ACQUIRED SUBGLOTTIC CYSTS IN THE LOW-BIRTH-WEIGHT INFANT - CHARACTERISTICS, TREATMENT, AND OUTCOME

Objective.-To provide a descriptive summary of characteristics, includ ing demographics, symptoms, risk factors, and outcome of acquired subg lottic cysts identified in the neonatal period. Design.-Patient series . Setting.-A tertiary neonatal care unit and referral neonatal follow- up clinic.Participants.-One hundred seventy-four preterm infants under going flexible bronchoscopy, 21 (12%) referred for airway evaluation b ecause of symptoms and 153 (88%) examined consecutively following 7 da ys or more of endotracheal intubation. Intervention.-None. Measurement s/Results.-Subglottic cysts were identified in 11 (7.2%) of 153 preter m infants examined prospectively at discharge from the neonatal intens ive care unit after prolonged intubation and two (10%) of 21 infants r eferred for airway evaluation. Infants with subglottic cysts were extr emely preterm (mean+/-SEM gestation, 26.7+/-0.5 weeks) and very low bi rth weight (894.6+/-64.6 g). The mean duration of intubation was 28.5/-5.0 days. Most infants, particularly those with large cysts, were sy mptomatic with stridor, hoarseness, or obstructive apnea. In two cases , airway symptoms began after discharge from the neonatal intensive ca re unit. Ten (91%) of the 11 patients were discharged receiving home o xygen. Generally, multiple cysts were present in the subglottic space, most prominently located in the posterior aspect of the trachea. Thre e of five patients with large cysts received a tracheostomy. Two addit ional patients had surgical marsupialization of the cysts, and six oth ers experienced resolution without treatment. One patient with large c ysts died of viral pneumonia 10 months after surgical intervention. An additional patient with large cysts died before surgical intervention secondary to chronic lung disease and cor pulmonale. All surviving in fants had resolution of signs of airway obstruction and 10 of the 11 d id not require supplemental oxygen or have symptoms of chronic pulmona ry disease at age 1 year. Conclusion.-Intubation-acquired subglottic m ucous cysts in the neonate may occur more commonly than was previously recognized. Symptoms of this lesion may mimic features of chronic lun g disease. Early identification of the cysts with flexible bronchoscop y is important since airway compromise may progress and surgical inter vention may be lifesaving.