Neonatal Clinical Care Unit, Princess Margaret Hospital for Children and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
School of Paediatrics and Child Health, Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.
Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F349-F354. doi: 10.1136/archdischild-2017-312962. Epub 2017 Sep 2.
To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates.
Retrospective case-control study.
Sole tertiary children's hospital.
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).
Incidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS.
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).
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.
分析新生儿重症监护病房（NICU）中需要手术干预的严重后天性声门下狭窄（SASGS）的发病情况和相关危险因素。
回顾性病例对照研究。
唯一的儿童三级医院。
2006 年 1 月至 2014 年 12 月间因 SASGS 接受手术干预的患者。对于每一位因获得性 SASGS 而接受手术治疗的新生儿，选择 2 名对照（与胎龄和出生年份相匹配）。
计算发病率，并使用条件逻辑回归分析比较病例和对照，以确定 SASGS 的危险因素。
37 名 NICU 毕业生因 SASGS 需要手术干预，其中 35 名在出生时胎龄<30 周。需要在新生儿期进行通气的存活患儿中，SASGS 的发生率为 27/2913（0.93%）。胎龄<28 周的婴儿（24/623=3.8%）的发生率高于胎龄≥28 周的婴儿（3/2290=0.13%；p=0.0001）。单因素分析显示，SASGS 的危险因素包括：插管次数较多（4 次比 2 次；p<0.001）；通气时间较长（16 天比 9.5 天；p<0.001）；计划性拔管（45.7%比 20.0%；p=0.007）；创伤性插管（34.3%比 7.1%；p=0.003）和气管内导管（ETT）过大（74.3%比 42.9%；p=0.001）。多因素分析显示，SASGS 的危险因素包括：谢尔曼比值>0.1（调整后的比值比（aOR）6.40；95%置信区间 1.65 至 24.77）；超过 5 次插管（aOR 3.74；95%置信区间 1.15 至 12.19）；创伤性插管（aOR 3.37；95%置信区间 1.01 至 11.26）。
SASGS 是 NICU 毕业生机械通气插管的严重后果，尤其是在早产儿中。在插管过程中尽量减少创伤、避免反复拔管/插管以及使用合适大小的 ETT 可能有助于预防这种严重并发症。
