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

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.