Changing trends in neonatal subglottic stenosis

OBJECTIVES: To determine whether there are any changes in the incidence and management of neonatal subglottic stenosis (SGS). METHODS: A retrospective chart review of 416 infants who were admitted to t he neonatal intensive care unit of the Children's National Medical Center b etween July 1, 1995, and June 30, 1996, was carried out. The incidence of a irway obstruction requiring anterior cricoid split or placement of tracheot omy tube was determined and compared with the incidence studied 10 years ag o at the same institution. RESULTS: One of 416 neonates required surgical intervention for airway obst ruction caused by SGS, far an overall neonatal SGS incidence of 0.24%. When only the neonates who were intubated for 48 hours or longer were considere d, the incidence of SGS was 0.49% (1/204). In neonates who were intubated f or 48 hours or longer and survived, the incidence of SGS was 0.63% (1/160). This is in comparison with the incidences of 0.65% (3/462), 1.5% (3/195), and 1.9% (3/159), respectively, seen in a study done at the Children's Nati onal Medical Center 10 years ago. Five infants in this current study requir ed,placement of a tracheotomy tube for reasons other than SGS. Two infants needed tracheotomy tube placement for micrognathia, and 3 others for centra l hypotonia, an omphalocele that required multiple surgical procedures, and choanal atresia with a serious heart anomaly, which was a manifestation of CHARGE association. None of these 5 infants had evidence of SGS at rigid e ndoscopy preceding the tracheotomy tube placement. CONCLUSION: The incidence and management of neonatal SGS remain unchanged d uring this study period when compared with those of 10 years ago.