Severe acquired subglottic stenosis in neonatal intensive care graduates:a case-control study

Rebecca Elizabeth Thomas, Shripada Rao, Corrado Minutillo, Shyan Vijayasekaran, Elizabeth Nathan

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates. Design Retrospective case–control study. Setting Sole tertiary children’s hospital. Participants 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). Main outcomes and measures Incidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS. Results 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). Conclusions 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.
Original languageEnglish
Pages (from-to)F349-F354
Number of pages6
JournalArchives of Disease in Childhood, Fetal and Neonatal Edition
Volume103
Issue number4
Early online date2 Sep 2017
DOIs
Publication statusPublished - Jul 2018

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Laryngostenosis
Neonatal Intensive Care
Case-Control Studies
Intubation
Neonatal Intensive Care Units
Incidence
Parturition
Artificial Respiration
Tertiary Care Centers
Premature Infants
Ventilation
Retrospective Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Newborn Infant
Pregnancy
Wounds and Injuries

Cite this

@article{0e044a865dfb4904a829f65a2ca2ccde,
title = "Severe acquired subglottic stenosis in neonatal intensive care graduates:a case-control study",
abstract = "Objective To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates. Design Retrospective case–control study. Setting Sole tertiary children’s hospital. Participants 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). Main outcomes and measures Incidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS. Results 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). Conclusions 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.",
author = "Thomas, {Rebecca Elizabeth} and Shripada Rao and Corrado Minutillo and Shyan Vijayasekaran and Elizabeth Nathan",
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pages = "F349--F354",
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Severe acquired subglottic stenosis in neonatal intensive care graduates:a case-control study. / Thomas, Rebecca Elizabeth; Rao, Shripada; Minutillo, Corrado; Vijayasekaran, Shyan; Nathan, Elizabeth.

In: Archives of Disease in Childhood, Fetal and Neonatal Edition, Vol. 103, No. 4, 07.2018, p. F349-F354.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Severe acquired subglottic stenosis in neonatal intensive care graduates:a case-control study

AU - Thomas, Rebecca Elizabeth

AU - Rao, Shripada

AU - Minutillo, Corrado

AU - Vijayasekaran, Shyan

AU - Nathan, Elizabeth

PY - 2018/7

Y1 - 2018/7

N2 - Objective To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates. Design Retrospective case–control study. Setting Sole tertiary children’s hospital. Participants 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). Main outcomes and measures Incidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS. Results 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). Conclusions 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.

AB - Objective To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates. Design Retrospective case–control study. Setting Sole tertiary children’s hospital. Participants 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). Main outcomes and measures Incidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS. Results 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). Conclusions 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.

U2 - 10.1136/archdischild-2017-312962

DO - 10.1136/archdischild-2017-312962

M3 - Article

VL - 103

SP - F349-F354

JO - Archives of Disease in Childhood, Fetal and Neonatal Edition

JF - Archives of Disease in Childhood, Fetal and Neonatal Edition

SN - 1359-2998

IS - 4

ER -