1235 NASOTRACHEAL INTUBATION: ABSENCE OF LONGTERM MOREIDITY

Abstract

Clinical sequelae have been reported in up to 10% of intubated neonates. A prospective and retrospective analysis revealed 94 patients intubated for greater than 24 hours and alive at discharge, 92 of whom were ventilated. The mean birth weight was 2294 gm (1010 gm-4600 gm), mean gestational age was 35 wk (28 wk-44 wk) and mean duration of intubation was 178.5 h (29 h-830 h). The mean total oxygen exposure was 250 h (12.5 h-1310 h) and mean requirement of oxygen greater than 60% was 24.3 h (0 h-229h) Of these patients, 30 required greater than one intubation, 13 to replace the orotracheal tube used for resuscitation. Post-extubation atelectasis occurred in 16 patients, 3 of whom required reintubation. There were 24 pneumothoraces of which 9 were present before intubation or as a result of surgery. All nasotracheal intubations were performed or supervised by experienced Pediatricians using the largest size possible non-tapered, non-cuffed, polyvinylchloride tube of size 3.0 mm or larger. Endotube position was determined clinically and confirmed roentgenographically. The only indication for tube replacement was accidental dislodgement (13) as no tube obstruction was documented in this series. Extubation was always performed in the morning, following Decadron 1 mg/kg. Follow-up has shown no evidence of tracheal stenosis or clinical stridor. Nasotracheal intubation by experienced physicians with appropriate tube care, without elective tube replacement will result in very low tracheal morbidity.

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