Acquired subglottic stenosis in children younger than 1 year in a resource-restricted hospital in South Africa
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Abstract
Background. Subglottic stenosis (SGS) is a congenital or acquired condition and is the most common site of airway narrowing in children. The pathogenesis of SGS includes subglottic mucosal pressure necrosis, leading to mucosal ulceration, perichondritis and mature scar formation. Acquired SGS accounts for 90% of laryngotracheal stenosis in children.
Objectives. To describe the associated disease factors, management and outcomes of infants with acquired SGS in a middle-income country.
Methods. A retrospective, descriptive study was performed between January 2018 and August 2022, including all infants aged ≤1 year who had bronchoscopically confirmed SGS. Data regarding demographics, intubation and invasive ventilation, various disease parameters, findings at bronchoscopy and short-term outcomes were collected. Descriptive statistical analysis was performed. Ethical approval was provided by Stellenbosch University.
Results. During the research period, 44 infants were diagnosed with acquired SGS, of whom 29 were included in the study. Most infants were born at term and underwent diagnostic bronchoscopy at a mean chronological age of <2 months. All infants were intubated and ventilated at birth, for a variety of diagnoses. Bronchoscopy showed grade 2 or worse stenosis in the majority, and most infants were managed successfully with balloon dilatation. An inappropriately sized endotracheal tube was used in 52% of infants, one-third of infants required multiple invasive ventilation periods, and one-third experienced unexpected extubation episodes.
Conclusion. In a resource-limited setting, SGS often develops as a result of preventable causes, with the majority of children being successfully treated with endoscopic procedures.
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