NECROTIZING TRACHEOBRONCHITIS IN VENTILAT ED NEONATES

Background. - Necrotizing tracheobronchitis is a severe complication o bserved in some mechanically ventilated neonates. Case report 1. - A t win premature (GA = 31 weeks), weighing 1 500 g required oral endotrac heal intubation for mechanical ventilation because he suffered from re spiratory distress syndrome. He was given indomethacin on day 4 for pa tent ductus arteriosus. Progressive weaning of ventilation on day 9 wa s dramatically complicated by hypoxia, respiratory acidosis and right pneumothorax. Immediate endoscopy showed total obstruction of trachea by necrotic secretions the suction of which was followed by rapid impr ovement of the respiratory condition. Bacterial examination of secreti ons showed coagulase-negative staphylococcus. The patient was given st eroids + antibiotics. Prolonged ventilation resulted in bronchopulmona ry dysplasia and the patient was only extubated at week 12 after a nor mal endoscopic control. Case report 2. - A premature girl (GA = 32 wee ks), weighing 1 800 g required oral endotracheal intubation for mechan ical ventilation because she suffered from respiratory distress syndro me. The respiratory condition worsened on day 3, requiring tracheograp hy which showed distal tracheal obstruction. Immediate endoscopy showe d thin, adherent and necrotic membranes which were removed by suction. The patient was given steroids + antibiotics and was extubated on day 14 after a normal endoscopic control. Conclusions. - This iatrogeneou s complication must be recognized in a ventilated infant when the resp iratory condition dramatically worsens. Emergency bronchoscopy permits endotracheal suction of necrotic secretions.