NECROTIZING TRACHEO-BRONCHITIS: A NEW COMPLICATION OF NEONATAL MECHANICAL VENTILATION

In 1982-83 7 neonates in 2 hospitals have developed sloughing of tracheal mucosa while on assisted ventilation. Gestation ranged from 26-40 wks; weight from 0.9-3 kg. Primary diagnosis was RDS in 4, persistent fetal circulation in 2 and aspiration in 1. 5 died at 1-4 days of age. At autopsy a thick basophilic membrane of necrotic epithelium and submucosa involved the distal part of the trachea and bronchi totally obstructing the airway in 2 patients. Repeated bronchoscopy in the survivors removed the obstructive plugs. Clinically all cases showed upper airway obstruction with poor chest movement, air trapping and severe CO2 retention. Pressure limited conventional ventilators were used initially followed by a trial of high frequency oscillation in 3. Peak pressures >35 cmH20 were used in 6. Hand bagging using dry 100% O2 was given for periods of 10-90 min. to all.