Statement on the care of the child with chronic lung disease of infancy and childhood.

Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation

Objective/Hypothesis: Neonatal subglottic stenosis is a known entity arising from endotracheal tube intubation. In the 1970s and 1980s, estimates of the incidence of subglottic stenosis were in the range of 0.9% to 8.3% of intubated neonates. Because of improved techniques of handling neonates who require ventilatory support, we thought the actual incidence of neonatal subglottic stenosis in the late 1990s was much lower. Study Design: We retrospectively reviewed all neonatal intensive-care unit (NICU) admissions from 1997 at our institution, which serves as a level 3 NICU. We also performed a MEDLINE search of the reported incidence of neonatal subglottic stenosis between 1960 and 1999. Methods: Analysis was performed to identify all children who developed subglottic stenosis at our institution. Data were also collected and analyzed with regard to average gestational age, average birth weight, average duration of intubation, and the number of children requiring tracheostomy. The reports identified in the literature were reviewed as to the incidence of subglottic stenosis. Results: A total of 544 neonates were admitted to the unit. Of these, 281 were intubated for an average of 11 days. No patients developed subglottic stenosis. Three patients required tracheostomies for other reasons. All studies published after 1983 reported an incidence of neonatal subglottic stenosis as less than 4.0%, and all studies published after 1990 reported an incidence of neonatal subglottic stenosis as less than 0.63%. Conclusions: Although our report applies to only a single institution in a single year, after reviewing the literature we think a downward trend exists in the incidence of neonatal subglottic stenosis in the late 1990s. The current incidence of neonatal subglottic stenosis is likely between 0.0% and 2.0%.

Neonatal subglottic stenosis--incidence and trends.

Blood pressure measurements in the newborn.

Objective:To identify the goals and methods for medical education about end-of-life care in the intensive care unit (ICU).Data Sources and Study Selection:A status report on palliative care, a summary report of recent research on palliative care education, articles in the medical literature on end-o

Incorporating palliative care into critical care education: principles, challenges, and opportunities.

• In the six-year period from 1975 through 1980, acquired subglottic stenosis was recognized in eight patients during the first year of life who survived intubated mechanical ventilation as newborn infants. Seven of eight cases occurred in infants who weighed less than 1,500 g at birth. This complication was not seen in the first three years of the review, when only nasotracheal intubation was practiced. In the second three years, orotracheal intubation was the predominant practice. Seven infants required tracheostomy and the outcome was poor: none has undergone decannulation and three have died. Recognition of this disorder as a cause of inability to extubate the very-low-birth-weight infant is stressed. (Am J Dis Child1983;137:40-43)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=PEDS&articleId=510767&pdfFileName=archpedi_137_1_013.pdf

Acquired subglottic stenosis in the very-low-birth-weight infant.

• Despite impressive improvements in outcome for infants cared for in neonatal intensive care units (NICUs), large tertiary-care referral units still admit a substantial number of infants who will not survive or, because of a predictably very poor outcome, should not be offered modern life-support techniques. Dealing with these infants can be extremely taxing on both the family and the staff. We have recently adapted the concepts first described in adult hospice care to the care of the dying neonate and his family. By providing a "Family Room" that is private yet close to the NICU and by training the staff in more supportive approaches toward these families, we have been able to deal with the problem of the dying newborn in a manner that has been beneficial to both families and staff. (Am J Dis Child1982;136:421-424)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=peds&articleId=510448&pdfFileName=archpedi_136_5_009.pdf

The application of hospice concepts to neonatal care.

The systolic, diastolic, and pulse pressures of 34 infants weighing less than 1200 g, who required mechanical ventilation for hyaline membrane disease, were prospectively evaluated in the first week of life and related to the magnitude of ductal shunting Seventeen infants developed a large patent ductus arteriosus (PDA) corresponding to significant left-to-right ductal shunting and requiring surgical ligation By the second day of life these patients with large PDAs had significantly lower mean systolic and diastolic BPs than the non-PDA infants There were no significant differences in pulse pressures between groups Both systolic and diastolic BPs promptly returned to control values after ligation A mean diastolic BP less than 28 mm Hg on the third day of life was significantly associated with a PDA in 93% of patients

Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant

A total of 162 episodes of ATL occurred in 58 of 166 consecutive infants ventilated for HMD with the Baby Bird infant ventilator. 48 of 73 infants 1500 grams survived. In 10 patients ATL occurred during intubation only (Type I); in 19, both during intubation and after attempted extubation (Type II); and in 29, after attempted extubation only (Type III). The incidence of ATL was significantly (P 1500g (Group B)). Type II was frequent in Group A (17/34), whereas Type III was more common in Group B (19/25). The most important variable was the length of time of intubation. ATL was extremely rare in either Group if initial intubation was 14 days (89 episodes). “Initial” intubation is contrasted with re-intubation for respiratory distress consequent to atelectasis. One or more re-intubations were necessary in 16 of 34 infants in Group A and 7 of 25 in Group B. Thus, atelectasis resulted in considerable morbidity. The right lung was involved in 83% of episodes (33% involved the right lower lobe). Tracheobronchial suctioning causes disproportionate damage to the right mainstem bronchus, and these infants were suctioned hourly. The predominance of right-sided ATL suggests that suctioning procedures in neonates should be critically studied.

/pdf/1247-atelectasis-atl-in-the-intubated-newborn-with-hyaline-4f92rxl0h1.pdf

Jonathan M. Whitfield

Papers

Acquired subglottic stenosis in the very-low-birth-weight infant.

The application of hospice concepts to neonatal care.

Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant

1247 atelectasis (atl)in the intubated newborn with hyaline membrane disease (hmd)

Nitric Oxide Use in Neonatal and Adult Patients at Baylor University Medical Center