Associated with Early In-Hospital Seizures in Pediatric Abusive Head Trauma

Abusive head trauma (AHT) is a common condition in children. Little is known in this condition regarding the frequency of seizures, the factors associated with increased risk of seizures, or the association of seizures with outcome. We sought to determine frequency and risks for in-hospital seizures after AHT. This was a single-center, retrospective chart review study at a 270 bed tertiary care referral pediatric hospital. A total of 54 cases of AHT were identified during the study period. During the first week following hospital admission, 33% of patients were observed to have clinical seizures. The occurrence of clinical seizures after admission was associated with findings on initial CT including midline shift, cerebral edema, and loss of gray white differentiation. MRI findings associated with clinical seizures after admission included midline shift, cerebral edema, infarction, and restricted diffusion. The presenting complaint of seizures or acute mental status changes well as a variety of abnormal imaging findings including gray white blurring, infarction, and edema were associated with short-term outcomes. Specific neuroradiologic findings identify children at greater risk for seizures, both clinical and subclinical, following AHT. Clinical and subclinical seizures are common in the initial hospitalization for AHT.

Tracheocutaneous fistula following paediatric tracheostomy—A 14-year experience at Alder Hey Children's Hospital

Objective: To assess the rate of tracheocutaneous fistula requiring surgical repair and the complications and outcomes following it in the ENT department of a tertiary referral university paediatric hospital. Methods: A retrospective review of all children requiring airway support with a tracheostomy between 1995 and 2009 and subsequently requiring closure of tracheocutaneous fistula. Results: One hundred and ninety-three children underwent 196 tracheostomies. Seventy-three children were successfully decannulated until now. Twenty-three children (11.9%) required subsequent surgical closure of their tracheocutaneous fistula. In all these children the age at tracheostomy was less than 1 year old, and the median age at decannulation was 4 years old, (range 2–9 yo). Surgical repair was undertaken 6–12 months after decannulation. There were 4 minor complications in the postoperative period (wound infection, haemorrhage and early recurrence) and no major complications. None of the patients have experienced any degree of significant airway stenosis and there was no need for a repeat tracheotomy in any of the tracheocutaneous fistula closure patients. The cosmetic results were deemed to be good. Conclusions: Our rate of tracheocutaneous fistula compares well with the reported rates in the literature (13–43%). There appears to be a significant relation to age at tracheostomy and duration of tracheostomy.

A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: A pediatric single center before/after study on a hemopoietic stem cell transplant ward

Some catheter-related bloodstream infections originate from catheter connectors; therefore, improved antisepsis of these might be expected to reduce the incidence of such infections. In this observational before/after study at a pediatric tertiary referral hospital, inpatients up to 16 years old undergoing hemopoietic stem cell transplants were studied. Catheter connection antisepsis was changed from 70% isopropanol alone to 2% chlorhexidine in 70% isopropanol. Numbers of catheter-related bloodstream infections before and after the change were monitored as were the numbers of catheter days experienced by patients. The infection rate before the change was 12 per 1000 catheter-days, and, following the change, this fell to 3 per 1000 catheter-days (P=.004). Similar falls followed the introduction of chlorhexidine to other wards. The introduction of chlorhexidine was followed by a profound, sustained fall in catheter-related infections. The results support the 2007 United Kingdom guidelines recommending 2% chlorhexidine in 70% isopropanol as a disinfectant of needleless connectors and hubs of central venous catheters.

Objective assessment of supraglottoplasty outcomes using polysomnography

Objective Supraglottoplasty is well documented as an effective procedure in the management of moderate to severe laryngomalacia. Traditionally assessed outcomes in the treatment of laryngomalacia include: reduced stridor, improved feeding and a resumption of weight-gain. Previous authors have documented the use of polysomnography in assessing the severity of paediatric laryngeal abnormalities. The aim of the current study was to objectively assess the efficacy of supraglottoplasty for laryngomalacia by comparing data from pre- and post-operative polysomnography. Methods A retrospective review was performed of patients undergoing supraglottoplasty for laryngomalacia at a tertiary referral paediatric hospital over a 35-month period. Patients were required to have undergone full overnight polysomnography both before and after supraglottoplasty. Pre- and post-operative polysomnographic results were compared and the statistical significance between mean values was determined. Results From a total of 46 patients, 10 were suitable for inclusion into the study. Mean age at first presentation was 2 months and 19 days (range 30–134 days). The surgical procedure performed was bilateral division of aryepiglottic folds alone in 1 patient (1/10), bilateral division of aryepiglottic folds and bilateral trimming of arytenoid mucosa in 5 patients (5/10) and bilateral aryepiglottic fold division, bilateral arytenoid mucosal trimming and epiglottic trimming or epiglottopexy in 4 patients (4/10). Statistically significant improvements occurred in mean values for Total Sleep Time (TST) ( P = 0.049), Lowest Oxygen Saturation Levels (SpO2 nadir) ( P = 0.006), Obstructive Apnoea Hypopnoea Index (OAHI) ( P = 0.009) and Respiratory Disturbance Index (RDI) ( P = 0.002), following supraglottoplasty. An improvement in mean Transcutaneous Carbon Dioxide (TcCO2) value occurred, but did not achieve statistical significance (57.1 vs. 52.8) ( P = 0.259). The mean age at which post-operative polysomnography confirmed a reversal of abnormal respiratory parameters following surgery was 5 months and 18 days. Conclusions Polysomnography is an effective method for objectively assessing the efficacy of supraglottoplasty for laryngomalacia. Supraglottoplasty effectively reverses the abnormal respiratory parameters occurring in moderate to severe laryngomalacia.

Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess

Objective Controversies remain regarding the management of orbital cellulitis (OC). The objective of this study was to examine the outcomes of patients admitted to our institution for orbital cellulitis during a 7-year period. Study Design Case series with chart review. Setting Tertiary referral pediatric hospital. Subjects and Methods Charts of 465 consecutive OC admissions were reviewed for presentation, imaging, medical and surgical treatment, and outcome. Results Of these patients, 189 were treated in the emergency room and 276 were admitted. CT scan was performed on 240 patients. Subperiosteal abscess (SPA) was noted in 68 patients. Of these, 47 were treated medically and 21 had surgery. Surgical patients were older (8.3 vs 6.2 years, P = 0.039), had larger abscesses (>10 mm, P < 0.001), required a longer admission (10.2 vs 6.6 days, P < 0.001), and had higher temperatures on admission (38.0°C vs 37.3°C, P = 0.03). Conclusion The majority of small SPAs as diagnosed on CT scans in younger children can be successfully treated medically. Surgery, however, should be considered for a worsening clinical examination. Our findings confirm those of previous reports on this clinical entity.

Intra-operative monitoring of cochlear function during cochlear implantation

The objective of this study was to determine if intra-operative auditory monitoring is feasible during cochlear implantation and whether this can be used as feedback to the surgeon to improve the preservation of residual hearing. This prospective non-randomised study was set in a paediatric tertiary referral hospital. Thirty eight consecutive paediatric patients undergoing cochlear implantation who had measurable auditory thresholds pre-operatively were divided into two cohorts. The unmonitored cohort included the first 22 patients and the monitored cohort included the last 16 patients. The main outcome measure(s) were pre-operative, intra-operative and more than one month post-operative average auditory thresholds at 500, 1000 and 2000 Hz measured using auditory steady-state response audiometry. The average pre-operative thresholds were 103.5 dB HL and 99.7 dB HL in the unmonitored and monitored cohorts, respectively. These were not statistically different (p > 0.3). In the monitored cohort, we measured auditory thresholds to assess cochlear function at multiple time points during the operation. Compared to baseline, thresholds were increased 0.7 dB after drilling the mastoidectomy and well, 0.2 dB after opening the cochlea and 4.6 dB after inserting the electrode array. One month post-operatively, the average thresholds were 114.0 dB HL in the unmonitored cohort but only 98.8 dB HL in the monitored cohort (p < 0.001). Both the use of intra-operative auditory monitoring and higher pre-operative thresholds were associated with improved preservation of residual hearing (p <or= 0.001). Intra-operative auditory monitoring is a viable tool that can provide real-time feedback to the surgeon during cochlear implant surgery. These data suggest that this can lead the surgeon to modify his or her surgical technique in ways that can improve the rate of long-term hearing preservation.

Paediatric allergic reactions in the emergency department: a review

Background:Allergic diseases are increasing in incidence worldwide and large numbers of children are now affected by allergy. Few studies have examined allergic reactions in children, particularly in the emergency department...

