The Incidence of Laryngotracheal Stenosis in Neonates With a History of Ventilator-Associated Pneumonia

Laryngoscope. 2020 Sep;130(9):2252-2255. doi: 10.1002/lary.28371. Epub 2019 Dec 4.


Objectives/hypothesis: Neonatal patients requiring prolonged intubation are susceptible to both infection and laryngotracheal stenosis (LTS). This study investigated the effect of ventilator-associated pneumonia (VAP) on the development of LTS in neonates.

Study design: Retrospective case-control study.

Methods: The incidence of LTS in neonates with VAP was compared with the incidence of LTS in matched intubated controls without VAP. Patients were treated at a tertiary-care medical center from 2004 to 2014. Eligible patient records were assessed for the development of LTS. Demographics, medical comorbidities, infection characteristics, and treatment variables were compared using unpaired t test or χ2 test. Statistical significance was set a priori at P < .05.

Results: When comparing the VAP patients with matched non-VAP controls, we found no significant differences in the incidence of LTS (VAP vs. non-VAP, 8.3% vs. 6.7%; P = .73). In subgroup analysis of the VAP cohort, LTS and non-LTS patients demonstrated similar VAP organisms on broncho-alveolar lavage (Klebsiella pneumoniae, Pseudomonas aeroginosa, Escherichia coli, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, and Enterobacter). Additionally, within the VAP cohort, LTS and non-LTS patients showed similar gestational age (LTS vs. non-LTS, 31.3 days vs. 28.1 days; P = .22), birth weight (LTS vs. non-LTS, 1.6 kg vs. 1.2 kg; P = .33), and similar intubation duration (LTS vs. non-LTS, 37.8 days vs. 27.5 days; P = .52).

Conclusions: In this neonatal cohort, VAP was not associated with an increased incidence of LTS. Given severity of the burden of LTS on the healthcare system, multi-institutional longitudinal investigation into contributing risk factors for neonatal LTS is warranted.

Level of evidence: NA Laryngoscope, 130:2252-2255, 2020.

Keywords: Ventilator-associated pneumonia; airway stenosis; laryngotracheal stenosis; neonates.

MeSH terms

  • Bronchoalveolar Lavage
  • Bronchoalveolar Lavage Fluid / microbiology
  • Case-Control Studies
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Laryngostenosis / epidemiology*
  • Laryngostenosis / microbiology
  • Male
  • Pneumonia, Ventilator-Associated / complications*
  • Pneumonia, Ventilator-Associated / microbiology
  • Retrospective Studies
  • Risk Factors
  • Tracheal Stenosis / epidemiology*
  • Tracheal Stenosis / microbiology