Hyaline membrane disease of the neonate prolonged intubation in management: Effects on the larynx

This is the authors' abstract. We don't add key points for this paper.

Hyaline membrane disease, an illness of premature neonates, is associated with 20–30% of all neonatal deaths and 50–70% of premature deaths in the United States. Often related to perinatal hypoxia, its basic pathophysiology consists of surfactant deficiency with diffuse atelectasis, and pulmonary hypoperfusion. With expanding knowledge of hyaline membrane disease, methods of management evolved to the use of assisted ventilation with endotracheal tubes. One hundred twenty‐two surviving infants with hyaline membrane disease were intubated for periods of four to 112 days at the Los Angeles County‐USC Medical Center over a five‐year period. Their clinical courses, and effects of intubation on their larynges, are discussed. Autopsy examination of 30 neonatal larynges after intubation revealed a high incidence of ulcerations within the cricoid area. The neonate's tolerance of intubation must be due to resiliency of its cricoid cartilage. Microscopic changes in cartilage with growth are demonstrated. With growth, cartilage matrix increases; it becomes less hydrated, more fibrous, and more rigid. Neonates with normal larynges can tolerate long periods of intubation with polyvinyl chloride, uniform diameter, endotracheal tubes. With the use of principles successful in neonatal intubation, older patients can tolerate longer periods of intubation than was acceptable in earlier years; however, while intubation of neonates can be measured in weeks, in older patients it should still be measured in days.