Estimating inspired oxygen concentration delivered by nasal prongs in children with bronchiolitis

The inspired oxygen concentration (FiO(2)) is an important criterion for assessing the severity of bronchiolitis. Oxygen delivery by nasal prongs is a measure of oxygen flow, but not FiO(2). We aimed to determine whether FiO(2) of oxygen delivered by nasal prongs could be predicted from nasal flow by relating arterial oxygen concentrations achieved with prongs to those achieved via head box in children with bronchiolitis. This is a pilot study conducted at a tertiary referral paediatric hospital. We studied hospitalised children less than 24 months old requiring supplemental oxygen because of bronchiolitis, an acute viral lower respiratory tract infection. Children admitted to the intensive care unit, and those with congenital cardiac disease or recent bronchodilator use were excluded. Subjects were studied in nasal prong, then head box oxygen. Arterial oxygen concentration was measured by a transcutaneous probe (tcPO(2)). Oxygen flows by nasal prongs and FiO(2) by head box were adjusted to achieve similar tcPO(2) readings. FiO(2) values were plotted against oxygen flow rates based on matching tcPO(2). We recorded tcPO(2) across a satisfactory range of values in eight children. TcPO(2) increased with increasing FiO(2) and nasal oxygen flow, but at variable rates between subjects. FiO(2) increased with increasing nasal oxygen flow, but this relationship was highly variable. In this study, it was not possible to estimate FiO(2) reliably from nasal oxygen flow rates in children with bronchiolitis. Nasal prong oxygen flow rates should be used with caution when assessing the severity of bronchiolitis in children.

Group A Streptococcal Isolates Temporally Associated with Acute Rheumatic Fever in Hawaii: Differences from the Continental United States

The annual incidence of acute rheumatic fever (ARF) in Hawaii has remained several times higher than that in the continental United States, particularly among ethnic Polynesians. The emm types of Streptococcus pyogenes that are associated with this nonsuppurative complication have, to our knowledge, not been previously reported in Hawaii. Patients with ARF were identified through an active surveillance system at Kapiolani Medical Center (Honolulu, HI), the only pediatric tertiary care referral hospital in Hawaii. Specimens were obtained by throat culture from patients who met the Jones criteria for ARF at the time of presentation (63 patients), prior to penicillin treatment, and from consenting family contacts (10 individuals). Eight patients and 2 close family contacts with positive throat culture results were identified from February 2000 through December 2005. Group A streptococci isolates were characterized by emm sequence typing. Unusual emm types were temporally associated with the onset of ARF. Emm types 65/69 (from 2 patients), 71, 92, 93, 98, 103, and 122 were isolated from the 8 patients with ARF, and emm types 52 and 101 were isolated from the 2 household contacts. So-called rheumatogenic emm types and/or serotypes, which were previously associated with ARF in the continental United States, were not found in this study. Instead, emm types that are not commonly included among group A streptococci isolates in the continental United States and that are seldom, if ever, temporally associated with ARF were identified. These findings suggest that unusual group A streptococci emm types play a significant role in the epidemiology of ARF in Hawaii.

CT in children with abdominal cancer: should we routinely include the pelvis?

It has been suggested that the pelvis should not be habitually included on abdominal CT examinations, but the potential benefit of such a practice in childhood abdominal malignancies is unknown. To estimate the yield and potential diagnostic benefit of abnormal findings on CT of the pelvis in children with malignant primary tumours in the upper abdomen. From a paediatric tertiary referral hospital we retrospectively included patients having abdominal CT for primary upper abdominal tumours (1997-2004), the scan range routinely including the pelvis. We reviewed and tabulated any pelvic abnormality, and calculated group proportions with 95% confidence intervals. We identified 230 children (2 days to 17 years old, median 2.9 years). Six (2.6%; 95% CI 0.5-4.7%) had abnormalities in the pelvis that would not have affected clinical management. Four (1.7%; 95% CI 0.1-3.4%) had findings that might have influenced staging, but only one was not detected by other modalities within 1 week of the CT. Our data suggest that diagnostically significant findings in the pelvis are rare; consequently, the habitual inclusion of the pelvis on abdominal CT for primary malignant tumours in the abdomen is not justified.

Laryngotracheal reconstruction in congenital laryngeal webs and atresias

To review the role of open laryngotracheal reconstruction (LTR) in congenital laryngeal webs and atresias. A retrospective chart review was undertaken in a specialist otorhinolaryngology unit in an academic tertiary referral paediatric hospital. Twenty-one patients with congenital laryngeal subglottic stenosis (SGS) underwent LTR between 1993 and 2003. Two groups were identified; one group had SGS alone (n = 6) and the other group had SGS associated with a laryngeal web (n = 15). Information recorded included presenting features, classification of lesion, surgery performed, and whether decannulation was achieved. All grades of stenosis (Myer-Cotton classification) and webs of type 2, 3, and 4 (Cohen's classification) were recorded. Fifteen patients had a staged reconstruction and 6 patients had a single-stage LTR. Complications included 2 revision procedures, 3 tracheocutaneous fistulas, and 1 death (cause unrelated). All appropriate patients were successfully decannulated at between 3 and 18 months post-LTR (median, 5 months). This series illustrates the effective role of open LTR in both congenital SGS alone and that in association with glottic webbing.