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Severe acquired subglottic stenosis in neonatal intensive care graduates: a case–control study
  1. Rebecca E Thomas1,2,
  2. Shripada C Rao1,2,
  3. Corrado Minutillo1,
  4. Shyan Vijayasekaran3,
  5. Elizabeth A Nathan4
  1. 1 Neonatal Clinical Care Unit, Princess Margaret Hospital for Children and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
  2. 2 School of Paediatrics and Child Health, Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
  3. 3 Department of Otolaryngology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
  4. 4 Biostatistics and Research Design Unit, School of Women’s and Infants’ Health, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Rebecca E Thomas, Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; becthomas73{at}


Objective To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates.

Design Retrospective case–control study.

Setting Sole tertiary children’s hospital.

Participants Patients who underwent surgical intervention for SASGS from January 2006 to December 2014. For each neonatal intensive care unit (NICU) graduate with acquired SASGS, two controls were selected (matched for gestation and year of birth).

Main outcomes and measures Incidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS.

Results Thirty-seven NICU graduates required surgical intervention for SASGS of whom 35 were <30-week gestation at birth. The incidence of SASGS in surviving children who had required ventilation in the neonatal period was 27/2913 (0.93%). Incidence was higher in infants <28-week gestation (24/623=3.8%) compared with infants ≥28-week gestation (3/2290=0.13%; p=0.0001). On univariate analysis, risk factors for SASGS were: higher number of intubations (4 vs 2; p<0.001); longer duration ventilation (16 vs 9.5 days; p<0.001); unplanned extubation (45.7% vs 20.0%; p=0.007); traumatic intubation (34.3% vs 7.1%; p=0.003) and oversized endotracheal tubes (ETTs) (74.3% vs 42.9%; p=0.001). On multivariate analysis, risk factors for SASGS were: Sherman ratio >0.1 (adjusted OR (aOR) 6.40; 95% CI 1.65 to 24.77); more than five previous intubations (aOR 3.74; 95% CI 1.15 to 12.19); traumatic intubation (aOR 3.37; 95% CI 1.01 to 11.26).

Conclusions SASGS is a serious consequence of intubation for mechanical ventilation in NICU graduates, especially in preterm infants. Minimising trauma during intubations, avoiding recurrent extubation/reintubations and using appropriate sized ETTs may help prevent this serious complication.

  • neonatology
  • anaesthetics
  • intensive care
  • ent
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  • Funding RET was the recipient of a Telethon (Western Australia) Research Fellowship to conduct research involving cuffed ETTs in neonates. This study was part of her Telethon fellowship training.

  • Disclaimer The funding source had no role in the design and conduct of the study; collection, management, analysis and interpretation of data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Ethics approval Princess Margaret for Hospital for Children Quality Improvement Commitee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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