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Tracheotomy in neonates
Author(s) -
Gibson R.,
Byrne J. E. T.
Publication year - 1972
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-197204000-00010
Subject(s) - tracheotomy , medicine , respiratory distress , pneumothorax , pneumonia , suction , surgery , pediatrics , tracheal tube , airway , intubation , mechanical ventilation , ventilation (architecture) , assisted ventilation , anesthesia , mechanical engineering , engineering
Fifty‐five tracheotomies have been performed on neonates. Forty suffered from respiratory distress syndrome and smaller groups had congenital defects and pneumonia. All tracheotomies were preceded by nasotracheal intubation for about 72 hours. Linear incision of the trachea from the second to fourth tracheal rings, insertion of lateral stay sutures and careful placement of the tube to allow aeration of both main bronchi have reduced complications. Eleven neonates developed pneumothorax as a result of high pressure ventilation; three had pneumonia, and one tracheotomy tube became temporarily” displaced. Fourteen of the neonates with respiratory distress syndrome recovered. Birth weight ranged from 1,200 G upward. Expert nursing is essential to ensure adequate humidification and suction. Neonates are defined as babies aged less than 28 days. This definition applies whether or not the birth is premature. Tracheotomies on young children have been reported in the past: Pickard 1 on premature babies; Holinger 2 on those younger than 12 months; and Bridges 3 on those aged less than five years. In all these papers, both operative and postoperative problems have been stressed. Complications have been emphasized by Oliver, et al. , 4 who, in a series of 294 tracheotomies, found all their operative complications and 85 percent of their postoperative difficulties in small infants. It must be assumed that in the past postoperative care especially has been difficult in many centers. Recent years have brought the development of more dependable apparatus for humidification and ventilation, and this has been applied to respiratory tract care in a large variety of conditions which were previously fatal in this age group. The care of such infants and the sophisticated apparatus used in treating them requires adequate numbers of highly‐trained medical and nursing staff available night and day. Such well‐staffed and well‐equipped Intensive Care Units, specializing in the treatment of neonates, are now found in many large hospital complexes throughout the United Kingdom and North America.