PT  - JOURNAL ARTICLE
AU  - Rebecca E Thomas
AU  - Shripada C Rao
AU  - Corrado Minutillo
AU  - Shyan Vijayasekaran
AU  - Elizabeth A Nathan
TI  - Severe acquired subglottic stenosis in neonatal intensive care graduates: a case–control study
AID  - 10.1136/archdischild-2017-312962
DP  - 2018 Jul 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F349--F354
VI  - 103
IP  - 4
4099  - http://fn.bmj.com/content/103/4/F349.short
4100  - http://fn.bmj.com/content/103/4/F349.full
SO  - Arch Dis Child Fetal Neonatal Ed2018 Jul 01; 103
AB  - 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.