Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment.

Abstract

Acquired stenosis of the trachea or bronchus in newborn infants is a possible complication of perinatal intubation and mechanical ventilation. Although the exact pathophysiology is unknown, stenosis formation seems to be initiated by pressure necrosis. Prematurity is thought to be an important risk factor for acquired airway stenosis. Management of stenotic lesions may be conservative, surgical, or endoscopic. Four patients were treated with endoscopic balloon dilatation with satisfactory results. Endoscopic balloon dilatation is the method of choice in most newborn infants with acquired bronchial or tracheal stenosis. (Arch Dis Child 1993;68:37-40) Acquired tracheal or bronchial stenosis may cause severe respiratory problems in newborn infants ventilated because of respiratory distress. In its most serious form it may result in prolonged mechanical ventilation, because all attempts to wean the affected neonate from the ventilator will fail. Four newborn infants with these problems are presented. A noninvasive endoscopic procedure for dilatation of acquired tracheal or bronchial stenosis is discussed, as are some recommendations for prevention.Case reports PATIENT 1 This patient was a newborn infant of 30 weeks' gestation. Owing to perinatal asphyxia, she was intubated and mechanically ventilated for one week. Within a few days after extubation, however, she developed respiratory insufficiency for which she was reintubated and again mechanically ventilated. Chest radiographs showed recurring atelectasis on both sides, hyperlucent areas, and a variable mediastinal shift. Despite intensive treatment, these severe abnormalities persisted.Bronchoscopy performed at the age of 4 weeks showed a right and left main bronchus which were too narrow to introduce the bronchoscope into the lumen. Bronchography showed a relatively long bilateral segmental stenosis in the main bronchi as well as an obstruction of the bronchus of the right lower lobe. We performed bronchoscopic balloon dilatation of the left main bronchus three times at one week intervals. At follow up bronchography an almost normal lumen of the left main bronchus was seen. In the nondilated right main bronchus, a stenosis, though less serious, persisted. One day after the final dilatation, the girl was definitively extubated.Respiratory infections with inspiratory stridor and wheezing often occurred during her first year and again after an interval of two years without symptoms. Recently bronchoscopic balloon dilatation of the right main bronchus has been performed, with good results.PATIENT 2 A newborn infant of 30 weeks' gestation developed a respiratory distress syndrome associated with hyaline membrane disease stage 3/4, for which she was intubated and mechanically ventilated for one week. Ten days after the first extubation she was reintubated because of respiratory insufficiency, now associated with an aspiration pneumonia. She had recurring atelectasis, mainly on the right side. Bronchoscopy showed a swollen, inflamed tracheal mucosa, which...

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“…Just as in dilatations with rods and rigid bronchoscopes, balloon dilatation is also more successful when one is dealing with immature scar tissue (granulation tissue), although there are reports of its efficiency in subglottic stenosis 4,6 . Dilatation my require to be repeated a few times in order to reach the desired outcome [2][3][4]7 . The first case of BLP for SGS described in the literature was in 1985, when Axon et al Reported a case of a symptomatic four-year old diagnosed with grade 2 SGS after intubation 10 .…”

“…Such technique is being used, since then, to treat stenosis secondary to prolonged intubation, re-stenosis after laryngotracheal reconstructions and after cricotracheal resections with end-to-end anastomosis, with promising results [3][4][5] . A large variety of balloons have already being tested, among them we have the Fogarty embolectomy catheter and a number of angioplasty balloons 2,6,7 . Dilatation may be carried out under direct visualization with laryngoscopy or bronchoscopy 7 or by fluoroscopic control 3,5 .…”

“…A large variety of balloons have already being tested, among them we have the Fogarty embolectomy catheter and a number of angioplasty balloons 2,6,7 . Dilatation may be carried out under direct visualization with laryngoscopy or bronchoscopy 7 or by fluoroscopic control 3,5 . The procedure is palliative in some cases (turning a Myer & Cotton 8 grade 3 SGS into a grade 2 or 1), and curative in others 9 .…”

Bronchoscopic Balloon Dilation (BBD) for Benign Tracheobronchial Stenosis

“…During BBD, chest pain, bronchospasm and atelectasis have been reported (Brown et al, 1987;Elkerbout et al, 1993;Hebra et al, 1991). Excessive balloon inflation may lacerate or rupture the airway, causing bleeding, pneumothorax, pneumomediastinum, or mediastinitis.…”

Nanomaterials for cartilage tissue engineering

“…Patients with congenital or benign stenosis of the trachea, resulting from trauma, inflammation or illness, require tracheal reconstruction [8]. Acquired tracheal stenosis occurs in 2-11 % of newborns [9]. In general, cancers in the nose, ear and trachea are increasing in numbers and often require resection, replacement and reconstruction.…”