Introduction: The risk of neonatal subglottic stenosis (SGS) after tracheostomy is not well described in the literature. The aim of this study is to describe the incidence of SGS after tracheostomy, and to examine the clinical course of patients who develop SGS following tracheostomy placement.
Methods: The study population includes patients who underwent tracheostomies between 10/2012 and 10/2020 at age 0-1 year who concomitantly had bronchoscopic examinations of their subglottic airways both before and after their tracheostomies. Patient demographics and treatment data including airway interventions and subsequent bronchoscopic findings were followed to characterize the evolution of the subglottis after tracheostomy.
Results: One hundred and eleven patients were identified with 98 (88%) having a normal subglottic airway or Grade I SGS prior to tracheostomy and 13 (12%) having Grade II or higher SGS. The most common indication for tracheostomy was pulmonary (n = 60), followed by upper airway obstruction (UAO) (n = 16) and combination of both pulmonary and UAO (n = 10). The incidence of new SGS after tracheostomy in this population was 29.5% (p < 0.001). Patients with SGS after tracheostomy had increased rates of prematurity, lower mean birth weight, and longer intervals between intubation and tracheostomy. SGS resolution after tracheostomy was associated with older age at the time of the procedure.
Conclusion: Evolution of SGS in neonates appears to be influenced by age, birth weight, and duration of intubation. Patient factors, including older age, may be associated with resolution of pre-tracheostomy SGS.